(1999). "Impact of combination therapy on managed care." American Journal of Managed Care 5(7): S456-S462.
	The major objectives of managed care are particularly applicable to hypertension, a very common disease that affects about 30% of the adult population. Although managed care organizations know that adequate blood pressure control has a considerable impact on reducing hypertension-related morbidity and mortality, managed care is, at present, doing a generally poor job of monitoring antihypertensive therapy. One of the major reasons for this is the difficulty in gathering the necessary data from administrative sources; only chart review,which is very costly and very time consuming, can provide the data needed. The value of disease management lies in its capacity to optimize clinical and economic outcomes as well as to improve service and quality of life, using inputs such as cost, time, clinical resources, and patient satisfaction. Disease management programs are instituted because they can lead to improved quality of life and reduced costs. While the focus in managed care has traditionally been on promoting risk modification behavior, providing patient education, and encouraging medication compliance, the treatment of hypertension itself has not been a major focus in most disease management programs. Measuring the effectiveness of the hypertension treatment is, however, one of the proposed measures for the Health Plan Employer Data and Information Set (HEDIS 2000) to profile health plan quality. From a managed care perspective, the potential benefits of combination therapy for hypertension include improved blood pressure control and improved patient compliance as a result of needing fewer pills and experiencing fewer side effects with low-dose therapy. Among the obstacles to combination therapy in the managed care setting are the addition of the combinations onto a formulary and lack of acceptance among physicians. Fixed-dose combination therapy with a calcium channel blocker and an angiotensin-converting enzyme (ACE) inhibitor can potentially reduce pharmacy costs if given to patients who are taking both drugs independently and to patients who are taking a calcium channel blocker but should probably also be taking an ACE inhibitor (eg, patients with diabetes or congestive heart failure). A mini-pharmacoeconomic analysis based on claims data over a-month period from HMO Colorado, a health maintenance organization, shows that switching patients on dual therapy with a calcium channel blocker and an ACE inhibitor to 1-pill combination therapy with both agents can result in substantial cost savings.

(2000). "Demonstrating excellence in academic public health practice. The Association of Schools of Public Health Council of Public Health Practice Coordinators." Journal of public health management and practice : JPHMP 6(1): 10-24.
	
(2002). "Everything has its price." Lancet Oncology 3(12): 707.
	
(2004). "Art project reinforces HIV/AIDS education." HIV prevention plus! 5(4): 1-2.
	
(2004). "Impending crisis in oral health care prompts look at dental education." Pennsylvania dental journal 71(6): 24-25.
	
(2005). "A call to action on health care disparities among minorities." Disease management advisor 11(12): 138-141, 133.
	That is according to a cadre of health care leaders who contend that health care quality cannot improve until America successfully addresses glaring inequities that leave many racial and ethnic minority populations at a disadvantage. In an effort to dramatically shift thefocusfrom research and discussion of disparities to development of practical interventions, the Robert Wood Johnson Foundation is putting millions of dollars behind a series of initiatives designed to identify and disseminate real-world solutions to the problem over the next three to four years.

(2007). "Mental health innovation. Winner: Oxfordshire PCT." The Health service journal Suppl.
	
(2009). "Training in Minimally Invasive Surgery - You Say You Want a Revolution." Journal of Minimally Invasive Gynecology 16(2): 113-120.
	
(2011). "Securing the future of our field." Journal of the American Society of Echocardiography 24(6).
	
Aakhus, E., et al. (2016). "A tailored intervention to implement guideline recommendations for elderly patients with depression in primary care: a pragmatic cluster randomised trial." Implementation Science 11: 15.
	Background: Elderly patients with depression are underdiagnosed, undertreated and run a high risk of a chronic course. General practitioners adhere to clinical practice guidelines to a limited degree. In the international research project Tailored Implementation for Chronic Diseases, we tested the effectiveness of tailored interventions to improve care for patients with chronic diseases. In Norway, we examined this approach to improve adherence to six guideline recommendations for elderly patients with depression targeting healthcare professionals, patients and administrators. Methods: We conducted a cluster randomised trial in 80 Norwegian municipalities. We identified determinants of practice for six recommendations and subsequently tailored interventions to address these determinants. The interventions targeted healthcare professionals, administrators and patients and consisted of outreach visits, a website presenting the recommendations and the underlying evidence, tools to manage depression in the elderly and other web-based resources, including a continuous medical education course for general practitioners. The primary outcome was mean adherence to the recommendations. Secondary outcomes were improvement in depression symptoms as measured by patients and general practitioners. We offered outreach visits to all general practitioners and practice staff in the intervention municipalities. We used electronic software that extracted eligible patients from the general practitioners' lists. We collected data by interviewing general practitioners or sending them a questionnaire about their practice for four patients on their list and by sending a questionnaire to the patients. Results: One hundred twenty-four of the 900 general practitioners (14 %) participated in the data collection, 51 in the intervention group and 73 in the control group. We interviewed 77 general practitioners, 47 general practitioners completed the questionnaire, and 134 patients responded to the questionnaire. Amongst the general practitioners who provided data, adherence to the recommendations was 1.6 percentage points higher in the intervention group than in the control group (95 % CI -6 to 9). Conclusions: The effectiveness of our tailored intervention to implement recommendations for elderly patients with depression in primary care is uncertain, due to the low response rate in the data collection. However, it is unlikely that the effect was large. It remains uncertain how best to improve adherence to evidence-based recommendations and thereby improve the quality of care for these patients.

Aarons, G. A. and D. H. Sommerfeld (2012). "Leadership, innovation climate, and attitudes toward evidence-based practice during a statewide implementation." Journal of the American Academy of Child and Adolescent Psychiatry 51(4): 423-431.
	Objective: Leadership is important in practice change, yet there are few studies addressing this issue in mental health and social services. This study examined the differential roles of transformational (i.e., charismatic) leadership and leadermember exchange (i.e., the relationship between a supervisor and their direct service providers) on team innovation climate (i.e., openness to new innovations) and provider attitudes toward adopting evidence-based practice (EBP) during a statewide evidence-based practice implementation (EBPI) of an intervention to reduce child neglect. Method: Participants were 140 case-managers in 30 teams providing home-based services to families in a statewide child-welfare system. Teams were assigned by region to EBPI or services as usual (SAU) conditions. Multiple group path analysis was used to examine associations of transformational leadership and leadermember exchange with innovation climate and attitudes toward adoption and use of EBP. Results: Transformational leadership predicted higher innovation climate during implementation, whereas leadermember exchange predicted higher innovation climate during SAU. Innovation climate was, in turn, associated with more positive attitudes toward EBP for the EBPI group. Conclusions: Strategies designed to enhance supervisor transformational leadership have the potential to facilitate implementation efforts by promoting a strong climate for EBPI and positive provider attitudes toward adoption and use of EBP. © 2012 American Academy of Child and Adolescent Psychiatry.

Abbas, M. R., et al. (2011). "Attitudes of medical students to medical leadership and management: a systematic review to inform curriculum development." BMC Medical Education 11: 8.
	Background: There is a growing acknowledgement that doctors need to develop leadership and management competences to become more actively involved in the planning, delivery and transformation of patient services. We undertook a systematic review of what is known concerning the knowledge, skills and attitudes of medical students regarding leadership and management. Here we report the results pertaining to the attitudes of students to provide evidence to inform curriculum development in this developing field of medical education. Methods: We searched major electronic databases and citation indexes within the disciplines of medicine, education, social science and management. We undertook hand searching of major journals, and reference and citation tracking. We accessed websites of UK medical institutions and contacted individuals working within the field. Results: 26 studies were included. Most were conducted in the USA, using mainly quantitative methods. We used inductive analysis of the topics addressed by each study to identity five main content areas: Quality Improvement; Managed Care, Use of Resources and Costs; General Leadership and Management; Role of the Doctor, and Patient Safety. Students have positive attitudes to clinical practice guidelines, quality improvement techniques and multidisciplinary teamwork, but mixed attitudes to managed care, cost containment and medical error. Education interventions had variable effects on students' attitudes. Medical students perceive a need for leadership and management education but identified lack of curriculum time and disinterest in some activities as potential barriers to implementation. Conclusions: The findings from our review may reflect the relatively little emphasis given to leadership and management in medical curricula. However, students recognise a need to develop leadership and management competences. Although further work needs to be undertaken, using rigorous methods, to identify the most effective and cost-effective curriculum innovations, this review offers the only currently available summary of work examining the attitudes of students to this important area of development for future doctors.

Abbott, M. B. and L. R. First (2009). "Report of colloquium III: challenges for pediatric graduate medical education and how to meet them--a quality improvement approach to innovation in pediatric graduate medical education." Pediatrics 123 Suppl 1: S22-25.
	Participants of the third colloquium of the Residency Review and Redesign in Pediatrics (R(3)P) Project concluded that pediatricians who practice ambulatory, hospital-based, a combination of ambulatory and hospital-based, and subspecialty pediatrics are sufficiently different to justify differences in general pediatric residency training. This conclusion along with others of previous colloquia led to the creation of a list of goals for innovative change in residency education and a draft of a quality improvement process by which they might be achieved.

Abdu, L. (2013). "Epidemiological Properties of Primary Open Angle Glaucoma in Nigeria." Journal of Ophthalmology: 6.
	Background. Primary open angle glaucoma (POAG) is progressive chronic optic neuropathy in adults in which intraocular pressure (IOP) and other currently unknown factors contribute to damage. POAG is the second commonest cause of avoidable blindness in Nigeria. Pattern of Presentation. POAG is characterized by late presentation. Absence of pain which is a driving force for seeking medical help, inadequacy of trained eye care personnel, paucity of facilities, misdistribution of resources, lack of awareness, poor education, and poverty may all contribute to this. Medical and surgical treatment options available are challenging and tasking. Screening for Glaucoma. Screening is the presumptive identification of unrecognized disease (POAG) by applying test(s) which can be applied rapidly. Such test(s) should be of high reliability, validity, yield, acceptable, and cost effective. The test should ideally be sensitive, specific, and efficient. It is difficult to select a suitable test that meets these criteria. Intraocular pressure (IOP) appears to be the easiest option. But, high IOP is not diagnostic nor does normal value exclude the disease. Health education is a possible strategy in early case detection and management. Treatment of POAG. Glaucoma treatment can either be medical or surgical (this includes laser). Considering unavailability, potency, cost, and long-term effects of medication, surgery (trabeculectomy) could be a better option. Laser trabeculoplasty is available in a few centers. Viscocanalostomy is not routinely performed. Patient education is vital to success as management is for life. Conclusion. POAG remains a cause of avoidable blindness in Nigeria. There is need for long-term strategy to identify patients early and institute prompt management. Improvement in training of eye care personnel and provision of up to date equipment is essential in achieving this goal.

Abe, M., et al. (2014). "Community health nurses' HIV health promotion and education programmes: a qualitative study." International Nursing Review 61(4): 515-524.
	BACKGROUND: Globally, nurses practice in many settings with people with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), taking an increasing share of the professional burden of care and helping to reduce morbidity and mortality. International literature is sparse about Thai community nurses providing primary healthcare programmes for people with HIV.
AIM: This study aimed to describe background, experiences and strategies of community nurses regarding their design and delivery of programmes for people living with HIV and AIDS in Chiang Mai Province, Thailand.
DESIGN: This study used a qualitative mixed-methods study employing a qualitative survey and in-depth interviews.
METHODS: Twenty community health nurses from 18 small community hospitals completed a survey comprising demographic data and 13 open-ended questions. Four of them later engaged in in-depth interviews using the same questions. Survey, interview data and field notes were analysed using interpretive content analysis.
FINDINGS: Four themes and six sub-themes portrayed participants' rich experiences and knowledge of HIV health promotion and education; challenges of daily work, discrimination and ethical issues; success through programme diversity comprising promotion of community volunteerism, networking and relationships; and holistic connections with Thai cultural traditions and Buddhism.
CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings help to recognize the diversity, uniqueness and contributions of Thai community nurses regarding culturally appropriate health promotion and education programmes for people living with HIV and AIDS. Findings inform nurses and health officials in and outside of the country to complement innovation in future HIV health promotion and education programmes.
LIMITATIONS: Our sample came from one province of Thailand. Findings might not be reflective of nurses elsewhere.
IMPLICATIONS FOR HEALTH AND NURSING POLICY: Three decades of collective experience in providing holistic and multifaceted HIV and AIDS nursing care, education and health promotion by community health nurses have the potential to effect new and existing policies and protocols on HIV community care in Thailand, but more research is required for this.Copyright © 2014 International Council of Nurses.

Abelmann, W. H., et al. (1997). "Generation of physician-scientists manpower: A follow-up study of the first 294 graduates of the Harvard-MIT program of health sciences and technology." Journal of Investigative Medicine 45(5): 272-275.
	Background: The MD program of the Harvard-MIT Division of Health Sciences and Technology was founded in 1970, One of its goals was the application of the academic resources of the two universities to the education of leaders in academic medicine and biomedical sciences, Methods: The first MD class was admitted in 1971, Prerequisites for admission are a strong background in quantitative sciences and demonstrated interest in research, Research and a thesis are obligatory, Enrollment in a PhD program is elective, Questionnaires were sent to 293 alumni who graduated from the MD program between 1975 and 1988, followed up by letters and telephone calls, Results: By 1988, 296 students had graduated, 207 with an MD only, 89 with MD-PhD degrees, Follow-up by questionnaires of 293 living graduates (92%), plus indirect data on 11 others, revealed that 212 (75%) held faculty appointments in 64 medical schools, Overall, 73.5% of respondents were engaged in research: 68% of MDs and 86% of MD-PhDs, One hundred and four (38%) respondents spent more than 50% of their time on research: 54 (29%) of MDs and 50 (60%) of MD-PhDs, Seventy-five percent of respondents were active in teaching, Conclusion: Our experience indicates that both an MD-PhD program and a research-oriented MD program are effective in producing physician-scientists and leaders in academic medicine.

Abou Tayoun, A. N., et al. (2014). "Democratizing Molecular Diagnostics for the Developing World." American Journal of Clinical Pathology 141(1): 17-24.
	Objectives: Infectious diseases that are largely treatable continue to pose a tremendous burden on the developing world despite the availability of highly potent drugs. The high mortality and morbidity rates of these diseases are largely due to a lack of affordable diagnostics that are accessible to resource-limited areas and that can deliver high-quality results. In fact, modified molecular diagnostics for infectious diseases were rated as the top biotechnology to improve health in developing countries. Methods: In this review, we describe the characteristics of accessible molecular diagnostic tools and discuss the challenges associated with implementing such tools at low infrastructure sites. Results: We highlight our experience as part of the "Grand Challenge" project supported by the Gates Foundation for addressing global health inequities and describe issues and solutions associated with developing adequate technologies or molecular assays needed for broad access in the developing world Conclusions: We believe that sharing this knowledge will facilitate the development of new molecular technologies that are extremely valuable for improving global health.

Abraham, Y. and A. Azaje (2013). "The new innovative medical education system in Ethiopia: Background and development." Ethiopian Journal of Health Development 27: 36-40.
	Background: A New Innovative Medical Education Initiative (NIMEI) had been launched in Ethiopia in February 2012 and the training of medical doctors using a new approach and curriculum initiated. Currently training is being conducted in ten universities and three hospitals across the country, all of whom have teaching hospitals, health centers and community attachment sites. The NIMEI curriculum is different from the existing curriculum in terms of uptake of students, years of education and is competency based and integrated Objective: The objective of this review is to give the background and objectives for introducing the NIMEI in Ethiopia. It also outlines the detailed process for developing the curriculum as well as for organizing the required system for initiating the training within the new initiative. Methods: Review and description of the background and process of developing a new innovative medical curriculum in Ethiopia through comparisons of experiences of similar undertaking from the literature. Results: The objectives, rationale as well as the approach and methodology used to develop the curriculum are outlined. The processes involved in the implementation and the initial appraisal of the developed curriculum was also discussed. Conclusion: In conclusion, this review highlights the possible impact of the NIMEI on the human resources for health development as well as for the overall health system of the country.

Absalom, A. R., et al. (2016). "Target-Controlled Infusion: A Mature Technology." Anesthesia and Analgesia 122(1): 70-78.
	Target-controlled infusions (TCIs) have been used in research and clinical practice for >2 decades. Nonapproved TCI software systems have been used during the conduct of almost 600 peer-reviewed published studies involving large numbers of patients. The first-generation pumps were first approved in 1996, and since then an estimated 25,000 units have been sold and used. Second-generation pumps were first approved in 2003. During 2004 to 2013, >36,000 units were sold. Currently, TCI systems are approved or available in at least 96 countries. TCI systems are used to administer propofol and opioids for IV sedation and general anesthesia for millions of patients every year. In countries where TCI systems are approved, nonapproved software is still commonly used in studies of the pharmacology of hypnotics and opioids, because research software offers greater flexibility than approved TCI systems. Research software is also readily integrated into data management modules. Although TCI is a part of established practice around the world, TCI devices have not received regulatory approval in the United States. In the United States, TCI administration of propofol and opioids for sedation and anesthesia is only possible using research software in IRB-approved research studies. © 2015 International Anesthesia Research Society.

Abu-Faraj, Z. O. (2008). "Project Alexander the Great: a study on the world proliferation of bioengineering/biomedical engineering education." Conference Proceedings: ... Annual International Conference of the IEEE Engineering in Medicine & Biology Society 2008: 2873-2876.
	Bioengineering/Biomedical Engineering is considered amongst the most reputable fields within the global arena, and will likely be the primer for any future breakthroughs in Medicine and Biology. Bioengineering/biomedical engineering education has evolved since late 1950s and is undergoing advancement in leading academic institutions worldwide. This paper delineates an original study on the world proliferation of bioengineering/biomedical engineering education and bears the name 'Project Alexander the Great'. The initial step of the project was to survey all 10448 universities, recognized by the International Association of Universities, spread among the 193 member states of the United Nations within the six continents. The project aims at identifying, disseminating, and networking, through the world-wide-web, those institutions of higher learning that provide bioengineering/biomedical engineering education. The significance of this project is multifold: i) the inception of a web-based 'world-map' in bioengineering/biomedical engineering education for the potential international student desiring to pursue a career in this field; ii) the global networking of bioengineering/biomedical engineering academic/research programs; iii) the promotion of first-class bioengineering/biomedical engineering education and the catalysis of global proliferation of this field; iv) the erection of bridges among educational institutions, industry, and professional societies or organizations involved in Bioengineering/Biomedical Engineering; and v) the catalysis in the establishment of framework agreements for cooperation among the identified institutions offering curricula in this field. This paper presents the results obtained from Africa and North America. The whole project is due to be completed by 2009.

Acharya, T., et al. (2004). "Biotechnology to improve health in developing countries - A review." Memorias Do Instituto Oswaldo Cruz 99(4): 341-350.
	The growing health disparities between the developing and the developed world call for urgent action from the scientific community. Science and technology have in the past played a vital role in improving public health. Today, with the tremendous potential of genomics and other advances in the life sciences, the contribution of science to improve public health and reduce global health disparities is more pertinent than ever before. Yet the benefits of modern medicine still have not reached millions of people in developing countries. It is crucial to recognize that science and technology can be used very effectively in partnership with public health practices in developing countries and can enhance their efficacy. The fight to improve global health needs, in addition to effective public health measures, requires rapid and efficient diagnostic tools; new vaccines and drugs, efficient delivery methods and novel approaches to therapeutics; and low-cost restoration of water soil and other natural resources. In 2002, the University of Toronto published a report on the "Top 10 Biotechnologies for Improving Health in Developing Countries". Here we review these new and emerging biotechnologies and explore how they can be used to support the goals of developing countries in improving health.

Acker, B. A., et al. (2008). "Health IM and Health IT: Frequent traveling companions." Journal of the American Health Information Management Association 79(11): 46-49.
	
Acker, M. A., et al. (2015). "History and Current Status of Cardiovascular Surgery at the University of Pennsylvania." Seminars in Thoracic & Cardiovascular Surgery 27(4): 370-373.
	The cardiothoracic surgery program at the University of Pennsylvania has enjoyed a decades long tradition of leadership and contributions to the field. Consistent with its place as a robust contributor in a major academic medical center, its focus is on the tripartite mission of clinical care, research and education, including the provision of cutting edge care delivered to patients in a multidisciplinary fashion. Faculty members' pursuit of translational research facilitates the delivery of such exceptional treatment and provision of excellent care. This foundation is ideal for the training of the outstanding surgeons of tomorrow, as evidenced by a history of such contributions. Copyright © 2015. Published by Elsevier Inc.

Ackerly, D. C., et al. (2011). "Training the next generation of physician-executives: an innovative residency pathway in management and leadership." Academic Medicine 86(5): 575-579.
	The rapidly changing field of medicine demands that future physician-leaders excel not only in clinical medicine but also in the management of complex health care enterprises. However, many physicians have become leaders "by accident," and the active cultivation of future leaders is required. Addressing this need will require multiple approaches, targeting trainees at various stages of their careers, such as degree-granting programs, residency and fellowship training, and career and leadership development programs. Here, the authors describe a first-of-its-kind graduate medical education pathway at Duke Medicine, the Management and Leadership Pathway for Residents (MLPR). This program was developed for residents with both a medical degree and management training. Created in 2009, with its first cohort enrolled in the summer of 2010, the MLPR is intended to help catalyze the emergence of a new generation of physician-leaders. The program will provide physicians-in-training with rigorous clinical exposure along with mentorship and rotational opportunities in management to accelerate the development of critical leadership and management skills in all facets of medicine, including care delivery, research, and education. To achieve this, the MLPR includes 15 to 18 months of project-based rotations under the guidance of senior leaders in many disciplines including finance, patient safety, health system operations, strategy, and others. Developing both clinical and management skill sets during graduate medical education holds the promise of engaging future leaders of health care at an early career stage, keeping more MD-MBA graduates within health care, and creating a bench of talented future physician-executives.Copyright © by the Association of American medical Colleges.

Ackerman, M. J. (2008). "Computer briefs: it all comes down to education." Journal of Medical Practice Management 23(4): 250-251.
	
Adams, A. M., et al. (2013). "Innovation for universal health coverage in Bangladesh: a call to action." Lancet 382(9910): 2104-2111.
	A post-Millennium Development Goals agenda for health in Bangladesh should be defined to encourage a second generation of health-system innovations under the clarion call of universal health coverage. This agenda should draw on the experience of the first generation of innovations that underlie the country's impressive health achievements and creatively address future health challenges. Central to the reform process will be the development of a multipronged strategic approach that: responds to existing demands in a way that assures affordable, equitable, high-quality health care from a pluralistic health system; anticipates health-care needs in a period of rapid health and social transition; and addresses underlying structural issues that otherwise might hamper progress. A pragmatic reform agenda for achieving universal health coverage in Bangladesh should include development of a long-term national human resources policy and action plan, establishment of a national insurance system, building of an interoperable electronic health information system, investment to strengthen the capacity of the Ministry of Health and Family Welfare, and creation of a supraministerial council on health. Greater political, financial, and technical investment to implement this reform agenda offers the prospect of a stronger, more resilient, sustainable, and equitable health system.

Adams, C. L. and L. Ladner (2004). "Implementing a simulated client program: Bridging the gap between theory and practice." Journal of Veterinary Medical Education 31(2): 138-145.
	Introduction - This paper outlines the design and implementation of an innovative communication skills training program at the Ontario Veterinary College (OVC). Based upon the body of research in human medical education reporting effective results through the use of standardized patients (SPs) for this type of training, an experiential learning laboratory using simulated clients (SCs) and patients was introduced to first-year veterinary students. Method - One hundred and four first-year students were assigned to 12 groups of eight or nine students plus a facilitator. Each student interacted with a simulated client and a patient while being observed by peers and a facilitator. The Calgary-Cambridge Observation Guide (CCOG) was used to guide students and facilitators with performance standards and feedback. Assessment strategies were utilized. Results - implementation of this program required extensive resources, including funding, expertise, facilitator training, time allotment in an already overburdened curriculum, and administrative and faculty support. Preliminary assessment revealed high student and facilitator satisfaction. The potential of this program for student education and assessment was recognized, and it will be expanded in years 2 and 3 of the DVM (Doctor of Veterinary Medicine) curriculum. Conclusions - Medical educators have created resources, including skills checklists and experiential learning modalities, that are highly applicable to veterinary medical education. Ongoing evaluation of the program is essential to determine whether we are meeting expectations for communication competency in veterinary medicine.

Adams, E. K., et al. (2008). "Sociodemographic, insurance, and risk profiles of maternal smokers post the 1990s: How can we reach them?" Nicotine & Tobacco Research 10(7): 1121-1129.
	Declines in prenatal smoking rates have changed the composition of maternal smokers while public policy during the 1990s has likely made it more difficult to reach them. Medicaid expansions during the 1980s/early 1990s insured more women some time during pregnancy, but the 1996 welfare reform unexpectedly reduced enrollment in Medicaid by eligible pregnant women; overall, insurance coverage has declined since 2000. As the public sector struggles with fewer resources, it is important to understand the sociodemographic characteristics of prenatal smokers, their patterns of care, and nonsmoking risk behaviors. Targeting scarce dollars to certain settings or sub-populations can strengthen the infrastructure for tobacco policy change. We provide more current information on maternal smokers in 2002 based on the Pregnancy Risk Assessment Monitoring System (PRAMS) for 21 states. Data on urban/rural location, insurance coverage, access patterns, and nonsmoking risk behaviors (e.g., abuse) among low-income (<16,000) and other maternal smokers are included. Low-income maternal smokers are the working poor living in predominately urban areas with fewer health care resources than low-income nonsmokers. Over 50% of low-income maternal smokers are uninsured pre-pregnancy and use a clinic as their usual source of care. Regardless of income, smokers exhibit rates of nonsmoking risks that are two to three times those of nonsmokers and high rates of unintended pregnancy (68%) of low-income smokers. These characteristics likely call for a bundle of social support services beyond cessation for smokers to quit and remain smoke-free postpartum.

Adams, R. C. and P. Snyder (1998). "Treatments for cerebral palsy: Making choices of intervention from an expanding menu of options." Infants and Young Children 10(4): 1-22.
	Family members face an increasing number of therapeutic and medical choices that can be made on behalf of their children with cerebral palsy. Various options are presented through the press and media, medical and educational literature, and the "information highway." While decisions about which courses of action to take are sometimes made unilaterally by families, often there are requests for input from the pediatrician or other professionals working with the child. This article organizes the variety of options that may be chosen by families and professionals under three major "menu" headings. Information and resources are presented that might be helpful for families and professionals to use as they attempt to answer the question, "What should we do?" Strategies for supporting families as they make decisions about possible courses of action are described.

Aday, L. A. and B. E. Quill (2000). "A framework for assessing practice-oriented scholarship in schools of public health." Journal of public health management and practice : JPHMP 6(1): 38-46.
	Within many schools of public health, substantial ambiguity surrounds the process of defining and rewarding faculty contributions to practice-oriented scholarly activities. Ernest L. Boyer introduced a powerful and compelling new paradigm for assessing the core domains of scholarship: the scholarships of discovery, integration, teaching, and application. This article draws on Boyer's domains and his colleagues, Charles E. Glassick, and others' criteria for evaluating them in introducing a framework for assessing practice-oriented scholarship within schools of public health. The article presents concepts, content, and defining criteria of practice-oriented scholarship and identifies the principles that might guide tenure and promotion decisions related to it.

Adcock, J. and E. Fottrell (2008). "The North-South information highway: case studies of publication access among health researchers in resource-poor countries." Global Health Action 1: 5.
	Background: Less than 2% of scientific publications originate in low-income countries. Transfer of information from South to North and from South to South is grossly limited and hinders understanding of global health, while Northern-generated information fails to adequately address the needs of a Southern readership. Methods: A survey of a new generation of health researchers from nine low-income countries was conducted using a combination of email questionnaires and face-to-face interviews. Data were gathered on personal experiences, use and aspirations regarding access and contribution to published research. Results: A total of 23 individuals from 9 countries responded. Preference for journal use over textbooks was apparent, however a preference for print over online formats was described among African respondents compared to respondents from other areas. Almost all respondents (96%) described ambition to publish in international journals, but cited English language as a significant barrier. Conclusion: The desire to contribute to and utilise contemporary scientific debate appears to be strong among study respondents. However, longstanding barriers remain in place and innovative thinking and new publishing models are required to overcome them.

Adebo, G. M. and S. D. Y. Alfred (2011). "Gender dimension of herbal medicine's knowledge and practice in Ekiti and Ondo States, Nigeria." Journal of Medicinal Plants Research 5(8): 1283-1290.
	In Nigeria several occupations and practices are gender biased right from their names and references. The womenfolk are not heard of but it was discovered that in almost all local markets in Nigeria, women engage in the sales of herbal products for the treatment of numerous ailments however, there are no available data of their contributions to herbal medicine. It is on this note that this study was carried out to examine the gender dimension of herbal medicine's knowledge and practice in Ekiti and Ondo States. A multi-stage random sampling method was used in selecting 140 respondents from the two States. A structured interview schedule was used in collecting the data. Results of the findings indicate that majority (81.4%) of herbal medicine practitioners in Ekiti and Ondo States were women. Data show a high level of patronage and effectiveness. Most of them inherited the practice from their parents but a few males learned it through informal training. Both genders engaged in the treatment of various ailments and were frequently patronized by patients with infertility problems, children's ailments, skin diseases and malaria. They mostly used indigenous methods in processing and preservation of herbs however a good proportion (23%) of the male gender has engaged in the modern method of processing and preservation of herbs. Challenges faced by herbal medicine practitioner in both States includes lack of processing facilities, low publicity, ignorance, low level of education and poor finance base. All the challenges were prominent among the female gender than their male counterparts. It is recommended that Agricultural extension agents should evolve a model for improving women's herbal medicine practice through non-formal education while the male counterparts who are more knowledgeable in the practice can be used as resource persons. Both the male and female herbal practitioners should be encouraged to form and join cooperative societies to enable them access loans. Young people should be encouraged to join the profession in order to prevent it from going into extinction.

Adegbola, M. (2010). "Nurses collaborating with cross disciplinary networks: starting to integrate genomics into practice." Journal of National Black Nurses' Association : JNBNA 21(1): 46-49.
	Nurses and other health-care providers are poised to include genetic discoveries into practice settings and to translate such knowledge for consumer benefit within culturally appropriate contexts. Nurses must seek collaboration with multi-disciplinary networks both locally and internationally. They must also capitalize on the expertise of other seasoned researchers in order to gain national and international exposure, recognition, and funding. Scholarly tailgating is using network relationships to achieve one's professional goals, and capitalizing on expert knowledge from seasoned researchers, educators, and practitioners from diverse international groups. By using scholarly tailgating principles, nurses can become important agents of change for multi-disciplinary networks, and thereby assist in decreasing health disparities. The purpose of this document is to encourage and inspire nurses to seek collaborative multi-disciplinary networks to enable genomic integration into health-care practice and education. Strategies for integrating genomics into practice settings are discussed.

Adhikari, S. R. (2012). "An assessment of a substitute or complement for inpatient and outpatient care of visceral leishmaniasis in Nepal." Journal of Vector Borne Diseases 49(4): 242-248.
	Background & objectives: The burden of visceral leishmaniasis (VL) in Nepal, as in other developing countries, falls disproportionately upon the rural poor. Promoting use of outpatient (OP) care, an alternative to inpatient (IP) care has long been advocated to reduce cost of care in both the demand and supply sides as substitution of relatively cheaper resources for expensive resources in the production of health care services. The paper aims to assess the intensity of demand for VL care and explore possibilities of the substitutability or complementation patterns between OP care and IP care of VL. Methods: In order to explore the possibility of substitute (or complement) of OP care for IP care, we exploited the ordinary least squared method by utilizing recently collected data from the VL endemic districts of Nepal. The sample size represented >25% of the population of VL of the country. The paper measured the sensitivity analysis of demand for OP and IP cares using appropriate demand models. Results: The coefficients of demand models gave negative relationship between quantity demanded for health care and their prices. It is plausible that OP price has strong power than IP price to determine the respective quantity demanded for health care. As expected, income has negative sign. but not significant that means income has no effect on determining the demand for health care because VL is a disease of poor. Conclusion: Recently, improvements in treatment and diagnostic techniques suggest a substitute of OP care for IP care; however, the OP and IF cares are complements due to behavioural factors.

Adler, S. R., et al. (2015). "The impact of intramural grants on educators' careers and on medical education innovation." Academic Medicine 90(6): 827-831.
	PURPOSE: The University of California, San Francisco (UCSF), Haile T. Debas Academy of Medical Educators Innovations Funding program awards competitive grants to create novel curricula and faculty development programs, compare pedagogical approaches, and design learner assessment methods. The authors examined the principal investigators' (PIs') perceptions of the impact of these intramural grants on their careers and on medical education innovation.
METHOD: At 12 months (project completion) and 24 months (follow-up), PIs submit a progress report describing the impact of their grant on their careers, work with collaborators, subsequent funding, project dissemination, and the UCSF curriculum. The authors analyzed these reports using qualitative thematic analysis and achieved consensus in coding and interpretation through discussion.
RESULTS: From 2001 to 2012, the program funded 77 PIs to lead 103 projects, awarding over $2.2 million. The authors analyzed reports from 88 grants (85.4%) awarded to 68 PIs (88.3%). PIs noted that the funding led to accelerated promotion, expanded networking opportunities, enhanced knowledge and skills, more scholarly publications and presentations, extramural funding, and local and national recognition. They also reported that the funding improved their status in their departments, enhanced their careers as medical educators, laid the foundation for subsequent projects, and engaged an array of stakeholders, including trainees and junior faculty.
CONCLUSIONS: These modest intramural education grants not only created innovative, enduring programs but also promoted educators' professional identity formation, fostered collaborations, supported junior faculty in finding their desired career paths, provided advancement opportunities, and raised the local and national profiles of recipients.

Agarwal, G. and P. Ramakant (2008). "Breast cancer care in India: The current scenario and the challenges for the future." Breast Care 3(1): 21-27.
	The incidence of breast cancer is low in India, but rising. Breast cancer is the commonest cancer of urban Indian women and the second commonest in the rural women. Owing to the lack of awareness of this disease and in absence of a breast cancer screening program, the majority of breast cancers are diagnosed at a relatively advanced stage. The quality of care available for breast cancer patients varies widely according to where the patient is treated. Although there are some centers of excellence providing multimodality protocol-based treatment at par with the best anywhere in the world, the vast majority of breast cancer patients undergo inadequate and inappropriate treatment due to lack of high-quality infrastructure and sometimes skills, and above all financial resources. The recent emphasis on health education, early diagnosis of cancers, and more public facilities for cancer treatment are expected to bring about the much needed improvement in breast cancer care in India.

Agarwal, G., et al. (2009). "Breast Cancer Care in Developing Countries." World Journal of Surgery 33(10): 2069-2076.
	Breast cancer is the commonest cancer of women the world over, and its incidence is rising, especially in developing countries, where the disease poses a major health care challenge. This growing incidence in developing countries reflects the advanced stage at diagnosis, low levels of public awareness of the risk for the disease, and poor medical infrastructure and expertise, with the resultant poor treatment outcomes. This article provides a collective edited summary of the presentations at the symposium titled "Breast Cancer Care in Developing Countries," held as part of the Breast Surgery International program at the International Surgical week 2007, Montreal, Canada, August 2007. The aim of the presentations was to bring out the diverse clinical pathological and outcomes-related facts of breast cancer care available to women in several countries. As the incidence of breast cancer continues to rise steadily in the developing world, the lack of awareness of this disease and the absence of breast cancer screening programs make it almost certain that the majority of breast cancers are diagnosed at an advanced stage. In addition, the quality of care available for breast cancer patients varies widely according to where the patient is treated. Though there are some centers of excellence providing multimodality protocol-based treatment on a par with the best anywhere in the world, most breast cancer patients receive inadequate and inappropriate treatment because of a lack of high-quality infrastructure-and sometimes skills-and, above all, because of limited financial resources. In countries where these limitations are present, there is a need to emphasize public health education, promoting early diagnosis. In addition, resources must be directed toward the creation of more public facilities for cancer treatment. As these goals are met, it is likely that there will be a much-needed improvement in breast cancer care in developing countries.

Agee, M. D. and T. D. Crocker (1996). "Parental altruism and child lead exposure - Inferences from the demand for chelation therapy." Journal of Human Resources 31(3): 677-691.
	We use parents' decisions to treat their children's body burdens of lead to infer parental ex ante willingness to pay for reduced burdens. Willingness to pay is estimated with a data set containing 256 observations; the data were originally gathered to assess the impact of children's body lead burdens upon their intellectual and behavioral development. Our results indicate that parental ex ante willingness to pay for a I percent reduction in child body lead burden exceeds the estimated ex post savings in medical treatment and compensatory education costs caused by the same reduction.

Agius, S., et al. (2008). "Managing change in postgraduate medical education: Still unfreezing?" Medical Teacher 30(4): e87-e94.
	Background: Modernizing Medical Careers (MMC) is an ambitious project to change the training of UK doctors. A key to its successful implementation is the ways that MMC is perceived and operationalized by senior doctors who act as local educational leaders and supervisors. Aims: To analyse hospital consultants' perceptions of the modernization process and its impact on their role as the primary educators of Senior House Officers (SHOs), using Schein's extended model to explain their stage in the process of change. Methods: We interviewed medical directors, College and clinical tutors and education supervisors at 6 Trusts. The transcripts were analysed using Schein's change model to explore the perceptions and assumptions of senior medical staff and to determine their stage in the process of change. Results: 12 tutors, 12 supervisors, and 4/6 medical directors approached agreed to participate (28/30). Nine themes emerged from transcript analysis. These were related to the three-stage model of change. Most participants were at the stage of 'unfreezing', expressing views around disconfirmation of expectations, guilt and anxiety and feelings of some psychological safety. A smaller number were at the stage of 'moving to a new position'. There were limited examples of 'refreezing'. Conclusions: At the local delivery level, most senior doctors were aware of the need to review their current position and alter their approaches and assumptions about postgraduate medical education. Yet only a minority were moving forward. Considerable work remains for successful implementation of MMC.

Agoritsas, T., et al. (2014). "Increasing the quantity and quality of searching for current best evidence to answer clinical questions: Protocol and intervention design of the MacPLUS FS Factorial Randomized Controlled Trials." Implementation Science 9(1).
	Background & aims: Finding current best evidence for clinical decisions remains challenging. With 3,000 new studies published every day, no single evidence-based resource provides all answers or is sufficiently updated. McMaster Premium LiteratUre Service - Federated Search (MacPLUS FS) addresses this issue by looking in multiple high quality resources simultaneously and displaying results in a one-page pyramid with the most clinically useful at the top. Yet, additional logistical and educational barriers need to be addressed to enhance point-of-care evidence retrieval. This trial seeks to test three innovative interventions, among clinicians registered to MacPLUS FS, to increase the quantity and quality of searching for current best evidence to answer clinical questions.Methods & design: In a user-centered approach, we designed three interventions embedded in MacPLUS FS: (A) a web-based Clinical Question Recorder; (B) an Evidence Retrieval Coach composed of eight short educational videos; (C) an Audit, Feedback and Gamification approach to evidence retrieval, based on the allocation of 'badges' and 'reputation scores.'. We will conduct a randomized factorial controlled trial among all the 904 eligible medical doctors currently registered to MacPLUS FS at the hospitals affiliated with McMaster University, Canada. Postgraduate trainees (n = 429) and clinical faculty/staff (n = 475) will be randomized to each of the three following interventions in a factorial design (A x B x C). Utilization will be continuously recorded through clinicians' accounts that track logins and usage, down to the level of individual keystrokes. The primary outcome is the rate of searches per month per user during the six months of follow-up. Secondary outcomes, measured through the validated Impact Assessment Method questionnaire, include: utility of answers found (meeting clinicians' information needs), use (application in practice), and perceived usefulness on patient outcomes.Discussion: Built on effective models for the point-of-care teaching, these interventions approach evidence retrieval as a clinical skill. If effective, they may offer the opportunity to enhance it for a large audience, at low cost, providing better access to relevant evidence across many top EBM resources in parallel. © 2014 Agoritsas et al.; licensee BioMed Central Ltd.

Agrawal, R., et al. (2014). "Role of Telemedicine Technology in Endocrine Surgery Knowledge Sharing." Telemedicine and e-Health 20(9): 868-874.
	Introduction:This retrospective study was designed to assess the outcome of telemedicine technology supportive of educational collaboration among endocrine surgery peers and its impact on knowledge and skill development.Materials and Methods:The study was carried out in the Department of Endocrine Surgery in collaboration with School of Telemedicine and Biomedical Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, during October 1999-December 2012. Telemedicine activities were divided into various modules (e.g., case/problem-based learning, clinical grand rounds, postgraduate course/continuing medical education/conference). Endocrine surgeons participating in such sessions were divided into two groups (faculty and residents). A multimodule questionnaire was constructed based on a Likert scale (2-7 points) to test various aspects (e.g., technical performance, role in knowledge exchange, skill development, level of satisfaction, and future recommendations). Responses were expressed in proportions, and the chi-squared test was used to find the differences in opinions of the study groups.Results:The questionnaire was sent to 38 surgeons, of whom 36 replied (response rate, 94.74%); of these respondents, 14 were faculty and 22 were residents. More than 80% of participants felt that the technology helped in learning new things and strengthening relations with peers, whereas >90% were of the view that it helped in knowledge exchange and development of skills as well as was helpful in supporting clinical decisions. More than 90% of participants were satisfied and enjoyed using this technology and also were of the opinion that the technology should be integrated into other specialties. Satisfaction with the technology was excellent to good for 94.44% of participants. Both faculty and residents were of the same opinion, and there was no significant difference in their replies.Conclusions:Knowledge sharing in a collaborative environment using telemedicine technology has been found successful in a low-resource setting and is now adopted in the departmental educational program.

Agu, K. A., et al. (2014). "The Incidence and Types of Medication Errors in Patients Receiving Antiretroviral Therapy in Resource-Constrained Settings." PLoS ONE [Electronic Resource] 9(1): 5.
	Purpose: This study assessed the incidence and types of medication errors, interventions and outcomes in patients on antiretroviral therapy (ART) in selected HIV treatment centres in Nigeria. Methods: Of 69 health facilities that had program for active screening of medication errors, 14 were randomly selected for prospective cohort assessment. All patients who filled/refilled their antiretroviral medications between February 2009 and March 2011 were screened for medication errors using study-specific pharmaceutical care daily worksheet (PCDW). All potential or actual medication errors identified, interventions provided and the outcomes were documented in the PCDW. Interventions included pharmaceutical care in HIV training for pharmacists amongst others. Chi-square was used for inferential statistics and P<0.05 indicated statistical significance. Results: Of 6,882 participants, 67.0% were female and 93.5% were aged >= 15years old. The participants had 110,070 medications filling/refilling visits, average (+/- SD) of 16.0 (+/- 0.3) visits per patient over the observation period. Patients were followed up for 9172.5 person-years. The number of drug items dispensed to participants was 305,584, average of 2.8 (+/- 0.1) drug items per patient. The incidence rate of medication errors was 40.5 per 100 person-years. The occurrence of medication errors was not associated with participants' sex and age (P>0.05). The major medications errors identified were 26.4% incorrect ART regimens prescribed; 19.8% potential drug-drug interaction or contraindication present; and 16.6% duration and/or frequency of medication inappropriate. Interventions provided included 67.1% cases of prescriber contacted to clarify/resolve errors and 14.7% cases of patient counselling and education; 97.4% of potential/actual medication error(s) were resolved. Conclusion: The incidence rate of medication errors was somewhat high; and majority of identified errors were related to prescription of incorrect ART regimens and potential drug-drug interactions; the prescriber was contacted and the errors were resolved in majority of cases. Active screening for medication errors is feasible in resource-limited settings following a capacity building intervention.

Ahalt, C., et al. (2013). "Paying the Price: The Pressing Need for Quality, Cost, and Outcomes Data to Improve Correctional Health Care for Older Prisoners." Journal of the American Geriatrics Society 61(11): 2013-2019.
	Despite a recent decline in the U.S. prison population, the older prisoner population is growing rapidly. U.S. prisons are constitutionally required to provide health care to prisoners. As the population ages, healthcare costs rise, states are forced to cut spending, and many correctional agencies struggle to meet this legal standard of care. Failure to meet the healthcare needs of older prisoners, who now account for nearly 10% of the prison population, can cause avoidable suffering in a medically vulnerable population and violation of the constitutional mandate for timely access to an appropriate level of care while incarcerated. Older prisoners who cannot access adequate health care in prison also affect community healthcare systems because more than 95% of prisoners are eventually released, many to urban communities where healthcare disparities are common and acute healthcare resources are overused. A lack of uniform quality and cost data has significantly hampered innovations in policy and practice to improve value in correctional health care (achieving desired health outcomes at sustainable costs). With their unique knowledge of complex chronic disease management, experts in geriatrics are positioned to help address the aging crisis in correctional health care. This article delineates the basic health, cost, and outcomes data that geriatricians and gerontologists need to respond to this crisis, identifies gaps in the available data, and anticipates barriers to data collection that, if addressed, could enable clinicians and policy-makers to evaluate and improve the value of geriatric prison health care.

Ahlert, M. and C. Pfarr (2016). "Attitudes of Germans towards distributive issues in the German health system." European Journal of Health Economics 17(4): 471-496.
	Social health care systems are inevitably confronted with the scarcity of resources and the resulting distributional challenges. Since prioritization implies distributional effects, decisions regarding respective rules should take citizens' preferences into account. In this study we concentrate on two distributive issues in the German health system: firstly, we analyze the acceptance of prioritizing decisions concerning the treatment of certain patient groups, in this case patients who all need a heart operation. We focus on the patient criteria smoking behavior, age and whether the patient has or does not have young children. Secondly, we investigate Germans' opinions towards income-dependent health services. The results reveal the strong effects of individuals' attitudes regarding general aspects of the health system on priorities, e.g. that individuals with an unhealthy lifestyle should not be prioritized. In addition, experience of limited access to health services is found to have a strong influence on citizens' attitudes, too. Finally, decisions on different prioritization criteria are found to be not independent.

Ahluwalia, N. (2002). "Intervention strategies for improving iron status of young children and adolescents in India." Nutrition Reviews 60(5): S115-S117.
	Despite advances in scientific knowledge regarding multiple etiology, treatment, and potential strategies for combating iron deficiency and deficiencies of other micronutrients, iron deficiency anemia, vitamin A deficiency, and iodine deficiency remain significant public health challenges for growing children and adolescents. The short-term efficient supplementation approach, although technically feasible, has not been successful due to problems with delivery and compliance. Evidence is building that preventive supplementation coupled with nutrition education may be a more effective strategy associated with better compliance and improvement in iron status. Long-term, effective approaches include fortification, dietary modification, public health and disease control measures, and income generation programs. Food fortification can be a cost-effective intervention strategy if technologically feasible, nutritionally sound, culturally acceptable and economically viable food vehicle(s) and fortificant(s) can be identifed. Foods such as wheat, rice, and salt are commonly consumed in India; research is underway to evaluate various fortificants for these foods. Doubly fortified salt with iodine and iron may be particularly promising in the Indian situation as it is affordable, culturally acceptable, and may enhance iron absorption from Indian dietaries containing inhibitors of iron absorption. Feasibility studies are underway to evaluate the stability and storage issues as well as bioavailability of fortificant iron. Dietary modification involves increased iron intake, by increasing total food intake and consumption of locally available iron-rich foods, and dietary practices favoring iron absorption. Blood loss associated with worm infestation can be controlled by periodic deworming and reducing reinfestation. Coordinating these major Intervention approaches by building partnerships between the community, existing nutrition and health programs, government, industry, and academic institutions is critical for success of these programs. Nutrition education must be integral to all of these strategies discusssed. Primary health care system and school infrastructure and staff, along with school children and community members, can be powerful resources for addressing malnutrition in children and adolescents. (C) 2002 International Life Sciences Institute.

Ahmad, W. and H. Bradby (2008). "Ethnicity and health - Key themes in a developing field." Current Sociology 56(1): 47-56.
	Ethnicity is a social division that is increasingly difficult to ignore. Ethnicity has to be considered alongside other social divisions including socioeconomic status which is crucial to explaining minority disadvantages in health. Identity is a key dimension of ethnicity, which encompasses self-ascribed and externally-imposed elements. The stigma associated with particular conditions, combined with the effects of racism and economic marginalization, can be central to some minority groups' ability to discuss disease and seek treatment. In a world where human rights are taken seriously, minority ethnic groups' presence in research has to become a routine consideration, rather than an optional extra. In research, as in service provision, planning for linguistic and cultural diversity represents additional work and will require extra resources.

Ahmed, R., et al. (2016). "Building capacity for education research among clinical educators in the health professions: A BEME (Best Evidence Medical Education) Systematic Review of the outcomes of interventions: BEME Guide No. 34." Medical Teacher 38(2): 123-136.
	Background/purpose: There is a growing desire for health professions educators to generate high-quality education research; yet, few of them encounter the training to do so. In response, health professions faculties have increasingly been devoting resources to provide members with the skills necessary for education research. The form and impact of these efforts have not been reviewed, though such a synthesis could be useful for practice. The objectives of this systematic review were to (1) identify interventions aimed at building capacity for education research among health professions clinical educators and (2) review the outcomes of these interventions. Methodology: We developed a systematic review protocol based on our pilot scoping search. This protocol underwent peer review and was prospectively registered with the Best Evidence Medical Education Collaboration. Based on this protocol, we conducted a comprehensive search of health professions' databases and related grey literature. Systematic methods were applied: two independent reviewers completed title screening and full text review for inclusion, data extraction, and methodological quality assessment. Studies were included if they reported outcomes for interventions designed to increase capacity for health professions clinical educators to conduct education research. We conducted a qualitative synthesis of the evidence which included detailed reporting of intervention characteristics and outcomes. Results: Our search returned 14, 149 results, 241 of which were retained after title and abstract screening, and 30 of which met inclusion criteria after full text review. Seven groups of interventions were identified, the most frequent being teaching scholars programs (n = 10), health professions education fellowships (n = 3) or master's programs (n = 4). The most commonly measured outcome was change related to enhanced scholarly outputs (grants, papers, abstracts, and presentations) post-intervention. Unfortunately, most of the included studies lacked detailed description of the intervention and were of low to moderate quality with post-test only design. Discussion/conclusions: This review demonstrates that various interventions can have a positive impact on the ability of health professions clinical educators to conduct education research. We note several key elements of the interventions including: (1) protected time, (2) mentorship and/or collaboration, (3) departmental and institutional commitment and leadership, and (4) financial support. Through our analysis we describe the complexities around evaluating clinical educators' health professions research activities and the interventions used to promote education research. While improved study quality would allow more detailed understanding and evaluation of these key features, we are able to provide recommendations for potential strategies for improving participation in and quality of health professions education research based on this analysis.

Ahn, R., et al. (2013). "Human Trafficking Review of Educational Resources for Health Professionals." American Journal of Preventive Medicine 44(3): 283-289.
	Context: Human trafficking is an increasingly well-recognized human rights violation that is estimated to involve more than 2 million victims worldwide each year. The health consequences of this issue bring victims into contact with health systems and healthcare providers, thus providing the potential for identification and intervention. A robust healthcare response, however, requires a healthcare workforce that is aware of the health impact of this issue; educated about how to identify and treat affected individuals in a compassionate, culturally aware, and trauma-informed manner; and trained about how to collaborate efficiently with law enforcement, case management, and advocacy partners. This article describes existing educational offerings about human trafficking designed for a healthcare audience and makes recommendations for further curriculum development. Evidence acquisition: A keyword search and structured analysis of peer-reviewed and gray literature, conducted in 2011 and 2012, yielded 27 items that provide basic guidance to health professionals on human trafficking. Evidence synthesis: The 27 resources differed substantially in format, length, scope, and intended audience. Topic areas covered by these resources included trafficking definitions and scope, health consequences, victim identification, appropriate treatment, referral to services, legal issues, and security. None of the educational resources has been rigorously evaluated. Conclusions: There is a clear need to develop, implement, and evaluate high-quality education and training programs that focus on human trafficking for healthcare providers. (Am J Prev Med 2013;44(3):283-289) (C) 2013 American Journal of Preventive Medicine

Aikins, A. D., et al. (2010). "Developing effective chronic disease interventions in Africa: insights from Ghana and Cameroon." Globalization and Health 6: 15.
	Background: Africa faces an urgent but 'neglected epidemic' of chronic disease. In some countries stroke, hypertension, diabetes and cancers cause a greater number of adult medical admissions and deaths compared to communicable diseases such as HIV/AIDS or tuberculosis. Experts propose a three-pronged solution consisting of epidemiological surveillance, primary prevention and secondary prevention. In addition, interventions must be implemented through 'multifaceted multi-institutional' strategies that make efficient use of limited economic and human resources. Epidemiological surveillance has been prioritised over primary and secondary prevention. We discuss the challenge of developing effective primary and secondary prevention to tackle Africa's chronic disease epidemic through in-depth case studies of Ghanaian and Cameroonian responses. Methods: A review of chronic disease research, interventions and policy in Ghana and Cameroon instructed by an applied psychology conceptual framework. Data included published research and grey literature, health policy initiatives and reports, and available information on lay community responses to chronic diseases. Results: There are fundamental differences between Ghana and Cameroon in terms of 'multi-institutional and multifaceted responses' to chronic diseases. Ghana does not have a chronic disease policy but has a national health insurance policy that covers drug treatment of some chronic diseases, a culture of patient advocacy for a broad range of chronic conditions and mass media involvement in chronic disease education. Cameroon has a policy on diabetes and hypertension, has established diabetes clinics across the country and provided training to health workers to improve treatment and education, but lacks community and media engagement. In both countries churches provide public education on major chronic diseases. Neither country has conducted systematic evaluation of the impact of interventions on health outcomes and cost-effectiveness. Conclusions: Both Ghana and Cameroon require a comprehensive and integrative approach to chronic disease intervention that combines structural, community and individual strategies. We outline research and practice gaps and best practice models within and outside Africa that can instruct the development of future interventions.

Aimaretti, G. and E. Ghigo (2005). "Hypopituitarism is a common neuro-endocrine disease: How manage to inform the medical community." Pituitary 8(3-4): 271-272.
	
Aita, M., et al. (2007). "Illuminating the processes of knowledge transfer in nursing." Worldviews on Evidence-Based Nursing 4(3): 146-155.
	Rationale: Over the past 10 years, there has been a propensity to translate research findings and evidence into clinical practice, and concepts such as knowledge transfer, research dissemination, research utilization, and evidence-based practice have been described in the nursing literature. Aim: This manuscript shows a selective review of the definitions and utilization of these concepts and offers a perspective on their interrelationships by indicating how knowledge transfer processes are the basis of all the concepts under review. Findings: Definitions and utilization of knowledge transfer in the literature have been influenced by educational and social perspectives and indicate two important processes that are rooted in the mechanisms of research dissemination, research utilization, and evidence-based practice. These processes refer to a cognitive and an interpersonal dimension. Knowledge transfer underlies a process involving cognitive resources as well as an interpersonal process where the knowledge is transferred between individuals or groups of individuals. Conclusion and Implications: This manuscript can contribute to our understanding of the theoretical foundations linking these concepts and these processes by comparing and contrasting them. It also shows the value and empirical importance of the cognitive and interpersonal processes of knowledge transfer by which research findings and evidence can be successfully translated and implemented into the nursing clinical practice. © 2007 Sigma Theta Tau International.

Aitkin, H. (2002). "Bridging the mountainous divide: A case for ICTs for mountain women." Mountain Research and Development 22(3): 225-229.
	Why would a telecommunication provider consider investing in telecommunications infrastructure services in remote mountainous areas? Population is sparse; installation costs are especially high given the poor road conditions, the distance from the main grid, and the frequent lack of reliable electricity; economies tend to operate at a subsistence level; villagers are often illiterate and unskilled in the use of even the most basic telecom services; and many mountain people are from minority groups, isolated as much by geography as by their language and culture. Often, too, isolated mountain communities have a disproportionately high population of women, children, and the elderly, on account of the common and ever-increasing out-migration by men of the household for seasonal employment. The women left behind are generally already overburdened with the responsibilities of family and home as well as subsistence farming and microeconomic activities. Why also should governments or donor agencies choose-to invest limited resources in information and communication technologies (ICTs) when basic human needs-food,'health, clean water, and education - urgently require improvement? How have ICTs ever benefited the poor? This article gives examples of successful ventures in mountain regions.

Ajayi, I. O., et al. (2013). "Assessing resources for implementing a community directed intervention (CDI) strategy in delivering multiple health interventions in urban poor communities in Southwestern Nigeria: a qualitative study." Infectious Diseases of Poverty 2: 18.
	Background: Many simple, affordable and effective disease control measures have had limited impact due to poor access especially by the poorer populations (urban and rural) and inadequate community participation. A proven strategy to address the problem of access to health interventions is the Community Directed Interventions (CDI) approach, which has been used successfully in rural areas. This study was carried out to assess resources for the use of a CDI strategy in delivering health interventions in poorly-served urban communities in Ibadan, Nigeria. Methods: A formative study was carried out in eight urban poor communities in the Ibadan metropolis in the Oyo State. Qualitative methods comprising 12 focus group discussions (FGDs) with community members and 73 key informant interviews (KIIs) with community leaders, programme managers, community-based organisations (CBOs), non-government organisations (NGOs) and other stakeholders at federal, state and local government levels were used to collect data to determine prevalent diseases and healthcare delivery services, as well as to explore the potential resources for a CDI strategy. All interviews were audio recorded. Content analysis was used to analyse the data. Results: Malaria, upper respiratory tract infection, diarrhoea and measles were found to be prevalent in children, while hypertension and diabetes topped the list of diseases among adults. Healthcare was financed mainly by out-of-pocket expenses. Cost and location were identified as hindrances to utilisation of health facilities; informal cooperatives (esusu) were available to support those who could not pay for care. Immunisation, nutrition, reproductive health, tuberculosis (TB) and leprosy, environmental health, malaria and HIV/AIDs control programmes were the ongoing interventions. Delivery strategies included house-to-house, home-based treatment, health education and campaigns. Community participation in the planning, implementation and monitoring of development projects was reported as common practice. The resources available for these activities and which constitute potential resources for the CDI process include community volunteers, CBOs and NGOs. Others are landlords; professional, women and youth associations; social clubs, religious organisations and the available health facilities. Conclusion: This study's findings support the feasibility of using the CDI process in delivering health interventions in urban poor communities and show that potential resources for the strategy abound in the communities.

Akeju, D. O., et al. (2016). "Human resource constraints and the prospect of task-sharing among community health workers for the detection of early signs of pre-eclampsia in Ogun State, Nigeria." Reproductive Health 13: 8.
	Background: The dearth of health personnel in low income countries has attracted global attention. Ways as to how health care services can be delivered in a more efficient and effective way using available health personnel are being explored. Task-sharing expands the responsibilities of low-cadre health workers and allows them to share these responsibilities with highly qualified health care providers in an effort to best utilize available human resources. This is appropriate in a country like Nigeria where there is a shortage of qualified health professionals and a huge burden of maternal mortality resulting from obstetric complications like pre-eclampsia. This study examines the prospect for task-sharing among Community Health Extension Workers (CHEW) for the detection of early signs of pre-eclampsia, in Ogun State, Nigeria. Methods: This study is part of a larger community-based trial evaluating the acceptability of community treatment for severe pre-eclampsia in Ogun State, Nigeria. Data was collected between 2011 and 2012 using focus group discussions; seven with CHEWs (n = 71), three with male decision-makers (n = 35), six with community leaders (n = 68), and one with member of the Society of Obstetricians and Gynaecologists of Nigeria (n = 9). In addition, interviews were conducted with the heads of the local government administration (n = 4), directors of planning (n = 4), medical officers (n = 4), and Chief Nursing Officers (n = 4). Qualitative data were analysed using NVivo version 10.0 3 computer software. Results: The non-availability of health personnel is a major challenge, and has resulted in a high proportion of facility-based care performed by CHEWs. As a result, CHEWs often take on roles that are designated for senior health workers. This role expansion has exposed CHEWs to the basics of obstetric care, and has resulted in informal task-sharing among the health workers. The knowledge and ability of CHEWs to perform basic clinical assessments, such as measure blood pressure is not in doubt. Nevertheless, there were divergent views by senior and junior cadres of health practitioners about CHEWs' abilities in providing obstetric care. Similarly, there were concerns by various stakeholders, particularly the CHEWs themselves, on the regulatory restrictions placed on them by the Standing Order. Conclusion: Generally, the extent to which obstetric tasks could be shifted to community health workers will be determined by the training provided and the extent to which the observed barriers are addressed.

Akhtar, S., et al. (2007). "Hyperendemic pulmonary tuberculosis in peri-urban areas of Karachi, Pakistan." BMC Public Health 7: 8.
	Background: Currently there are very limited empirical data available on the prevalence of pulmonary tuberculosis among residents of marginalized settings in Pakistan. This study assessed the prevalence of pulmonary tuberculosis through active case detection and evaluated predictors of pulmonary tuberculosis among residents of two peri-urban neighbourhoods of Karachi, Pakistan. Methods: A cross-sectional study was conducted in two peri-urban neighbourhoods from May 2002 to November 2002. Systematic sampling design was used to select households for inclusion in the study. Consenting subjects aged 15 years or more from selected households were interviewed and, whenever possible, sputum samples were obtained. Sputum samples were subjected to direct microscopy by Ziehl-Neelson method, bacterial culture and antibiotic sensitivity tests. Results: The prevalence ( per 100,000) of pulmonary tuberculosis among the subjects aged 15 years or more, who participated in the study was 329 ( 95% confidence interval ( CI): 195-519). The prevalence ( per 100,000) of pulmonary tuberculosis adjusted for non-sampling was 438 ( 95% CI: 282-651). Other than cough, none of the other clinical variables was significantly associated with pulmonary tuberculosis status. Analysis of drug sensitivity pattern of 15 strains of Mycobacterium tuberculosis revealed that one strain was resistant to isoniazid alone, one to streptomycin alone and one was resistant to isoniazid and streptomycin. The remaining 12 strains were susceptible to all five drugs including streptomycin, isoniazid, rifampicin, ethambutol, and pyrazinamide. Conclusion: This study of previously undetected tuberculosis cases in an impoverished peri-urban setting reveals the poor operational performance of Pakistan's current approach to tuberculosis control; it also demonstrates a higher prevalence of pulmonary tuberculosis than current national estimates. Public health authorities may wish to augment health education efforts aimed at prompting health-seeking behaviour to facilitate more complete and earlier case detection. Such efforts to improve passive case-finding, if combined with more accessible DOTS infrastructure for treatment of detected cases, may help to diminish the high tuberculosis-related morbidity and mortality in marginalized populations. The economics of implementing a more active approach to case finding in resource-constrained setting also deserve further study.

Akinci, F., et al. (2005). "Examining the association between preventive screenings and subsequent health services utilization by patients with type 2 diabetes mellitus." Disease Management & Health Outcomes 13(2): 129-135.
	Introduction: In recent years, health plans have turned to disease management programs as a means of reducing inpatient utilization while promoting preventive outpatient services provided for patients with type 2 diabetes mellitus. Aim: The purpose of this study was to assess the association between four preventive diabetes screenings (retinal eye exams, glycosylated hemoglobin [HbA(1c)] testing, lipid testing, and albumin testing) in the base study period, and health services utilization patterns during a 24-month follow-up study period for 2641 patients with type 2 diabetes. Methods: Claims data from Regence BlueShield of Idaho for the three periods of 2000 (base period), 2001, and 2002 (results period) have provided the basis for this empirical analysis. Based on our review of the relevant literature and results from disease management and health plan management programs, the central hypothesis of this Study was that the four preventive diabetes screenings in the base study period would be associated with lower inpatient utilization and greater preventive outpatient utilization during a 24-month follow-up study period. Simple linear association analysis was used to measure the relationship between the utilization of preventive diabetes screenings and subsequent utilization of emergency room, inpatient, and preventive outpatient services. Results: The study results show that for patients who comply with recommended lipid screening services, health plans can expect to see a significant reduction in the number of inpatient admissions over the subsequent 2 years, while marginal inpatient reductions might be expected following HbA(1c), testing. Furthermore, for patients who comply with recommended screenings of either retinal eye exams or albumin testing, health plans can expect to see these patients utilizing preventive outpatient services more frequently in the subsequent 2 years. Conclusions: Pursuing a state- or federal-supported screening program for patients with type 2 diabetes could reduce frequent utilization of inpatient services. Furthermore, in support of the goal of disease management programs to reduce inpatient utilization and increase preventive outpatient service utilization among the increasing proportion of members with type 2 diabetes, health plans are encouraged to provide education about and monitor their patients' compliance with recommended screenings in the future. Further studies should examine the role of lipid testing in reducing the risk of microvascular diseases. Future research should also pursue an understanding of how a reduction in inpatient utilization is associated with an increased emphasis on lipid screening.

Akinyemiju, T. F. (2012). "Socio-Economic and Health Access Determinants of Breast and Cervical Cancer Screening in Low-Income Countries: Analysis of the World Health Survey." PLoS ONE [Electronic Resource] 7(11): 8.
	Background: Breast and Cervical cancer are the two most common cancers among women in developing countries. Regular screening is the most effective way of ensuring that these cancers are detected at early stages; however few studies have assessed factors that predict cancer screening in developing countries. Purpose: To assess the influence of household socio-economic status (SES), healthcare access and country level characteristics on breast and cervical cancer screening among women in developing countries. Methods: Women ages 18-69 years (cervical cancer screening) and 40-69 years (breast cancer screening) from 15 developing countries who participated in the 2003 World Health Survey provided data for this study. Household SES and healthcare access was assessed based on self-reported survey responses. SAS survey procedures (SAS, Version 9.2) were used to assess determinants of breast and cervical cancer screening in separate models. Results: 4.1% of women ages 18-69 years had received cervical cancer screening in the past three years, while only 2.2% of women ages 40-69 years had received breast cancer screening in the past 5 years in developing countries. Cancer screening rates varied by country; cervical cancer screening ranged from 1.1% in Bangladesh to 57.6% in Congo and breast cancer screening ranged from 0% in Mali to 26% in Congo. Significant determinants of cancer screening were household SES, rural residence, country health expenditure (as a percent of GDP) as well as healthcare access. Discussion: A lot more needs to be done to improve screening rates for breast and cervical cancer in developing countries, such as increasing health expenditure (especially in rural areas), applying the increased funds towards the provision of more, better educated health providers as well as improved infrastructure.

Akl, E. A., et al. (2012). "Using GRADE methodology for the development of public health guidelines for the prevention and treatment of HIV and other STIs among men who have sex with men and transgender people." BMC Public Health 12: 9.
	Background: The World Health Organization (WHO) Department of HIV/AIDS led the development of public health guidelines for delivering an evidence-based, essential package of interventions for the prevention and treatment of HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) and transgender people in the health sector in low-and middle-income countries. The objective of this paper is to review the methodological challenges faced and solutions applied during the development of the guidelines. Methods: The development of the guidelines followed the WHO guideline development process, which utilizes the GRADE approach. We identified, categorized and labeled the challenges identified in the guidelines development process and described the solutions through an interactive process of in-person and electronic communication. Results: We describe how we dealt with the following challenges: (1) heterogeneous and complex interventions; (2) paucity of trial data; (3) selecting outcomes of interest; (4) using indirect evidence; (5) integrating values and preferences; (6) considering resource use; (7) addressing social and legal barriers; (8) wording of recommendations; and (9) developing global guidelines. Conclusion: We were able to successfully apply the GRADE approach for developing recommendations for public health interventions. Applying the general principles of the approach while carefully considering specific challenges can enhance both the process and the outcome of guideline development.

Al Nuaimi, E., et al. (2015). "Applications of big data to smart cities." Journal of Internet Services and Applications 6: 15.
	Many governments are considering adopting the smart city concept in their cities and implementing big data applications that support smart city components to reach the required level of sustainability and improve the living standards. Smart cities utilize multiple technologies to improve the performance of health, transportation, energy, education, and water services leading to higher levels of comfort of their citizens. This involves reducing costs and resource consumption in addition to more effectively and actively engaging with their citizens. One of the recent technologies that has a huge potential to enhance smart city services is big data analytics. As digitization has become an integral part of everyday life, data collection has resulted in the accumulation of huge amounts of data that can be used in various beneficial application domains. Effective analysis and utilization of big data is a key factor for success in many business and service domains, including the smart city domain. This paper reviews the applications of big data to support smart cities. It discusses and compares different definitions of the smart city and big data and explores the opportunities, challenges and benefits of incorporating big data applications for smart cities. In addition it attempts to identify the requirements that support the implementation of big data applications for smart city services. The review reveals that several opportunities are available for utilizing big data in smart cities; however, there are still many issues and challenges to be addressed to achieve better utilization of this technology.

Alanen, S., et al. (2008). "Hypertension guideline implementation: Experiences of Finnish primary care nurses." Journal of Evaluation in Clinical Practice 14(5): 830-835.
	Rationale, aims and objectives: Evidence-based guidelines on hypertension have been developed in many western countries. Yet, there is little evidence of their impact on the clinical practices of primary care nurses. Method: We assessed the style of implementation and adoption of the national Hypertension Guideline (HT Guideline) in 32 Finnish health centres classified in a previous study as 'disseminators' (n = 13) or 'implementers' (n = 19). A postal questionnaire was sent to all nurses (n = 409) working in the outpatient services in these health centres. Additionally, senior nursing officers were telephoned to enquire if the implementation of the HT Guideline had led to a new division of labour between nurses and doctors. Results: Questionnaires were returned from 327 nurses (80.0%), while all senior nursing officers (n = 32) were contacted. The majority of nurses were of the opinion that the HT Guideline has been adopted into clinical practice. The recommendations in the HT Guideline were adopted in clinical practice with varying success, and slightly more often in implementer health centres than in disseminator health centres. Nurses in implementer health centres more often agreed that multiple channels had been used in the implementation (P < 0.001). According to senior nursing officers the implementation of the HT Guideline had led to a new division of labour between nurses and doctors in about a half of the health centres, clearly more often in implementer health centres (P < 0.001). Conclusions: The HT Guideline was well adopted into clinical practice in Finland. The implementation of the HT Guideline had an impact on clinical practices, and on creating a new division of labour between nurses and doctors. © 2008 The Authors.

Albanese, M., et al. (2009). "Physician practice change II: implications of the Integrated Systems Model (ISM) for the future of continuing medical education." Academic Medicine 84(8): 1056-1065.
	In a companion paper, the authors provide the development and description of the Integrated Systems Model (ISM). In this article, they describe 14 general implications of the ISM for continuing medical education (CME). They discuss how applying the ISM would change CME by describing (1) how CME and the larger health care environment would be restructured if they were based on the ISM and (2) how the ISM would impact CME under the current environment of health care in the United States. They close by describing how the ISM can be used as CME moves to address the long lag between discovery and practice and begins to decrease its dependence on pharmaceutical companies. The ISM helps not only explain why the current health care system in the United States (or anywhere) produces what it produces, but also predict what that system would produce if it changed. At present, the ISM is a conceptual model, but with more research into measures of its various elements, it could become a more quantitatively predictive model. In its present form, however, the ISM can serve Marinopoulos's call for a "sound conceptual model of what influences the effectiveness of CME" and address Grimshaw's concern that current research lacks "a theoretical base to support the choice and development of interventions as well as the interpretation of study results." The statistician George Box said, "All models are wrong, some models are useful." The authors believe that the ISM is useful and that maybe it will prove Box wrong.

Albertsen, A. (2016). "Taxing unhealthy choices: The complex idea of liberal egalitarianism in health." Health Policy 120(5): 561-566.
	Under the heading of liberal egalitarianism, Cappelen and Norheim present a novel approach regarding how we are to assess health disadvantages reflecting people's choices. It seeks to uphold a commitment to principles of responsibility and egalitarianism, while avoiding objections that such theories fail for humanitarian, liberal or fairness reasons. The approach draws a line between those of such diseases which are life-threatening, costly to treat relative to income or undermining important political capabilities and those which are not. For the latter kind, their approach allows for co-payment, whereas the former requires a different measure. Here, the authors maintain that unhealthy choices should be taxed and treatment offered equally to everyone without further cost. While this is an interesting approach, it faces important difficulties. It consists of two elements, which can come into tension with each other when concerns for severity of disease and personal responsibility recommend the employment of different elements. Furthermore, as it stands, the approach is incomplete because it seems unable to address important non-monetary shortages, such as the organ shortage. Finally, it is not apparent how the approach is able to address the significant ways in which social circumstances influences people's choices in health and their ability to stay healthy. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Albino, J. E. N., et al. (2008). "Assessing Dental Students' Competence: Best Practice Recommendations in the Performance Assessment Literature and Investigation of Current Practices in Predoctoral Dental Education." Journal of Dental Education 72(12): 1405-1435.
	In this article, the Task Force oil Student Outcomes Assessment of the American Dental Education Association's Commission on Change and Innovation in Dental Education describes the current status of student outcomes assessment in U.S. dental education. This review is divided into six sections. The first summarizes the literature on assessment of dental students' performance. Section two discusses catalysts, with a focus on problem-based learning, for development of new assessment methods, while the third section presents several resources and guides that can be used to inform selection of assessment techniques for various domains of competence. The fourth section describes the methodology and results of a 2008 survey of current assessment, practices in U.S dental schools. In the fifth section, findings from this survey are discussed within the context of compentency-based education, the educational model for the predoctoral curriculum endorsed by the American Dental Education Association and prescribed by the Commission on Dental Accreditation. The article concludes With a summary of assessments recommended as optimal strategies to measure three components of professional competence based on the triangulation model. The survey of assessment practices in predoctoral education was completed by 931 course directors, representing 45 percent of course directors, nationwide. from fifty-three of the fifty-six U.S. dental schools. Survey findings indicate that five traditional mainstays of student performance evaluation, multiple-choice testing, lab practicals. daily grades, clinical competency exams, and procedural requirements-still comprise the primary assessment tools in dental education. The survey revealed that a group of newer, assessment techniques. although frequently identified as best practices in the literature and commonly used in other areas of health professions education. are rarely employed in predoctoral dental education.

Alcaraz, K. I., et al. (2016). "The ConNECT Framework: a model for advancing behavioral medicine science and practice to foster health equity." Journal of Behavioral Medicine: 1-16.
	Health disparities persist despite ongoing efforts. Given the United States’ rapidly changing demography and socio-cultural diversity, a paradigm shift in behavioral medicine is needed to advance research and interventions focused on health equity. This paper introduces the ConNECT Framework as a model to link the sciences of behavioral medicine and health equity with the goal of achieving equitable health and outcomes in the twenty-first century. We first evaluate the state of health equity efforts in behavioral medicine science and identify key opportunities to advance the field. We then discuss and present actionable recommendations related to ConNECT’s five broad and synergistic principles: (1) Integrating Context; (2) Fostering a Norm of Inclusion; (3) Ensuring Equitable Diffusion of Innovations; (4) Harnessing Communication Technology; and (5) Prioritizing Specialized Training. The framework holds significant promise for furthering health equity and ushering in a new and refreshing era of behavioral medicine science and practice. © 2016 Springer Science+Business Media New York

Alexander, J. A., et al. (2012). "Midterm observations and recommendations from the evaluation of the AF4Q initiative." The American journal of managed care 18(6 Suppl): s126-132.
	To offer midterm observations and recommendations based on how Aligning Forces for Quality (AF4Q) alliances are faring in their journey toward improving healthcare quality at the community level. This study used a mixed method design. Longitudinal evaluation data to date were analyzed, including results from multiple surveys, qualitative analysis of key informant interviews, review of secondary documents and analysis of secondary data, and ongoing tracking of the activities of the 16 participating alliances. The observations and recommendations are based on consensus achieved by the AF4Q evaluation team investigators after in-depth iterative discussions. Six formative observations are identified and discussed: (1) stakeholder support and participation has been maintained despite changes in economic and political environments; (2) progress on program goals has been slow; (3) the "alignment" in the AF4Q initiative has been slow to materialize; (4) the AF4Q initiative has established a productive network of peer communities; (5) the impact of the AF4Q initiative, and the time to observe impact, vary by community, based on history and context; and (6) sustainability is the major future challenge for the AF4Q initiative. Multi-stakeholder alliances' efforts to improve quality should be viewed as "pieces of the health reform puzzle" rather than stand-alone solutions. As healthcare reform is challenged politically, alliances can practice the bipartisanship that focuses conversation on what is good for the community and how best to achieve community goals amid a potential sea of change in both federal and state policy and funding.

Alexander, L., et al. (2009). "Building capacity without disrupting health services: public health education for Africa through distance learning." Human Resources for Health 7: 8.
	The human resources crisis in Africa is especially acute in the public health field. Through distance education, the School of Public Health of the University of the Western Cape, South Africa, has provided access to master's level public health education for health professionals from more than 20 African countries while they remain in post. Since 2000, interest has increased overwhelmingly to a point where four times more applications are received than can be accommodated. This home-grown programme remains sensitive to the needs of the target learners while engaging them in high-quality learning applied in their own work contexts. This brief paper describes the innovative aspects of the programme, offering some evaluative indications of its impact, and reviews how the delivery of text-led distance learning has facilitated the realization of the objectives of public health training. Strategies are proposed for scaling up such a programme to meet the growing need in this essential area of health human resource capacity development in Africa.

Alexander, S., et al. (2011). "Implementation of Customized Health Information Technology in Diabetes Self Management Programs." Clinical Nurse Specialist 25(2): 63-70.
	Purpose: The project was a nurse-led implementation of a software application, designed to combine clinical and demographic records for a diabetes education program, which would result in secure, long-term record storage. Background/Rationale: Clinical information systems may be prohibitively expensive for small practices and require extensive training for implementation. A review of the literature suggests that the use of simple, practice-based registries offer an economical method of monitoring the outcomes of diabetic patients. Project Description: The database was designed using a common software application, Microsoft Access. The theory used to guide implementation and staff training was Rogers' Diffusion of Innovations theory (1995). Outcomes: Outcomes after a 3-month period included incorporation of 100% of new clinical and demographic patient records into the database and positive changes in staff attitudes regarding software applications used in diabetes self-management training. These objectives were met while keeping project costs under budgeted amounts. Conclusions: As a function of the clinical nurse specialist (CNS) researcher role, there is a need for CNSs to identify innovative and economical methods of data collection. The success of this nurse-led project reinforces suggestions in the literature for less costly methods of data maintenance in small practice settings. Ongoing utilization and enhancement have resulted in the creation of a robust database that could aid in the research of multiple clinical issues. Implications: Clinical nurse specialists can use existing evidence to guide and improve both their own practice and outcomes for patients and organizations. Further research regarding specific factors that predict efficient transition of informatics applications, how these factors vary according to practice settings, and the role of the CNS in implementation of such applications is needed.

Alexopoulos, E. C. and M. Geitona (2009). "Self-Rated Health: Inequalities and Potential Determinants." International Journal of Environmental Research and Public Health 6(9): 2456-2469.
	Understanding social inequalities in health is of great importance; it provides the conceptual frame for investigating the social factors that affect health, together with empirical evidence for improving population health. Individual and socioeconomic data, disease related conditions and self rated health (SRH) ratings were collected from a representative sample of 1,000 participants in order to study health inequalities in Greece. 20.8% of men and 37.2% of women reported poor health status. Significant inequalities in SRH were observed. Strong associations of poor SRH with gender, age, insurance coverage and chronic diseases were identified. Social insurance scheme captured partly the effects of educational level, income and residence area in SRH in multivariate analysis. Respondents under chronic treatment and those suffering from cardiovascular, musculoskeletal and neurological/psychiatric disorders exhibited the highest risk of reporting poor SRH. Our findings provide decision-makers with insights into how to manage health inequalities by prioritizing preventive measures and consequently, progress towards the fair distribution of healthcare resources.

Alfieri, J., et al. (2012). "Development and Impact Evaluation of an E-Learning Radiation Oncology Module." International Journal of Radiation Oncology Biology Physics 82(3): E573-E580.
	Purpose: Radiation oncologists are faced with the challenge of irradiating tumors to a curative dose while limiting toxicity to healthy surrounding tissues. This can be achieved only with superior knowledge of radiologic anatomy and treatment planning. Educational resources designed to meet these specific needs are lacking. A web-based interactive module designed to improve residents' knowledge and application of key anatomy concepts pertinent to radiotherapy treatment planning was developed, and its effectiveness was assessed. Methods and Materials: The module, based on gynecologic malignancies, was developed in collaboration with a multidisciplinary team of subject matter experts. Subsequently, a multi-centre randomized controlled study was conducted to test the module's effectiveness. Thirtysix radiation oncology residents participated in the study; 1920 were granted access to the module (intervention group), and 17 in the control group relied on traditional methods to acquire their knowledge. Pretests and posttests were administered to all participants. Statistical analysis was carried out using paired t test, analysis of variance, and post hoc tests. Results: The randomized control study revealed that the intervention group's pretest and post-test mean scores were 35% and 52%, respectively, and those of the control group were 37% and 42%, respectively. The mean improvement in test scores was 17% (p < 0.05) for the intervention group and 5% (p = not significant) for the control group. Retrospective pretest and post-test surveys showed a statistically significant change on all measured module objectives. Conclusions: The use of an interactive e-learning teaching module for radiation oncology is an effective method to improve the radiologic anatomy knowledge and treatment planning skills of radiation oncology residents. (C) 2012 Elsevier Inc.

Al-Hadithy, N. and S. Ghosh (2013). "Smartphones and the plastic surgeon." Journal of Plastic Reconstructive and Aesthetic Surgery 66(6): E155-E161.
	Surgical trainees are facing limited training opportunities since the introduction of the European Working Time Directive. Smartphone sales are increasing and have usurped computer sales for the first time. In this context, smartphones are an important portable reference and educational tool, already in the possession of the majority of surgeons in training. Technology in the palm of our hands has led to a revolution of accessible information for the plastic surgery trainee and surgeon. This article reviews the uses of smartphones and applications for plastic surgeons in education, telemedicine and global health. A comprehensive guide to existing and upcoming learning materials and clinical tools for the plastic surgeon is included. E-books, podcasts, educational videos, guidelines, work-based assessment tools and online logbooks are presented. In the limited resource setting of modern clinical practice, savvy plastic surgeons can select technological tools to democratise access to education and best clinical care. (C) 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Al-Hussaini, A. and A. Tomkinson (2016). "Exploring medical undergraduates' perceptions of the educational value of a novel ENT iBook: a qualitative study." Journal of Visual Communication in Medicine 39(1-2): 3-9.
	Undergraduate otolaryngology exposure is limited. It may be consolidated by the use of an iBook as a self-study tool. Following invitation to participate by email, five focus groups were formed, each consisting of six medical students (18 female, 12 male, median age 23 years). The focus group transcripts were imported to the qualitative data analysis software NVivo (QSR International, UK). The iBook was found to have a clear and consistent presentation, and a focused and user-friendly style, with reasonable interactivity and a good range of well-integrated media elements. It was, overall, perceived to be a valuable educational resource by the medical students.

Ali, M. K. and K. M. V. Narayan (2009). "The United States and global health: inseparable and synergistic? The Institute of Medicine's report on global health." Global Health Action 2: 6.
	In the wake of dynamic economic and political transitions worldwide, the Institute of Medicine recently released its report advocating investments in global health from the United States ( US). The expert panel reinforces the 'transnational and interdisciplinary' nature of global health research and practice as an endeavor 'to improve health and achieve greater equity for all people worldwide.' This report was judiciously timed given the growing recognition of global health, and is also acknowledged for incorporating themes that are particularly pertinent to the twenty-first century. New paradigms are introduced, denouncing the dichotomous distinction between rich and poor countries with the rapidly transitioning countries emerging as global powers, and affirming the need for models of respectful partnership and wider translation of science into practice. Cultivating sustainable partnerships and investing in the understanding and combat of diseases worldwide will become increasingly important for the US to maintain its global competitiveness, and may offer lessons in innovation, efficiency, and organization of institutions and human resources.

Alicata, D., et al. (2016). "Telemental Health Training, Team Building, and Workforce Development in Cultural Context: The Hawaii Experience." Journal of Child and Adolescent Psychopharmacology 26(3): 260-265.
	Objective: The goal of the University of Hawaii (UH) child and adolescent psychiatry telemental health (TMH) program is to train child and adolescent psychiatry fellows to provide behavioral health services for the children of Hawaii and the Pacific Islands in the cultural context of their rural communities using interactive videoteleconferencing (IVTC). The training experience balances learning objectives with community service. Learning objectives include: Understanding mental health disparities in rural communities, leveraging community resources in ongoing treatment, providing culturally effective care, and improving health care access and delivery through TMH service research and evaluation. Methods: We describe the UH experience. Several UH faculty are experienced with IVTC technology. They are triple-board trained, are recognized for their research in program evaluation and mental health disparities, and are committed to serving Hawaii's rural communities. We demonstrate the role of TMH in linking children and their families living in rural communities with multiple mental health treatment providers. The service-learning curriculum and a unique collaboration with Mayo Clinic provide the opportunity to examine the role of TMH in global service, and training, education, and research. Results: TMH provides direct services to patients and consultation on Hawaii Island and Maui County. The collaboration with the Mayo Clinic brings further consultation in complex diagnostics, pharmacogenomics, and cross-cultural psychiatry. A curriculum provides trainees experience with IVTC with the goal of potential recruitment to underserved rural communities. The TMH program at UH is unique in its team building and workforce development by joining multiple entities through IVTC and translating expertise from the Mayo Clinic to rural communities, and strengthening collaboration with local child and adolescent psychiatrists, and primary care and other mental health providers. Conclusions: The UH psychiatry program is a model program to develop an expert mental health workforce in cultural context for children living in rural communities.

Alikhan, A., et al. (2010). "Podcasting in dermatology education." Journal of Dermatological Treatment 21(2): 73-79.
	Background: Podcasting is a relatively new technology, which allows users to subscribe to audio/video broadcasts online, download new ones, and transfer to their MP3 devices. Studies in medical and dental schools have demonstrated that podcasting is an effective learning method. Objective: To discuss the history, strengths, and weaknesses of the dermatology-related podcasts available for download. Methods: An iTunes search was performed, and five dermatology-related podcasting subscriptions were accessed; the previous 10 podcasts in each subscription were assessed to compile an overall picture. Authors listened to all podcasts, evaluated them independently, then shared their evaluations to optimally capture details. Results: Each of the podcasting services had its own strengths and weaknesses. While some were targeted towards practicing physicians, others were targeted to patients and medical students. Furthermore, none of the services updated at a regular, timely interval. Our analysis was limited to podcasts in the English language. We did not assess the accuracy of the content of the podcasts. Conclusion: Podcasting allows a truly mobile educational resource, one that could benefit dermatologists. Prestigious journals and large institutions should become more involved in developing informative, evidence-based podcasts at regular intervals. Videocasting offers the possibility of viewing procedures. Conferences are also prime ground for podcasts. Improved regulation and increased interest (from large organizations and institutions) will be crucial to the future of podcasting.</.

Alimi, M. and V. Rahimi-Movaghar (2012). "Biographical sketch: Nosrat Ollah Ameli, MB, ChB (Hons), ChM (Birm), FICS, FRCS (Eng)." British Journal of Neurosurgery 26(5): 630-636.
	Nosrat Ollah Ameli (1913-2010) was one of the pioneers in Iranian neurosurgery. After training in England in the 1950s, Ameli returned to his country to found the Darioush Kabir Hospital, where he started the first neurosurgical ward in collaboration with Prof. E. Samiy. Here he applied his genius and innovation to develop unique approaches to the management of challenging neurosurgical techniques, in the context of limited resource available at that time. He started the training of neurosurgeons in Iran. He was internationally recognised being elected as a vice president of the World Federation of Neurosurgical Societies (WFNS). His efforts extended beyond neurosurgery to many other fields. He published extensively in international peer reviewed medical journals around the world and contributed to the foundation of Acta Medica Iranica journal, the first scientific medical journal in English published by Tehran University of Medical Sciences. His efforts to improve medical education in Iran continued even through his years of retirement. This article recounts Nosrat Ollah Ameli's many contributions to Iran's medical education as well as his achievements as a neurosurgeon.

Alinier, G. (2007). "A typology of educationally focused medical simulation tools." Medical Teacher 29(8): E243-E250.
	Background: The concept of simulation as an educational tool in healthcare is not a new idea but its use has really blossomed over the last few years. This enthusiasm is partly driven by an attempt to increase patient safety and also because the technology is becoming more affordable and advanced. Aims: Simulation is becoming more commonly used for initial training purposes as well as for continuing professional development, but people often have very different perceptions of the definition of the term simulation, especially in an educational context. This highlights the need for a clear classification of the technology available but also about the method and teaching approach employed. The aims of this paper are to discuss the current range of simulation approaches and propose a clear typology of simulation teaching aids. Method: Commonly used simulation techniques have been identified and discussed in order to create a classification that reports simulation techniques, their usual mode of delivery, the skills they can address, the facilities required, their typical use, and their pros and cons. Results: This paper presents a clear classification scheme of educational simulation tools and techniques with six different technological levels. They are respectively: written simulations, three-dimensional models, screen-based simulators, standardized patients, intermediate fidelity patient simulators, and interactive patient simulators. This typology allows the accurate description of the simulation technology and the teaching methods applied. Thus valid comparison of educational tools can be made as to their potential effectiveness and verisimilitude at different training stages. Conclusions: The proposed typology of simulation methodologies available for educational purposes provides a helpful guide for educators and participants which should help them to realise the potential learning outcomes at different technological simulation levels in relation to the training approach employed. It should also be a useful resource for simulation users who are trying to improve their educational practice.

Alinier, G. and A. Platt (2014). "International overview of high-level simulation education initiatives in relation to critical care." Nursing in Critical Care 19(1): 42-49.
	The use of simulation in health care education has become very topical across all professions and specialties in order to improve patient safety and quality of care. In the last decade, the adoption of more realistic simulation-based teaching methodologies, which serves as a bridge between the acquisition and application of clinical skills, knowledge, and attributes, has been accompanied by the development of a multitude of international and national simulation societies. These serve as important exchange fora for educators, clinicians, researchers, and engineers who desire to learn and share their experience and knowledge around simulation-based education. Several countries have derived their own strategy in order to promote the use of such training methodology. Current key national strategies will be presented in this paper alongside a discussion of their expected impact. Various approaches have been adopted and each has their own place and the potential to be adopted by other nations depending on their political, economic or even geographic context. Within the critical care arena, simulation has generated considerable interest and there is a growing evidence base for its use as a learning and teaching strategy within this environment. A number of critical care-related associations and societies are now recognizing simulation as an appropriate pedagogical approach and acknowledging its potential to improve patient care and clinical outcomes. Its implementation should be carefully considered to ensure that developments are based on current best educational practice to maximize the efficiency of these educational interventions. © 2013 British Association of Critical Care Nurses.

Al-Iryani, B., et al. (2013). "Process evaluation of school-based peer education for HIV prevention among Yemeni adolescents." Sahara J 10(1): 55-64.
	In 2005, a survey was conducted among all the 27 high schools of Aden, which revealed low levels of knowledge on major prevention measures, and a high level of stigma and discrimination towards people living with HIV (PLWH). The results served as a baseline for implementing a school-based peer education intervention for HIV prevention in the 27 schools of Aden. In 2008, and after 3 years of implementation, a quasi-experimental evaluation was conducted, which revealed that the peer education intervention has succeeded in improving HIV knowledge and skills; and in decreasing stigmatization of PLWH. This process evaluation aims to give a deeper understanding of the quasi-experimental evaluation which was conducted in the 27 high schools of Aden, and to highlight the factors that facilitated or inhibited school peer education in such a conservative Muslim setting. Qualitative methodologies were pursued, where 12 focus group discussions and 12 in-depth interviews were conducted with peer educators, targeted students, school principals, social workers, and parents of peer educators. Results revealed that school-peer education was well received. There was an apparent positive effect on the life skills of peer educators, but the intervention had a lesser effect on targeted students. Key enabling factors have been the high quality of training for peer educators, supportive school principals, and acceptance of the intervention by parents. These findings are important for improving the life skills and peer education intervention at the school level, and in better planning and implementation of life skills and peer programmes at a national scale. © 2013 Copyright 2013 Buthaina Al-Iryani, Huda Basaleem, Khaled Al-Sakkaf, Gerjo Kok, Bart van den Borne. Published by Taylor & Francis.

Al-Khafaji, A. and S. M. Cho (2007). "Rapid response system: Let's not get carried away! [1]." Critical Care Medicine 35(9): 2235.
	
Al-Khaldi, Y. M. and A. I. Al-Sharif (2002). "Availability of resources of diabetic care in primary health care settings in Aseer region, Saudi Arabia." Saudi Medical Journal 23(12): 1509-1513.
	Objective: The objective of this study is to evaluate the availability of resources of diabetes care in primary health care settings in Aseer region, Southwest, Kingdom of Saudi Arabia. Methods: This study was conducted during September 2001 by distributing a questionnaire to all technical directors of primary health care centers (PHCCs) in Aseer region. The questionnaire, designed by the authors, contained 6 sections that dealt with the necessary structures of diabetic care in the region in addition to the data base of PHCC such as served population, distance from the hospital, and total working physicians and nurses at the PHCC. The data from the questionnaire was entered and analyzed using Statistical Package for Social Sciences. Results: Two hundred and forty-two PHCC technical directors responded to the questionnaire. Total served population by PHCC was 970,306 individuals. Total working physicians were 391 and nurses were 902. Diabetics represented 2.7% of the total served population. More than 90% of PHCCs have diabetic files, registers, appointment system and protocol for diagnosis and treatment of diabetes. Oral hypoglycemic agents were always available at 55% of PHCCs while metformin was not available at 52% of PHCCs. Diabetic identification cards were available in 80.4% of PHCCs while the health education means were less available, except for health education programs was available at 97.5% of PHCCs. At least, 40% of PHCCs were provided financially or by different means of health education through community health committees. Conclusion: This study revealed that resource items for diabetic care are inadequate in particular drugs and laboratory facilities. Establishment of a diabetes committee in Aseer region is a priority in order to manage such shortages and to plan, supervise and coordinate the diabetic care in the region.

Al-Khatib, I. A., et al. (2015). "Public perception of hazardousness caused by current trends of municipal solid waste management." Waste Management 36: 323-330.
	Municipal solid waste (MSW) piling up is becoming a serious problem in all developing countries (DC) as a result of inequitable waste collection and treatment. Citizens' collaboration is partly based on understanding their views and their active involvement in MSW planning; on the other hand the assessment of the perception of hazardousness related with MSW is considered rather important as well since the identification of the weak points of the applied MWM strategy is eased and the level of required training is determined. Researchers implemented a case study in the West Bank (WB) and Gaza Strip (GS) regions of Palestine, taking into consideration previous researches in other developing countries. They reached to safe and useful conclusions regarding the parameters which mean the greatest in the waste management field as far as DC are concerned. Lack of skilled manpower, irregular collection services, inadequate equipment used for waste collection, inadequate legal provisions, and resource constraints are additional factors that are confirmed to be challenging the waste management scenarios in all DCs today. The research takes those factors under consideration but focuses on the educational gap and the results revealed interesting trends a significant relationship between respondent's educational attainment and their awareness of hazardous waste (hazard perception); the results will indicate the measure taking required to avoid accidents occurred in those regions (burns from toxics, cuts from sharps, etc). National policy and legislation development based on the research outcomes will ensure equitable and accessible services are in place in order to move towards a healthier environment. Specialized health education and training programs on national scale are also needed to enhance awareness on hazardous waste. (C) 2014 Elsevier Ltd. All rights reserved.

Alkraiji, A., et al. (2013). "Barriers to the widespread adoption of health data standards: An exploratory qualitative study in tertiary healthcare organizations in Saudi Arabia." Journal of Medical Systems 37(2).
	Although health data standards are perceived to be the essential solution for interoperability barriers within medical IT systems, the level of adoption of those standards still remains frustratingly low. Little is known about the barriers facing their adoption within the healthcare organizations context. In addressing this gap in the literature, based on IT related standards adoption theories such as Diffusion of Innovation Theory and the theories surrounding the Economics of Standards, a qualitative multiple-case study was undertaken in Saudi Arabia to investigate those barriers. The results exposed that few standards were adopted because of four broad reasons, managerial, technical, educational and governmental. While some of the findings can be rooted to those related standards theories, others can be underpinned through the normative literature. Core barriers are the lack of a national regulator and a data exchange plan, and the lack of an adequate policy regarding medical IT systems and information management and national healthcare system; also important are technical barriers and the switching costs to the standards. The outcome of this study can be used in forming effective interventions when planning to use health data standards and, in particular those in developing countries. © 2013 Springer Science+Business Media New York.

Al-Kubaisi, N. J., et al. (2010). "Knowledge, attitudes and practices of primary health care physicians towards evidence-based medicine in Doha, Qatar." Eastern Mediterranean Health Journal 16(11): 1189-1197.
	Physicians worldwide are being encouraged to apply evidence-based medicine (EBM) to improve their clinical care. A cross-sectional questionnaire study was carried to determine the knowledge, attitudes and practices regarding EBM among 182 primary care physicians in Doha, Qatar. The current promotion of EBM was welcomed by most physicians (98.4%). While 92.2% had access to the Internet, this was mostly at home. The major perceived barriers to practising EBM in primary care were lack of free personal time (75.3%), limited resources and facilities (62.6%), no library in the locality (61.0%) and lack of training workshops and courses (61.0%). There was a statistically significant association between years since graduation and welcoming the EBM concept as well as with frequency of reading journals.

Allaire, A. S., et al. (2011). "Barriers and facilitators to the dissemination of DECISION+, a continuing medical education program for optimizing decisions about antibiotics for acute respiratory infections in primary care: a study protocol." Implementation Science 6: 3.
	BACKGROUND: In North America, acute respiratory infections are the main reason for doctors' visits in primary care. Family physicians and their patients overuse antibiotics for treating acute respiratory infections. In a pilot clustered randomized trial, we showed that DECISION+, a continuing medical education program in shared decision making, has the potential to reduce the overuse of antibiotics for treating acute respiratory infections. DECISION+ learning activities consisted of three interactive sessions of three hours each, reminders at the point of care, and feedback to doctors on their agreement with patients about comfort with the decision whether to use antibiotics. The objective of this study is to identify the barriers and facilitators to physicians' participation in DECISION+ with the goal of disseminating DECISION+ on a larger scale.
METHODS/DESIGN: This descriptive study will use mixed methods and retrospective and prospective components. All analyses will be based on an adapted version of the Ottawa Model of Research Use. First, we will use qualitative methods to analyze the following retrospective data from the pilot study: the logbooks of eight research assistants, the transcriptions of 15 training sessions, and 27 participant evaluations of the DECISION+ training sessions. Second, we will collect prospective data in semi-structured focus groups composed of family physicians to identify barriers and facilitators to the dissemination of a future training program similar to DECISION+. All 39 family physicians exposed to DECISION+ during the pilot project will be eligible to participate. We will use a self-administered questionnaire based on Azjen's Theory of Planned Behaviour to assess participants' intention to take part in future training programs similar to DECISION+.
DISCUSSION: Barriers and facilitators identified in this project will guide modifications to DECISION+, a continuing medical education program in shared decision making regarding the use of antibiotics in acute respiratory infections, to facilitate its dissemination in primary care on a large scale. Our results should help continuing medical educators develop a continuing medical education program in shared decision making for other clinically relevant topics. This will help optimize clinical decisions in primary care.

Allen, M., et al. (2010). "Medical education needs to teach health technology assessment." Medical Teacher 32(1): 62-64.
	Health technology assessment evaluates the effects of drugs, devices, procedures and policies on patients and the healthcare system. Because of its potential to optimize healthcare resources and patient care, health technology assessment is becoming increasingly important in healthcare systems at national and local levels. This article provides an explanation of health technology assessment and an example of its application in residency education.

Allen, M. C. (2002). "Preterm outcomes research: A critical component of neonatal intensive care." Mental Retardation and Developmental Disabilities Research Reviews 8(4): 221-233.
	While early preterm outcome studies described the lives of preterm survivors to justify the efforts required to save them, subsequent studies demonstrated their increased incidence of cerebral palsy, mental retardation, sensory impairments, minor neuromotor dysfunction, language delays, visual-perceptual disorders, learning disability and behavior problems compared to fullterm controls. Because infants born at the lower limit of viability require the most resources and have the highest incidence of neuro-developmental disability, there is concern that resources have gone primarily to neonatal intensive care and are not available for meeting the followup, health, educational and emotional needs of these fragile infants and their families. Despite many methodological concerns, preterm outcome studies have provided insight into risk factors for and causes of CNS injury in preterm infants. Nevertheless, it remains difficult to predict neuro-developmental outcome for individual preterm infants. Perinatal and neonatal risk factors are inadequate proxies for neurodevelopmental disability. Recent randomized controlled trials with one to five year neurodevelopmental followup have provided valuable information about perinatal and neonatal treatments. Recognizing adverse longterm neurodevelopmental effects of pharmacological doses of postnatal steroids is a sobering reminder of the need for longterm neurodevelopmental followup in all neonatal randomized controlled trials. Ongoing longterm preterm neurodevelopmental studies, analysis of changes in outcomes over time and among centers, and evaluation of the longterm safety, efficacy and effectiveness of many perinatal and neonatal management strategies and proposed neuroprotective agents are all necessary for further medical and technological advances in neonatal intensive care. (C) 2002 Wiley-Liss, Inc.

Allen, S., et al. (2014). "Targeting improvements in patient safety at a large academic center: an institutional handoff curriculum for graduate medical education." Academic Medicine 89(10): 1366-1369.
	PROBLEM: Handoffs are an integral component of patient care, and the number of handoffs has increased as a result of duty hours restrictions for resident physicians. A structured handoff curriculum improves accuracy and has been shown to decrease medical errors. A standardized approach across all specialties is lacking in the published literature. The authors discuss the development and implementation of an institution-wide handoff curriculum for incoming first-year residents.
APPROACH: An Innovation in Graduate Medical Education committee, including faculty from multiple specialties, identified an educational deficiency in handoffs and selected this as the target for the educational innovation. Meetings were held to develop and implement an extensive handoff curriculum for incoming first-year residents. The designed curriculum included large- and small-group sessions, and a specialty-specific observed simulated handoff experience. The authors analyzed participants' pre- and postsurveys using descriptive statistics.
OUTCOMES: One hundred and twenty-four participants attended the formalized handoff training day. Following training, residents recognized that dedicated time for verbal exchange, templates for accessing and recording information, interactive handoffs giving priority to ill patients, and highlighting action items were most important for effective handoff.
NEXT STEPS: Both undergraduate and graduate medical education curricula need to develop formalized training and methods to assess competencies in handoffs. Training incoming residents is a logical starting place, but programs should be systematically disseminated across all specialties, from residents to faculty, in order to be effectively integrated into the culture of an institution.

Al-Moamary, M. S., et al. (2010). "Innovations in medical internship: benchmarking and application within the King Saud bin Abdulaziz University for Health Sciences." Education for Health 23(1): 367.
	INTRODUCTION: While the medical internship (MI) has evolved in some countries into competency-based training with innovative tools for assessment and feedback, the traditional MI is still the norm in many countries.
AIM: To describe recent advances in the MI in several countries, to discuss the current MI situation in Saudi Arabia as an example of a country that applies a traditional MI, and to present a Framework for Medical Interns' Competencies (FMIC) implemented within the King Saud bin Abdulaziz University for Health Sciences (KSAU-HS).
METHODS: Common electronic databases were searched for the years 1990 to 2008 under keywords related to medical internship education. Information on curricula designed for medical interns or junior doctors in selected countries was obtained by searching relevant websites. At the KSAU-HS, the FMIC was created by first building the case for the urgent need for revising the MI and adapting international approaches to the KSA's needs, followed by dialogue among faculty and leaders, planning, coordination and execution of the framework.
RESULTS: Two trends were identified in the recent evolution of the MI. In North America, the first postgraduate year now serves the traditional purpose of the MI. Australia and the United Kingdom have embedded the MI within junior doctor training. These innovative curricula have in common a focus on the domains of medical knowledge, clinical practice, professionalism and communication skills. The FMIC applies innovative principles during the MI years customized to the local medical education setting.
CONCLUSION: The evolution in medical education and healthcare systems worldwide has necessitated innovations in the MI. The FMIC is a model whereby innovative curriculum was introduced to enhance the outcomes of the MI in a country that has applied a traditional MI.

Al-Nood, H., et al. (2004). "Prevalence of the sickle cell gene in Yemen: A pilot study." Hemoglobin 28(4): 305-315.
	To determine the prevalence of the sickle cell gene (beta(S)) in Yemen and amongst people from different regions of the country living in the capital, Sana'a City, cord blood samples from 1,500 consenting mothers were collected from hospitals in Sana'a City between July and December 2001. The names and original homes of the parents were recorded. Cation exchange high performance liquid chromatography (HPLC) analysis was used for screening, while isoelectric focusing (IEF) and DNA polymerase chain reaction (PCR) were used to confirm Hb S [beta6(A3)Glu-->Val]. Thirty-three samples were found to show Hb FAS, giving an overall likely beta(S) gene frequency of 0.011. The beta(S) gene frequency varied with the part of the country from which the parents came. Amongst people from Taiz and Haja in the west, the gene frequency was more than 0.04, but less than 0.004 amongst people from Ibb, adjacent to the governorate (administrative division) of Taiz. Of 66 chromosomes from babies carrying the beta(S) gene, only 1.5% also carried the -158 (C-->T) (G)gamma-globin gene XmnI site compared with 16.1% of 168 chromosomes from babies without the beta(S) gene from the same regions. The results of this study show a higher beta(S) gene frequency in the western coastal part of Yemen than in the central mountainous and eastern desert areas. The incidence of affected homozygous births may therefore reach 20/10,000 in certain areas, although it is much lower than this overall. Limited health resources can best be invested in developing a program of education, screening and health care, initially prioritizing those communities residing in the western areas of Yemen with the highest beta(S) gene frequency.

Alpay, L., et al. (2011). "An empowerment-based approach to developing innovative e-health tools for self-management." Health Informatics Journal 17(4): 247-255.
	E-health is seen as an important technological tool in achieving self-management; however, there is little evidence of how effective e-health is for self-management. Example tools remain experimental and there is limited knowledge yet about the design, use, and effects of this class of tools. By way of introducing a new view on the development of e-health tools dedicated to self-management we aim to contribute to the discussion for further research in this area. Our assumption is that patient empowerment is an important mechanism of e-health self-management and we suggest incorporating it within the development of self-management tools. Important components of empowerment selected from literature are: communication, education and health literacy, information, self-care, decision aids and contact with fellow patients. All components require skills of both patients and the physicians. In this discussion paper we propose how the required skills can be used to specify effective self-management tools. © 2011 The Author(s).

Alpert, J. M. (2015). "Evaluating the Content of Family Physician Websites in the United States." Journal for Healthcare Quality 37(5): 311-318.
	The Internet provides easier access to health information and has become a powerful resource for managing one's health. In addition to websites that provide general health information, physicians create personalized websites to give patients an overview of their practice. The purpose of this study was to evaluate characteristics of family physician websites to determine the type of content provided. Over 900 family physicians from the US News & World Reports' best doctors list were reviewed to determine if a website existed. Then, each website was measured against seven main categories: information about the practice, medical information provided, communication, functionality, links, advertisements, and advanced tools. Although the majority provided basic information, only 21.4% had a website and most failed to provide additional information such as medical education, staff details, and accepted insurance. Furthermore, most physician websites were devoid of web 2.0 applications, despite the popularity of more tech-savvy services such as booking online appointments, social networking platforms, and patient portals. Because patients are becoming more consumer-centric about their health, physicians must keep up with technology in order to match patient expectations and preferences. Doing so will help attract new patients and has the ability to enhance the patient-provider relationship.

Al-Shorbaji, N. (2008). "E-health in the Eastern Mediterranean Region: a decade of challenges and achievements." Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ihhiihhīyah li-sharq al-Mutawassi 14 Suppl: S157-173.
	
Altman, K. W., et al. (2005). "Changing impact of gastroesophageal reflux in medical and otolaryngology practice." Laryngoscope 115(7): 1145-1153.
	Objectives/Hypothesis. A major trend in gastroesophageal reflux disease (GERD) is an observed increased prevalence of the problem, with an associated burden on health care resources. There are relatively few objective reports of increasing prevalence of this disease, and there are no epidemiologic reports that discuss changing practice strategies in managing the disease. The clinical problem is of critical importance to practicing otolaryngologists, who manage the impact of GERD on diseases affecting the ear, nose, and throat. The hypothesis of this thesis is that 1) GERD is an increasing problem affecting outpatient office visits over time, and 2) the disease is increasingly managed with prescription pharmacotherapy. Study Design: Retrospective national medical database review using the National Ambulatory Medical Care Survey. Methods. Twelve years of data (1990-2001) were examined with visits weighted to provide U.S. estimates of care. Average annual frequencies and visit rates were calculated for total visits and by age, sex, race, and physician specialty. Selected issues in GERD treatment were also examined, including prescriptions and physician/patient counseling regarding stress management, tobacco abuse, and diet modification. Trends were reported based on changes in care across three time periods to satisfy statistical significance: 1990 to 1993, 1994 to 1997, and 1998 to 2001. Results. Between 1990 and 1993 and 1998 and 2001, there was a significant increase in U.S. ambulatory care visits for GERD, from a rate of 1.7 per 100 to 4.7 per 100. There were no significant changes in race, although there was a small trend toward increased GERD visits in the age group over 44 years old and in the male sex. Office visits to otolaryngologists increased from 89,000 to 421,000 between the time periods of 1990 to 1993 and 1998 to 2001. This also represented a percent increase in office encounters by otolaryngologists compared with visits by all specialties from 2.9% to 4.4%. Over the three time periods, there was a fall in prescriptions for histamine (H2) blockers from 58.1% to 20.7% of total prescriptions. Over the same three time periods, prescriptions of proton pump inhibitors increased from 13.2% to 64.6%. Physician recommendations for over the counter medications fell from 18.8% to 6.6%. Average annual counseling during ambulatory care visits for GERD was assessed for the period from 1998 to 2001 as follows: diet counseling was provided at 27.2% of encounters, tobacco cessation counseling was provided at 3.9%, and stress management was discussed at 3.9% Conclusions: During the 1990s, there was a substantial increase in the use of ambulatory care services for GERD. Although much of this increase was among the primary care community, otolaryngologists appeared to have an increasingly prominent role in the management of this disease. There have also been dramatic changes in physician prescribing patterns for GERD, with the emergence of the - predominant role of proton pump inhibitors. However, the use of physician counseling for lifestyle modification of factors known to affect GERD remains very low. The increasing impact of GERD on physician practice emphasizes the importance of both physician and patient education in the delivery of health care related to this disease.

Altuwaijri, M. M. (2010). "Supporting the Saudi e-health initiative: The master of health informatics programme at KSAU-HS." Eastern Mediterranean Health Journal 16(1): 119-124.
	The health sector in Saudi Arabia has made significant progress in recent decades with some hospitals receiving international recognition. However, this has not been accompanied by advancements in the field of health informatics, which are necessary for hospitals to achieve certain objectives such as enhancing the quality of health care and reducing the time and cost of health care delivery. In this paper we describe the status of e-health in Saudi Arabia, along with some of the national e-health initiatives such the establishment of a new Master of Health Informatics degree programme and the Saudi Association for Health Informatics. A proposal for an e-health plan in Saudi Arabia is also discussed.

Alverson, D. C., et al. (2004). "Distributed interactive virtual environments for collaborative experiential learning and training independent of distance over Internet2." Studies in Health Technology & Informatics 98: 7-12.
	Medical knowledge and skills essential for tomorrow's healthcare professionals continue to change faster than ever before creating new demands in medical education. Project TOUCH (Telehealth Outreach for Unified Community Health) has been developing methods to enhance learning by coupling innovations in medical education with advanced technology in high performance computing and next generation Internet2 embedded in virtual reality environments (VRE), artificial intelligence and experiential active learning. Simulations have been used in education and training to allow learners to make mistakes safely in lieu of real-life situations, learn from those mistakes and ultimately improve performance by subsequent avoidance of those mistakes. Distributed virtual interactive environments are used over distance to enable learning and participation in dynamic, problem-based, clinical, artificial intelligence rules-based, virtual simulations. The virtual reality patient is programmed to dynamically change over time and respond to the manipulations by the learner. Participants are fully immersed within the VRE platform using a head-mounted display and tracker system. Navigation, locomotion and handling of objects are accomplished using a joy-wand. Distribution is managed via the Internet2 Access Grid using point-to-point or multi-casting connectivity through which the participants can interact. Medical students in Hawaii and New Mexico (NM) participated collaboratively in problem solving and managing of a simulated patient with a closed head injury in VRE; dividing tasks, handing off objects, and functioning as a team. Students stated that opportunities to make mistakes and repeat actions in the VRE were extremely helpful in learning specific principles. VRE created higher performance expectations and some anxiety among VRE users. VRE orientation was adequate but students needed time to adapt and practice in order to improve efficiency. This was also demonstrated successfully between Western Australia and UNM. We successfully demonstrated the ability to fully immerse participants in a distributed virtual environment independent of distance for collaborative team interaction in medical simulation designed for education and training. The ability to make mistakes in a safe environment is well received by students and has a positive impact on their understanding, as well as memory of the principles involved in correcting those mistakes. Bringing people together as virtual teams for interactive experiential learning and collaborative training, independent of distance, provides a platform for distributed "just-in-time" training, performance assessment and credentialing. Further validation is necessary to determine the potential value of the distributed VRE in knowledge transfer, improved future performance and should entail training participants to competence in using these tools.

Alyeshmerni, D., et al. (2014). "Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan." Rambam Maimonides Medical Journal 5(3): e0017.
	Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA), and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

Ambrose, J. A. (2014). "Do advances in technology in the catheterization laboratory for percutaneous coronary interventions negatively influence an operator's technique, decision making, and judgment?" Jacc: Cardiovascular Interventions 7(10): 1198-1199.
	
Amde, W. K., et al. (2014). "Building capacity to develop an African teaching platform on health workforce development: a collaborative initiative of universities from four sub Saharan countries." Human Resources for Health 12: 11.
	Introduction: Health systems in many low-income countries remain fragile, and the record of human resource planning and management in Ministries of Health very uneven. Public health training institutions face the dual challenge of building human resources capacity in ministries and health services while alleviating and improving their own capacity constraints. This paper reports on an initiative aimed at addressing this dual challenge through the development and implementation of a joint Masters in Public Health (MPH) programme with a focus on health workforce development by four academic institutions from East and Southern Africa and the building of a joint teaching platform. Methods: Data were obtained through interviews and group discussions with stakeholders, direct and participant observations, and reviews of publications and project documents. Data were analysed using thematic analysis. Case description: The institutions developed and collaboratively implemented a 'Masters Degree programme with a focus on health workforce development'. It was geared towards strengthening the leadership capacity of Health ministries to develop expertise in health human resources (HRH) planning and management, and simultaneously build capacity of faculty in curriculum development and innovative educational practices to teach health workforce development. The initiative was configured to facilitate sharing of experience and resources. Discussion: The implementation of this initiative has been complex, straddling multiple and changing contexts, actors and agendas. Some of these are common to postgraduate programmes with working learners, while others are unique to this particular partnership, such as weak institutional capacity to champion and embed new programmes and approaches to teaching. Conclusions: The partnership, despite significant inherent challenges, has potential for providing real opportunities for building the field and community of practice, and strengthening the staff and organizational capacity of participant institutions. Key learning points of the paper are: the need for long-term strategies and engagement; the need for more investment and attention to developing the capacity of academic institutions; the need to invest specifically in educational/teaching expertise for innovative approaches to teaching and capacity development more broadly; and the importance of increasing access and support for students who are working adults in public health institutions throughout Africa.

Ameh, N., et al. (2008). "Computer knowledge amongst clinical year medical students in a resource poor setting." African Health Sciences 8(1): 40-43.
	Objective: To study the computer knowledge and desires of clinical year medical students at one of the oldest and largest medical schools in Nigeria. Design: A survey using validated structured questionnaires. Setting: Medical school of Ahmadu Bello University, Zaria, Nigeria. Subjects: Two hundred and thirty seven clinical year (4(th), 5(th) and 6(th) years) medical students. Outcome measures: Computer knowledge, mode of acquiring computer knowledge, regular access to computer, desire for inclusion of computer training in curriculum. Results: One hundred twenty (50.6%) students had knowledge of computer technology and it use. Of these, 108 (90%) had no regular access to a computer and none owned a computer; only 32 (26.7%) were sufficiently familiar with computer tools to perform advanced tasks, but 72 (60%) were comfortable with word processing. Seventy two of the 120 students acquired their computer knowledge through self-learning efforts while 45 (37.5%) attended short periods of formal training. Overall, 45.7% of males and 64.5% of females had computer knowledge. The main reason for lack of computer knowledge was lack of time and lack of access to a computer. Eighty percent of all students would like computer education to be included in medical school curriculum. Conclusion: Knowledge and use of computers amongst clinical year medical students in this setting is low. It is important that computer education be taught to the students to enhance their ability to use electronic information and communicate more effectively using computer resources.

Ameh, S., et al. (2015). "Factors associated with appropriate home management of uncomplicated malaria in children in Kassena-Nankana district of Ghana and implications for community case management of childhood illness: a cross-sectional study." BMC Public Health 15: 10.
	Background: Home management of uncomplicated malaria (HMM) is now integrated into the community case management of childhood illness (CCM), an approach that requires parasitological diagnosis before treatment. The success of CCM in resource-constrained settings without access to parasitological testing significantly depends on the caregiver's ability to recognise malaria in children under five years (U5), assess its severity, and initiate early treatment with the use of effective antimalarial drugs in the appropriate regimen at home. Little is known about factors that influence effective presumptive treatment of malaria in U5 by caregivers in resource-constrained malaria endemic areas. This study examined the factors associated with appropriate HMM in U5 by caregivers in rural Kassena-Nankana district, northern Ghana. Methods: A cross-sectional household survey was conducted among 811 caregivers recruited through multistage sampling. A caregiver was reported to have practiced appropriate HMM if an antimalarial drug was administered to a febrile child in the recommended regimen (correct dose and duration for the child's age). Binary logistic regression was used to determine factors associated with appropriate HMM. Results: Of the 811 caregivers, 87% recognised the symptoms of uncomplicated malaria in U5, and 49% (n = 395) used antimalarial drugs for the HMM. Fifty percent (n = 197) of caregivers who administered antimalarial drugs used the appropriate regimen. In the multivariate logistic regression, caregivers with secondary (OR = 1.71, 95% CI: 1.03, 2.83) and tertiary (OR = 3.58, 95% CI: 1.08, 11.87) education had increased odds of practicing appropriate HMM compared with those with no formal education. Those who sought treatment in the hospital for previous febrile illness in U5 had increased odds of practicing appropriate HMM (OR = 2.24, 95% CI: 1.12, 4.60) compared with those who visited the health centres. Conclusions: Half of caregivers who used antimalarial drugs practiced appropriate HMM. Educational status and utilisation of hospitals in previous illness were associated with appropriate HMM. Health education programmes that promote the use of the current first line antimalarial drugs in the appropriate regimen should be targeted at caregivers with no education in order to improve HMM in communities where parasitological diagnosis of malaria may not be feasible.

Ament, B. H. L., et al. (2012). "Resources as a Protective Factor for Negative Outcomes of Frailty in Elderly People." Gerontology 58(5): 391-397.
	Background: Although frailty is often conceptualized in terms of deficits, the level of frailty can be perceived as a complex interplay between deficits and resources. Objective: We studied whether resources such as educational level, financial situation, and living-alone status moderate the negative effects of deficits on two potentially adverse consequences of frailty: self-perceived health and receiving professional care. Methods: Logistic regression analysis was performed with data from a cross-sectional survey, designed by the public health service in the south of the Netherlands. The questionnaire was completed by a representative sample of people aged 70 and over (n = 5,559). Interaction effects between deficits (multimorbidity, difficulty performing ADLs, psychological distress, loneliness) and resources (educational level, financial situation, living-alone status) were studied in relation to self-perceived health and receiving professional care. Results: We found that in males the effect of difficulty in performing ADLs on self-perceived health was modified by educational level (p < 0.05, indicating that difficulty in performing ADLs is more strongly related to moderate/bad self-perceived health for those with higher education). In females, the effect of psychological distress on self-perceived health was modified by educational level (p < 0.05, indicating that suffering from psychological distress is more strongly related to moderate/bad self-perceived health for those with higher education) and the effect of difficulty in performing ADLs on receiving professional care was modified by living-alone status (p < 0.05, indicating that difficulty in performing ADLs was more strongly related to receiving professional care for those women who lived alone). Conclusions: Resources moderate the impact of personal deficits on self-perceived health and receiving professional care. Some frail people seem to be more vulnerable as they lack resources such as a high level of education. This should be taken into account in deciding when elderly people are at risk of negative outcomes of frailty and is therefore important for health professionals and policy-makers. Copyright (C) 2012 S. Karger AG, Basel

Amin, A. N., et al. (2014). "Hospitalist Perspective on the Treatment of Skin and Soft Tissue Infections." Mayo Clinic Proceedings 89(10): 1436-1451.
	The prevalence of skin and soft tissue infections (SSTIs) has been increasing in the United States. These infections are associated with an increase in hospital admissions. Hospitalists play an increasingly important role in the management of these infections and need to use hospital resources efficiently and effectively. When available, observation units are useful for treating low-risk patients who do not require hospital admission. Imaging tools may help to exclude abscesses and necrotizing soft tissue infections; however, surgical exploration remains the principal means of diagnosing necrotizing soft tissue infections. The most common pathogens that cause SSTIs are streptococci and Staphylococcus aureus. Methicillin-resistant S aureus (MRSA) is a prevalent pathogen, and concerns are increasing regarding the unclear distinctions between community-acquired and hospital-acquired MRSA. Other less frequent pathogens that cause SSTIs include Enterococcus species, Escherichia coli, Klebsiella species, Enterobacter species, and Pseudomonas aeruginosa. Cephalexin and clindamycin are suitable options for infections caused by streptococcal species and methicillin-susceptible S aureus. The increasing resistance of S aureus and Streptococcus pyogenes to erythromycin limits its use in these infections, and better alternatives are available. Parenteral cefazolin, nafcillin, or oxacillin can be used in hospitalized patients with nonpurulent cellulitis caused by streptococci and methicillin-susceptible S aureus. When oral MRSA therapy is indicated, clindamycin, doxycycline, trimethoprim-sulfamethoxazole, or linezolid is appropriate. Vancomycin, linezolid, daptomycin, tigecycline, telavancin, and ceftaroline fosamil are intravenous options that should be used in MRSA infections that require patient hospitalization. In the treatment of patients with SSTIs, hospitalists are at the forefront of providing proper patient care that reduces hospital costs, duration of therapy, and therapeutic failures. This review updates guidelines on the management of SSTIs with a focus on infections caused by S aureus, particularly MRSA, and outlines the role of the hospitalist in the effective management of SSTIs. (C) 2014 Mayo Foundation for Medical Education and Research

Aminpour, F. (2012). "The influence of Iranian scientific journals in disseminating medical information." Journal of Research in Medical Sciences 17(2): 171-175.
	Background: Scientific journals are the most credible and updated information resources for valid information in the various fields of science and technology. The present study investigates the status of Iranian scientific journals in disseminating medical information to the world of science. Materials and Methods: Total 163 Iranian medical journals accredited by national medical journals commission of Iranian ministry of health and medical education were evaluated through a cross-sectional study. The results were represented in descriptive statistics in the form of table and chart. Results: The study showed that 89.6% of Iranian medical journals were covered by regional information databases. Web of Science database indexed 22 (13.5%) Iranian journals in the field of medical science. Only six (6.7%) journals were indexed by Medline. Fifty-eight (35.6%) journals were in English, 102 (62.6%) in Persian, and three (1.8%) were bilingual which published their articles both in Persian and English languages. The highest Impact factor belonged to Iranian Journal of Allergy Asthma and Immunology. Conclusions: Improving scientific credibility of Iranian scholarly journals and their influence in disseminating medical information calls for a precise scientific and executive administration in publishing standards and also in the quality of content.

Amoako-Sakyi, D. and H. Amonoo-Kuofi (2015). "Problem-based learning in resource-poor settings: lessons from a medical school in Ghana." BMC Medical Education 15: 221.
	Problem-based learning (PBL) is arguably one of the most important innovations in medical education in the last century. The evident benefits of PBL and the changing face of medicine and medical education have led many institutions including those in resource-poor settings to consider the adoption of PBL curricula. However, experts are uncertain about how successful PBL will be in such settings, as literature on the implementation of PBL in resource-poor settings appears to be inadequate. The University of Cape Coast is located in a resource-poor setting, however, its medical school has used PBL curriculum since 2007. In a descriptive prose, this article discusses the PBL implementation processes, the challenges faced, the mitigation strategies employed, and the lessons learned at University of Cape Coast School of Medical Sciences (UCCSMS). The arguments fall under the broad themes of curricular structure, resource constraints, faculty development, and assessment. The peculiar socioeconomic situation of Ghana, challenges in funding of tertiary education, and the resource implications of PBL provided the context for the arguments. It emerged out of the discussion that PBL has to be implemented as whole curriculum to be effective. Regular faculty development activities on PBL and the alignment of assessment methods with PBL also emerged as important issues in the discussion. The article argues that in spite of its cost implication, a PBL curriculum can be successfully implemented in resource-constrained settings.

Amoran, O. E., et al. (2012). "Determinants of intermittent preventive treatment of malaria during pregnancy (IPTp) utilization in a rural town in Western Nigeria." Reproductive Health 9: 8.
	Background: Malaria infection in pregnancy is a major risk factor for maternal and child death, and substantially increases the risk of miscarriage, stillbirth and low birthweight. The aim of this study therefore is to assess the prevalence and determinants of Intermittent preventive treatment of Malaria [IPTp] utilization by pregnant women in a rural town in Western Nigeria. Methods: This study is an analytical cross-sectional study. All pregnant women that were due for delivery and were attending the three primary health care center in Sagamu town, Nigeria within a 2 months period were recruited into the study. A semi-structured questionnaire was used to collect relevant information. Results: A total of 255 pregnant women were recruited into the study. The mean age of respondents was 28.07 +/- 5.12 years. The mean parity and booking age was 2.7 +/- 1.67 and 4.42 +/- 1.7 months respectively. The prevalence of Malaria attack in the last 3 months was 122(47.8%). Only 107/255 (40.4%) practice IPTp for malaria prevention during the current pregnancy, with only 14.6% of them taking the second dose during pregnancy as recommended. Chloroquine [27.1%] was the most frequently used medication for the treatment of Malaria in Pregnancy. Early booking age [OR = 1.11, C. I = 0.61-2.01], adverse last pregnancy outcome [OR = 1.23, C. I = 0.36-4.22], and parity [OR = 1.87, C. I = 0.25-16.09] were not statistically significantly associated with IPTp utilization. The only predictor of IPTp use was the knowledge of prophylaxis for malaria prevention [OR = 2.47, C. I = 1.06-3.52] using multivariate analysis. Conclusion: The study concludes that most women who attend ANC in rural areas in Nigeria do not receive IPTp as expected. A major determinant of utilization of IPTp among the study population was the knowledge of prophylaxis for malaria prevention. This study highlights the importance of health education of the pregnant women in increasing IPTp uptake despite the regular drug stock out at the facility level in rural areas in low resource countries.

Ananthapavan, J., et al. (2014). "Economics of Obesity - Learning from the Past to Contribute to a Better Future." International Journal of Environmental Research and Public Health 11(4): 4007-4025.
	The discipline of economics plays a varied role in informing the understanding of the problem of obesity and the impact of different interventions aimed at addressing it. This paper discusses the causes of the obesity epidemic from an economics perspective, and outlines various justifications for government intervention in this area. The paper then focuses on the potential contribution of health economics in supporting resource allocation decision making for obesity prevention/treatment. Although economic evaluations of single interventions provide useful information, evaluations undertaken as part of a priority setting exercise provide the greatest scope for influencing decision making. A review of several priority setting examples in obesity prevention/treatment indicates that policy (as compared with program-based) interventions, targeted at prevention (as compared with treatment) and focused upstream on the food environment, are likely to be the most cost-effective options for change. However, in order to further support decision makers, several methodological advances are required. These include the incorporation of intervention costs/benefits outside the health sector, the addressing of equity impacts, and the increased engagement of decision makers in the priority setting process.

Ancheta, I. B., et al. (2015). "One size does not fit all: cardiovascular health disparities as a function of ethnicity in Asian-American women." Applied Nursing Research 28(2): 99-105.
	Objective: Although few studies have examined cardiovascular disease in Asian-American subgroups separately, limited data in Asian Americans strongly suggest that some subgroups are at increased risk. The present study examined modifiable cardiovascular risk factor profiles as a function of Asian ethnicity. Methods: This descriptive cross-sectional pilot study recruited Asian-American women (N = 147) in northeast Florida including Cambodians (n = 39), Chinese (n = 36), Filipinos (n = 49), and Vietnamese (n = 23). Risk factors included blood pressure, body mass index, waist circumference and blood lipids. Results: Filipino participants (41%) had >= 4 risk factors compared to 21% Cambodian, 13% Vietnamese and 0% Chinese. The Chinese had significantly more participants (44%) with the absence of CVD risk factors compared to all other subgroups. Obesity rate (18%), mean BMI: 26 +/- 5 kg/m(2) and mean triglycerides (173 +/- 103 mg/dL) were highest in Filipinas (n = 49). The Chinese (n = 36) had a low rate (4%) of obesity with a mean BMI of 23 +/- 3 kg/m(2) and the least risk factors along with the lowest triglycerides (88 +/- 44 mg/dL). Cambodians (n = 39; BMI of 24 +/- 3 kg/m(2)) and Vietnamese (n = 23; BMI: 22 +/- 3 kg/m(2)) had low rates of obesity with comparable rates of unhealthy lipids and hypertension as the Filipinas. Conclusions: Modifiable CVD risk factor profiles significantly differed as a function of ethnicity supporting the premise that Asian-American women cannot be categorized as one group and the traditional "one size fits all" prevention or treatment of CVD risk factors should be re-considered. (C) 2014 Elsevier Inc. All rights reserved.

Anderko, L., et al. (2006). "The Midwest Nursing Centers Consortium Research Network: Translating Research Into Practice." Policy, Politics, & Nursing Practice 7(2): 101-109.
	Community nursing centers (CNCs) serve the health needs of culturally diverse populations that are often marginalized and likely to experience disparities in health. CNCs utilize innovative models of primary health care that blend traditional medical management with nursing case management and community-based health promotion strategies. This article describes the mission and activities of the Midwest Nursing Centers Consortium Research Network (MNCCRN), a practice-based research network (PBRN) funded by the Agency for Healthcare Research and Quality, and is one of only two federally funded nonphysician primary care PBRNs and the only PBRN in the United States comprising exclusively CNCs. The MNCCRN utilizes Advanced Practice Nurses to deliver primary health care with a particular emphasis on reducing health disparities. The MNCCRN has successfully established a multisite, multistate collaboration for community-based participatory research that will ultimately inform practice, education, and health policy. © 2006, Sage Publications. All rights reserved.

Andersen, O. S. and M. K. O'Banion (2010). "Medical Scientist Training Programs: federal funding offers support and drives innovation." Academic Medicine 85(10): 1559.
	
Anderson, B. L., et al. (2010). "Knowledge, Opinions, and Practice Patterns of Obstetrician-Gynecologists Regarding Their Patients' Use of Alcohol." Journal of Addiction Medicine 4(2): 114-121.
	Objective: To evaluate the evolution of fetal alcohol spectrum disorder prevention practices including awareness and use of recently published tools. Methods: Fellows of the American College of Obstetricians and Gynecologists were asked about their knowledge, opinions, and practice regarding alcohol-related care. Eight hundred obstetrician-gynecologists (ob-gyns) were selected; 48.1% returned the survey. Results: The majority (66.0%) indicated that occasional alcohol consumption is not safe during any period of pregnancy. There was no consensus when asked if alcohol's effect on fetal development is clear (46.9% thought it was clear and 45.9% did not). Most (82.2%) ask all pregnant patients about alcohol use only during patients' initial visit, whereas 10.6% ask during initial and subsequent visits. Most (78.5%) advise abstinence when pregnant women report alcohol use. When asked which validated alcohol risk screening tool they most commonly use with pregnant patients, 57.8% said they use no tool. Although 71.9% felt prepared to screen for risky or hazardous drinking, older ob-gyns indicated feeling significantly more unprepared than younger ob-gyns. "Patient denial or resistance to treatment" was the top issue affecting alcohol screening and "referral resources for patients with alcohol problems" was the resource needed most. Most ob-gyns were not aware of the National Institute on Alcohol Abuse and Alcoholism "Clinician's Guide" or the American College of Obstetricians and Gynecologists "Fetal Alcohol Spectrum Disorder Prevention Tool Kit." Conclusions: There are few changes in the alcohol-related screening and treatment patterns of ob-gyns since 1999; although perceived barriers and needs have changed. Interventions, including referral resources and continuing medical education training, are warranted.

Anderson, B. O. (2010). "The Breast Health Global Initiative: Why It Matters to All of Us." Oncology-New York 24(13): 1230-1234.
	The Breast Health Global Initiative (BHGI) applied an evidence-based consensus review process to the development of guidelines for breast cancer early detection, diagnosis, treatment and health care systems in low-and middle-income countries (LMCs). Breast cancer outcomes correlate with the degree to which (1) cancers are detected at early stages, (2) newly detected cancers can be diagnosed correctly, and (3) appropriately selected multimodality treatment can be provided properly and in a timely fashion. Cancer prevention through health behavior modification may influence breast cancer incidence in LMCs, although prevention strategies alone cannot eliminate the great majority of breast cancer cases. Diagnosing breast cancer at earlier stages will reduce breast cancer mortality, assuming that appropriate multimodality treatment is provided. Programs to promote breast self-awareness and clinical breast examination and resource-adapted mammographic screening are important steps in early detection. Obstacles to breast cancer early detection, diagnosis, and treatment occur in industrialized countries as well as LMCs. Understanding implementation in LMCs can inform policy makers in the U. S. on how to improve health care delivery in underserved communities, where the challenges mirror those of low-resource environments.

Anderson, B. O., et al. (2011). "Optimisation of breast cancer management in low-resource and middle-resource countries: executive summary of the Breast Health Global Initiative consensus, 2010." Lancet Oncology 12(4): 387-398.
	The purpose of the Breast Health Global Initiative (BHGI) 2010 summit was to provide a consensus analysis of breast cancer control issues and implementation strategies for low-income and middle-income countries (LMCs), where advanced stages at presentation and poor diagnostic and treatment capacities contribute to lower breast cancer survival rates than in high-income countries. Health system and patient-related barriers were identified that create common clinical scenarios in which women do not present for diagnosis until their cancer has progressed to locally advanced or metastatic stages. As countries progress to higher economic status, the rate of late presentation is expected to decrease, and diagnostic and treatment resources are expected to improve. Health-care systems in LMCs share many challenges including national or regional data collection, programme infrastructure and capacity (including appropriate equipment and drug acquisitions, and professional training and accreditation), the need for qualitative and quantitative research to support decision making, and strategies to improve patient access and compliance as well as public, health-care professional, and policy-maker awareness that breast cancer is a cost-effective, treatable disease. The biggest challenges identified for low-income countries were little community awareness that breast cancer is treatable, inadequate advanced pathology services for diagnosis and staging, and fragmented treatment options, especially for the administration of radiotherapy and the full range of systemic treatments. The biggest challenges identified for middle-resource countries were the establishment and maintenance of data registries, the coordination of multidisciplinary centres of excellence with broad outreach programmes to provide community access to cancer diagnosis and treatment, and the resource-appropriate prioritisation of breast cancer control programmes within the framework of existing, functional health-care systems.

Anderson, B. O. and R. Jakesz (2008). "Breast Cancer Issues in Developing Countries: An Overview of the Breast Health Global Initiative." World Journal of Surgery 32(12): 2578-2585.
	Of the 411,000 breast cancer deaths around the world in 2002, 221,000 (54%) occurred in low- and middle-income countries (LMCs). Guidelines for breast health care (early detection, diagnosis, and treatment) that were developed in high-resource countries cannot be directly applied in LMCs, because these guidelines do not consider real world resource constraints, nor do they prioritize which resources are most critically needed in specific countries for care to be most effectively provided. Established in 2002, the Breast Health Global Initiative (BHGI) created an international health alliance to develop evidence-based guidelines for LMCs to improve breast health outcomes. The BHGI held two Global Summits in October 2002 (Seattle) and January 2005 (Bethesda) and using an expert consensus, evidence-based approach developed resource-sensitive guidelines that define comprehensive pathways for step-by-step quality improvement in health care delivery. The BHGI guidelines, now published in English and Spanish, stratify resources into four levels (basic, limited, enhanced, and maximal), making the guidelines simultaneously applicable to countries of differing economic capacities. The BHGI guidelines provide a hub for linkage among clinicians and alliance among governmental agencies and advocacy groups to translate guidelines into policy and practice. The breast cancer problem in LMCs can be improved through practical interventions that are realistic and cost-effective. Early breast cancer detection and comprehensive cancer treatment play synergistic roles in facilitating improved breast cancer outcomes. The most fundamental interventions in early detection, diagnosis, surgery, radiation therapy, and drug therapy can be integrated and organized within existing health care schemes in LMCs. Future research will study what implementation strategies can most effectively guide health care system reorganization to assist countries that are motivated to improve breast cancer outcome in their populations.

Anderson, B. O., et al. (2006). "Breast cancer in limited-resource countries: Health care systems and public policy." Breast Journal 12(1): S54-S69.
	As the largest cancer killer of women around the globe, breast cancer adversely impacts countries at all levels of economic development. Despite major advances in the early detection, diagnosis, and treatment of breast cancer, health care ministries face multitiered challenges to create and support health care programs that can improve breast cancer outcomes. In addition to the financial and organizational problems inherent in any health care system, breast health programs are hindered by a lack of recognition of cancer as a public health priority, trained health care personnel shortages and migration, public and health care provider educational deficits, and social barriers that impede patient entry into early detection and cancer treatment programs. No perfect health care system exists, even in the wealthiest countries. Based on inevitable economic and practical constraints, all health care systems are compelled to make trade-offs among four factors: access to care, scope of service, quality of care, and cost containment. Given these trade-offs, guidelines can define stratified approaches by which economically realistic incremental improvements can be sequentially implemented within the context of resource constraints to improve breast health care. Disease-specific "vertical" programs warrant "horizontal" integration with existing health care systems in limited-resource countries. The Breast Health Global Initiative (BHGI) Health Care Systems and Public Policy Panel defined a stratified framework outlining recommended breast health care interventions for each of four incremental levels of resources (basic, limited, enhanced, and maximal). Reallocation of existing resources and integration of a breast health care program with existing programs and infrastructure can potentially improve outcomes in a cost-sensitive manner. This adaptable framework can be used as a tool by policymakers for program planning and research design to make best use of available resources to improve breast health care in a given limited resource setting.

Anderson, B. O., et al. (2008). "Guideline Implementation for Breast Healthcare in Low-income and Middle-income Countries Overview of the Breast Health Global Initiative Global Summit 2007." Cancer 113(8): 2221-2243.
	Breast cancer outcomes in low- and middle-income countries (LMCs) correlate with the degree to which 1) cancers are detected at early stages, 2) newly detected cancers can be diagnosed correctly, and 3) appropriately selected multi-modality treatment can be provided properly in a timely fashion. The Breast Health Global Initiative (BHGI) invited international experts to review and revise previously developed BHGI resource-stratified guideline tables for early detection, diagnosis, treatment, and healthcare systems. Focus groups, addressed specific issues in breast pathology, radiation therapy, and management of locally advanced disease. Process metrics were developed based on the priorities established in the guideline stratification. The groups indicated that cancer prevention through health behavior modification could influence breast cancer incidence in LMCs, Diagnosing breast cancer at earlier stages will reduce breast cancer mortality. Programs to promote breast self-awareness and clinical breast examination and resource-adapted mammographic screening are important early detection steps. Breast imaging, initially with ultrasound and, at higher resource levels with diagnostic mammography, improves preoperative diagnostic assessment and permits image-guided needle sampling. Multimodality therapy includes surgery, radiation, and systemic therapies. Government intervention is needed to address drug-delivery problems relating to high cost and poor access. Guideline dissemination and implementation research plays a crucial role in improving care. Adaptation of technology is needed in LMCs, especially for breast imaging, pathology, radiation therapy, and systemic treatment. Curricula for education and training in LMCs should be developed. applied, and studied in LMC-based learning laboratories to aid information transfer of evidence-based BHGI guidelines. Cancer 2008;113(8 suppl):2221-43. Published 2008 41, the American Cancer Society

Anderson, J. M., et al. (2009). "Inequities in health and healthcare viewed through the ethical lens of critical social justice: Contextual knowledge for the global priorities ahead." Advances in Nursing Science 32(4): 282-294.
	The authors use the backdrop of the Healthy People 2010 initiative to contribute to a discussion encompassing social justice from local to national to global contexts. Drawing on findings from their programs of research, they explore the concept of critical social justice as a powerful ethical lens through which to view inequities in health and in healthcare access. They examine the kind of knowledge needed to move toward the ideal of social justice and point to strategies for engaging in dialogue about knowledge and actions to promote more equitable health and healthcare from local to global levels. Copyright © 2009 Wolters Kluwer Health.

Anderson, J. M., et al. (2007). "Health care reform and the paradox of efficiency: "Writing in" culture." International Journal of Health Services 37(2): 291-320.
	Widespread global migration is occurring at the same time that health care delivery systems in Western nations are undergoing major restructuring. The call for health care to be more efficient, economical, and responsive to diverse cultural populations has come from several sectors, including governments and researchers. This has led to policies to address perceived deficiencies in health care services. The authors draw on their research at health care institutions in a western Canadian city to probe, first, how the concept of culture is interpreted within organizations; and second, how culture is "written into health systems" as they undergo restructuring. Meanings and interpretations of culture are not transparent; moreover, "writing in" culture is not simply a matter of health care providers learning about their clients' "belief systems" and being sensitive to these beliefs. Belief systems and people's experiences of the care they receive are negotiated within highly complex "organizational cultures," located in broader macroeconomic and political structures, and discourses that shape how health care systems are organized. The authors consider whether current discourses on cost containment are in competition with providing equitable health care services to diverse client populations. © 2007, Baywood Publishing Co., Inc.

Anderson, M. B., et al. (2015). "Really Good Stuff: Lessons learned through innovation in medical education. Introduction." Medical Education 49(5): 511-512.
	
Anderson, W. A. and I. B. Harris (2003). "Arthur S. Elstein, Ph.D.: skeptic, scholar, teacher and mentor." Advances in Health Sciences Education 8(2): 173-182.
	Arthur S. Elstein, Ph.D. has said that he has been motivated to address two research questions throughout this career: How do physicians make decisions? and How can we help them make better ones? He has addressed these questions using the tools of a psychologist but the results of his research in medical cognition, medical reasoning, and judgement have had a lasting impact on medical education and how future physicians are prepared. Further, through teaching and mentoring, he has produced a second generation of medical education researchers and leaders; and perhaps most importantly, through his role modeling of skepticism and scholarship, he has taught what a professional educator must do to succeed in medical education. His distinguished thirty-eight year career was primarily at the Office of Medical Education Research and Development at Michigan State University's College of Human Medicine (1968-1994) and, after his retirement there, in the Department of Medical Education and the School of Public Health at the University of Illinois at Chicago. During his career he authored or edited four books, wrote 22 book chapters, published 99 articles, and made more than 900 presentations. He received many prestigious awards. This article gives an overview of Elstein's career and accomplishments and his perspectives on significant innovations in medical education, the role of professional medical educators, the major lessons he has learned during his career.

Andersson, N., et al. (2007). "Nurses in paediatric care - Self-reported professional self and perceived research utilization." Scandinavian Journal of Caring Sciences 21(4): 426-433.
	The aim was to describe how nurses in different professional levels evaluated their professional self and perceived barriers to research utilization in paediatric care. The sample consisted of three groups of nurses: control, trainee and specialists (n = 113) employed at two Paediatric University hospitals in Sweden. The control and trainee groups were nurses with a general education and the specialists had a specialist education in paediatric care. The nurses answered the two questionnaires: the Professional Self Description Form (PSDF) and the Barriers Scale. The results showed that the highest scores in the PSDF were found in sensitivity in all the three groups and consideration (in control and specialist group) and creativity (trainee group). The control group scored significantly higher in the item persistence. In the Barriers Scale, the three groups scored the greatest barriers in; 'there is insufficient time on the job to implement new ideas' and 'the nurses do not have time to read research'. The lowest barriers were found in; 'the nurse is unwilling to change/try new ideas' and 'the nurse is unaware of research'. The specialist nurses had significantly higher barriers in; 'the nurse is isolated from knowledgeable colleagues with whom to discuss the research', 'the nurse is unwilling to try new ideas' and 'administration will not allow implementation'. No correlations were found between the PSDF and the Barriers Scale. In conclusion, the self-evaluation of professional self and perceived research utilization showed few differences between the nurses. These findings indicate that the professional self is independent of educational level and work experiences while barriers to research utililization increases with competence and experience. © 2007 Nordic College of Caring Science.

Andolsek, K. M., et al. (2013). "Fostering creativity: how the Duke Graduate Medical Education Quasi-Endowment encourages innovation in GME." Academic Medicine 88(2): 185-191.
	The Duke Medicine Graduate Medical Education Quasi-Endowment, established in 2006, provides infrastructure support and encourages educational innovation. The authors describe Duke's experience with the "grassroots innovation" part of the fund, the Duke Innovation Fund, and discuss the Innovation Fund's processes for application, review, and implementation, and also outcomes, impact, and intended and unintended consequences.In the five years of the Innovation Fund described (2007-2011), 105 projects have been submitted, and 78 have been funded. Thirty-seven projects have been completed. Approved funding ranged from $2,363 to $348,750, with an average award of $66,391. This represents 42% of funding originally requested. Funding could be requested for a period of 6 months to 3 years. The average duration of projects was 27 months, with a range from 6 months to 36 months. Eighty percent of projects were completed on time. Two projects were closed because of lack of progress and failure to adhere to reporting requirements. Thirty-nine are ongoing.Program directors report great success in meeting project outcomes and concrete impacts on resident and faculty attitudes and performance. Ninety-two percent report that their projects would have never been accomplished without this funding. Projects have resulted in at least 68 posters, abstracts, and peer-reviewed presentations. At least 12 peer-reviewed manuscripts were published.There has been tremendous diversity of projects; all 13 clinical departments have been represented. Interdepartmental and intradepartmental program cooperation has increased. This modest seed money has resulted in demonstrable sustainable impacts on teaching and learning, and increased morale and scholarly recognition.

Andrade, E. L., et al. (2015). "Victor and Erika Webnovela: An Innovative Generation @ Audience Engagement Strategy for Prevention." Journal of Health Communication 20(12): 1465-1472.
	Entertainment-education (E-E) approaches for young audiences continue to evolve in order to keep stride with younger generations' affinity for technology. E-E and novelas have been used with a wide variety of audiences in the United States, in particular hard-to-reach Latino populations, and have demonstrated effectiveness in disseminating culturally relevant prevention information for a wide variety of health-related risk factors and behaviors. This study discusses the formative research and active engagement of Latino youth living in Langley Park, Maryland, for the development and filming of an innovative 6-episode webnovela titled Victor and Erika (V&E). V&E is part of a larger branding strategy of the Adelante Positive Youth Development intervention that seeks to prevent substance abuse, sexual risk, and interpersonal violence among Latino youth; V&E is also an intervention component. The V&E webnovela is a dramatic portrayal of the lives of 2 immigrant Latino teenagers that also disseminates risk prevention messages. The storyline represents the turning the corner (to a better life) theme that underlies the Adelante intervention brand. Formative research was conducted for character development (n = 20) and creative development of the episodes (n = 14). Results of the formative research showed that youth recommended inclusion of the following topics in V&E episodes: sex, unintended pregnancy, fidelity, trust, family dynamics, immigration status, violence, school dropout, respect, home life, and poverty. Detailed character and episode descriptions are provided, and the implications of using the V&E series as a tool for in-person and online engagement of youth and the dissemination of prevention messages are also discussed.

Andrews, R. J. and L. M. Quintana (2015). "Unpredictable, unpreventable and impersonal medicine: global disaster response in the 21st century." Epma Journal 6: 12.
	The United Nations has recognized the devastating consequences of "unpredictable, unpreventable and impersonal" disasters-at least US $2 trillion in economic damage and more than 1.3 million lives lost from natural disasters in the last two decades alone. In many disasters (both natural and man-made) hundreds-and in major earthquakes, thousands-of lives are lost in the first days following the event because of the lack of medical/surgical facilities to treat those with potentially survivable injuries. Disasters disrupt and destroy not only medical facilities in the disaster zone but also infrastructure (roads, airports, electricity) and potentially local healthcare personnel as well. To minimize morbidity and mortality from disasters, medical treatment must begin immediately, within minutes ideally, but certainly within 24 h (not the days to weeks currently seen in medical response to disasters). This requires that all resources-medical equipment and support, and healthcare personnel-be portable and readily available; transport to the disaster site will usually require helicopters, as military medical response teams in developed countries have demonstrated. Some of the resources available and in development for immediate medical response for disasters-from portable CT scanners to telesurgical capabilities-are described. For immediate deployment, these resources-medical equipment and personnel-must be ready for deployment on a moment's notice and not require administrative approvals or bureaucratic authorizations from numerous national and international agencies, as is presently the case. Following the "trauma center/stroke center" model, disaster response incorporating "disaster response centers" would be seamlessly integrated into the ongoing daily healthcare delivery systems worldwide, from medical education and specialty training (resident/registrar) to acute and subacute intensive care to long-term rehabilitation. The benefits of such a global disaster response network extend far beyond the lives saved: universal standards for medical education and healthcare delivery, as well as the global development of medical equipment and infrastructure, would follow. Capitalizing on the humanitarian nature of disaster response with its suspension of the cultural, socioeconomic and political barriers that often paralyze international cooperation and development-disaster response can be predictable, loss of life can be preventable and benefits can be both personal and societal.

Andrulis, D. P. (2003). "Reducing racial and ethnic disparities in disease management to improve health outcomes." Disease Management & Health Outcomes 11(12): 789-800.
	The heightened awareness of substantial racial and ethnic disparities in health outcomes has major implications for how healthcare providers effectively manage health conditions among diverse populations. This report identifies five dimensions that address the major causes of disparities that can exert significant influence over the success and quality of the patient-physician relationship, treatment plans, and health outcomes. These five dimensions are (i) biological and genetic influences; (ii) differential access to care; (iii) quality of care disparities; (iv) clinical-patient perceptions and realities; and (v) language and communication barriers. Recommended disease management actions for health practitioners and healthcare organizations focus on promoting more effective interactions between both the patient and the physician in the clinical encounter, methods for improving patient understanding, and education and information to improve treatment adherence and outcome. Educational strategies include: adapting existing protocols in the clinical setting; using communities, the internet and other sources of information; recognizing the importance of racial and ethnic concordance; and assuring competent communication and interpretation in the clinical encounter. Governments also perform several critical functions in addressing racial and ethnic disparities, such as setting the tone and offering leadership, guidance and support for practitioners and their healthcare settings. Ultimately, effective disease management will require practitioners, as well as healthcare organizations and agencies to integrate knowledge and actions around the multiple causes of ethnic and racial disparities into clinical regimens through training, on-site services and resource development.

Andrus, N. C. and N. M. Bennett (2006). "Developing an interdisciplinary, community-based education program for health professions students: The Rochester experience." Academic Medicine 81(4): 326-331.
	To successfully meet the nation's changing health needs, future health professionals must learn skills in applied health promotion and disease prevention. To achieve these goals, the Center for Rochester's Health (the Center), a collaboration of the Monroe County Department of Public Health and the University of Rochester School of Medicine and Dentistry and School of Nursing, all located in Rochester, New York, developed an innovative education program that gives interdisciplinary teams of students opportunities to partner with community agencies engaged in research-oriented health improvement initiatives, The Center started this course in 1998, under the auspices of a national initiative supported by the Health Resources and Services Administration and the Institute for Healthcare Improvement. The authors discuss the challenges related to the implementation and institutionalization of this interdisciplinary population-based education program. They describe their experiences over a seven-year period, from 1998 to 2005, including the various factors that enabled them to make necessary changes in the program activities and the ways in which the Center was able to bring departments together to consider new course directions for engaging students in the community health improvement process. They discuss the different stages of program development, including the early years of program planning and later curriculum changes that involved the development of an online population health curriculum. The authors conclude that by understanding changes in the education goals of various health professions schools and by adapting education programs to meet the needs of students from these schools, program planners will have more opportunities to sustain community-based education programs.

Anesetti-Rothermel, A., et al. (2012). "Beyond Reach and Effectiveness: Evaluating the Not-On-Tobacco (N-O-T) Program in West Virginia From 2000 to 2005." Health Promotion Practice 13(4): 506-514.
	Despite most teenage smokers wanting to quit, their likelihood of success resembles that of flipping a coin. Evidence-based cessation programs, like the American Lung Association's Not-On-Tobacco (N-O-T) program, are effective. Evaluation of program dissemination is critical. This study uses the RE-AIM framework to evaluate the N-O-T program in West Virginia from 2000 to 2005. RE-AIM components consisted of four measures. Regional dissemination was measured using comparative differences between Regional Educational Service Agency regions (RESAs). Significant associations were found between RESAs for numerous characteristics. Among the RE-AIM components, two measures of Implementation were significantly different between RESAs. Variability between RESAs provided valuable descriptive evidence of N-O-T program dissemination in West Virginia. Therefore, geographical tailoring grounded in community-based participatory research could increase the N-O-T program's overall dissemination. © 2012 Society for Public Health Education.

Angeles, R. N., et al. (2014). "Developing a Theoretical Framework for Complex Community-Based Interventions." Health Promotion Practice 15(1): 100-108.
	Applying existing theories to research, in the form of a theoretical framework, is necessary to advance knowledge from what is already known toward the next steps to be taken. This article proposes a guide on how to develop a theoretical framework for complex community-based interventions using the Cardiovascular Health Awareness Program as an example. Developing a theoretical framework starts with identifying the intervention's essential elements. Subsequent steps include the following: (a) identifying and defining the different variables (independent, dependent, mediating/intervening, moderating, and control); (b) postulating mechanisms how the independent variables will lead to the dependent variables; (c) identifying existing theoretical models supporting the theoretical framework under development; (d) scripting the theoretical framework into a figure or sets of statements as a series of hypotheses, ifthen logic statements, or a visual model; (e) content and face validation of the theoretical framework; and (f) revising the theoretical framework. In our example, we combined the "diffusion of innovation theory" and the "health belief model" to develop our framework. Using the Cardiovascular Health Awareness Program as the model, we demonstrated a stepwise process of developing a theoretical framework. The challenges encountered are described, and an overview of the strategies employed to overcome these challenges is presented. © 2013 Society for Public Health Education.

Angelini, D. J., et al. (2012). "Midwifery and obstetrics: twenty years of collaborative academic practice." Obstetrics & Gynecology Clinics of North America 39(3): 335-346.
	This review describes a collaborative educational practice model partnering midwifery and obstetrics within a department of obstetrics and gynecology. For more than 20 years, the authors' model has demonstrated sustainability and influence on medical education. The focus is on resident education in obstetrics, using midwifery faculty as teachers in the obstetric and obstetric triage settings. This noncompetitive and integrated educational practice model has achieved sustainability and success using midwives in a collaborative approach to medical education. The continuing collaboration and innovation within medical and resident education are important elements for the future of collaborative practice.Copyright © 2012 Elsevier Inc. All rights reserved.

Angood, P. B. (2016). "REFLECTIONS ON EVOLVING CHANGE." Physician leadership journal 3(3): 4-6.
	Physician leadership is increasingly recognized as pivotal for improved change in health care. Multi-professional care teams, education and leadership are evolving trends that are important for health care's future.

Angood, P. B., et al. (2000). "Telemedicine at the top of the world: The 1998 and 1999 Everest Extreme Expeditions." Telemedicine Journal and e-Health 6(3): 315-325.
	The National Aeronautics and Space Administration (NASA) initially established a Commercial Space Center (CSC) in the Department of Surgery at Yale University School of Medicine to further develop and evaluate technologies in information systems, telecommunications applied to medicine, and physiologic sensors. The CSC is known as the Medical Informatics and Technology Applications Consortium (MITAC). The overall purpose for this NASA program is to leverage technology, innovation, and resources from industry and academia through collaborative partnerships. The Yale-NASA CSC/MITAC organized the Everest Extreme Expeditions (E3) for the spring Himalayan climbing seasons in the years 1998 and 1999. The primary mission was to deliver advanced medical support with global telemedicine capabilities to one of the world's most remote and hostile settings-Mount Everest. The purpose was both humanitarian (providing medical support) and scientific (conducting medical and technology research). The Yale team provided medical care for the Everest Base Camp community; conducted validation experiments for several types of advanced medical technologies in this remote, hostile environment; and performed real-time monitoring of selected climbers, while also assessing the basic science of altitude physiology. Additionally, the teams conducted outreach medical care to the citizens of Nepal and provided several educational forums for a variety of medical and nonmedical personnel-including school-age children. As part of the project's mission, the E3 medical teams at both Nepal and New Haven were on a 24-hour emergency call system to deliver medical care in the event of a crisis. Unlike most of the teams at Everest, the mission of E3 was not to climb the 29,028-foot mountain the Nepalese call Sagarmatha ("Sky Head"). The mountain served as an extreme testing ground for telemedicine. The lessons learned from this testbed are reviewed here and further clarify the abilities to provide better health care in remote and extreme environments-which for some may even be their home environment during/after a medical illness.

Angstman, G. (1996). "Getting physician and organization buy-in: A disease management strategy." Joint Commission Journal on Quality Improvement 22(8): 551-556.
	This conference, originally titled ''implementing Practice Guidelines: A Focus on Changing Physician Behavior and Employing Technology,'' was held by the Zitter Group in Scottsdale, Arizona, January 21-23, 1996. The Zitter Group is a San Francisco-based health care education and publishing firm that focuses on outcomes research, disease management, pharmacoeconomics, and health care quality improvement. Conference Goals The conference was designed to fulfill the following learning objectives: Distinguish between types of guidelines and identify appropriate applications for various settings of care; Explain methods for addressing legal liability and risk-exposure issues related to practice guideline development and implementation; Describe the role of patient input into guideline development and implementation; Identify key success factors and tools for achieving physician buy-in to quality improvement and practice guideline implementation efforts; Identify technology applications for implementing practice guidelines; and Describe examples and tools for measuring patient outcomes and health care utilization resulting from guide line implementation efforts. Conference Program and Participants The two-day conference of presentations, panels, and work-shops and breakout sessions was organized into three segments focusing on (1) securing physician buy-in and other dimensions of guideline development and implementation, (2) using technology to integrate guidelines into electronic systems, and (3) measuring the impact of guidelines on outcomes. A preconference workshop outlined the issues and drew out the various guideline-related needs and experiences of the conference participants, who for the most part were clinicians and who spanned a broad spectrum of experience with guidelines. Eleven presentations with the key resources and references of faculty with direct guideline implementation experience were summarized and adapted for this journal issue. Six presentations survey the implementation issues of engaging physicians through disease management strategy, understanding legal issues, checking implementability of guidelines to improve physician compliance, incorporating patient preferences, creating physician profiling systems to encourage change, and interpreting the Maine experience with the affirmative defense. Three presentations explore approaches to integrating guidelines into existing information systems, developing and testing computerized decision support systems, and using the electronic patient record at the point of care. Two presentations recount processes for measuring the results of specific guidelines in terms of patients' outcomes from the perspectives of a large consulting company and a large community health maintenance organization.

Anikeeva, O. and P. Bywood (2013). "Social media in primary health care: opportunities to enhance education, communication and collaboration among professionals in rural and remote locations: did you know? Practical practice pointers." Australian Journal of Rural Health 21(2): 132-134.
	
Anonymous (2010). "Smartphoning it in. New applications are turning cell phones into medical devices." Harvard Health Letter 36(1): 1-3.
	
Anonymous (2015). "Adapting to a changing environment in research, education, and technology." European Heart Journal 36(1): 3.
	
Anselmi, L., et al. (2015). "Going beyond horizontal equity: An analysis of health expenditure allocation across geographic areas in Mozambique." Social Science & Medicine 130: 216-224.
	In contexts where health services are mostly publicly provided and access is still limited, health financing systems require some mechanism for distributing financial resources across geographic areas according to population need. Equity in public health expenditure has been evaluated either by comparing allocations across spending units to equitable shares established using resource allocation formulae, or by using benefit incidence analysis to look at the distribution of expenditure across individual service users. In the latter case, the distribution across individuals has typically not been linked to the mechanisms that determine the allocation across geographic areas, and to the utilization of specific services by individuals. In this paper, we apply benefit incidence analysis in an innovative way to assess horizontal and vertical equity in the geographic allocation of recurrent expenditure for outpatient health care across districts in Mozambique. We compare the actual distribution of expenditure with horizontal and vertical equity benchmarks, set according to measures of economic status and need for health care. We quantify the observed inequities and the relative contributions of service use and resource allocation. We analyse government and donor expenditure separately and combined, for the years 2008-2011 to compare changes over time and funding source. We use data from a number of national routine sources. Results show improvements in both horizontal and vertical equity, along with the gradual alignment of government and donor resources over time, which resulted in almost horizontally and vertically equitable resource allocation in 2011. However, inequities in the distribution of expenditure across beneficiaries persisted and were driven by inequities in service use. The discrepancy between economic and need indicators highlighted initial differences in government and donor expenditure targets, raising questions about the purpose of public health expenditure and confirming the importance of clearly defining equity objectives to inform and evaluate resource allocation policies. (C) 2015 Elsevier Ltd. All rights reserved.

Antman, E. M., et al. (2012). "Usefulness of medical conferences [3]." JAMA - Journal of the American Medical Association 308(1): 31-32.
	
Antommaria, A. H. M., et al. (2007). "Evaluation of an innovative pediatric clerkship structure using multiple outcome variables including career choice." Journal of Hospital Medicine 2(6): 401-408.
	BACKGROUND: Few studies have examined alternative structures for inpatient clerkships. OBJECTIVE: Compare 2 inpatient clerkship structures using multiple outcome variables. DESIGN: Prospective, randomized controlled trial. SETTING: Tertiary-care, freestanding children's hospital. SUBJECTS: All medical students enrolled in the third-year pediatric clerkship in the 2001-2003 academic years. INTERVENTION: A clerkship structure consisting of an academic attending, a third-year pediatric resident, and 4 third-year medical students, but no interns. MEASUREMENTS: Student end-of-rotation examinations, evaluations, a questionnaire, and career choices were used to evaluate the intervention. Patient logs and resource utilization were also assessed. Statistical analysis included evaluating differences between groups and measuring effect size. RESULTS: Two hundred and three students were randomized. Compared with those on the traditional services, students on the intervention service encountered more key diagnoses in the patients they cared for (4.4 vs. 3.6, P < .01). These students also gave higher ratings to their overall attitude (4.48 vs. 4.26, P = .02) and input into patient care decisions (4.45 vs. 3.98, P < .01). More than twice as many students on the intervention service matched in pediatrics (OR 2.52, 95% confidence interval 0.99-6.38). Multivariate analysis of length of stay and total charges for selected patients revealed similar outcomes. CONCLUSIONS: A third-year pediatric clerkship that focuses on students is associated with increased satisfaction, higher interest in pediatrics, and consistent resource utilization. The intervention, therefore, merits continuation, whereas further research is required to identify which aspects of the intervention are responsible for its positive effects.

Antoniades, A., et al. (2015). "Medical Content Searching, Retrieving, and Sharing Over the Internet: Lessons Learned From the mEducator Through a Scenario-Based Evaluation." Journal of Medical Internet Research 17(10): 20.
	Background: The mEducator Best Practice Network (BPN) implemented and extended standards and reference models in e-learning to develop innovative frameworks as well as solutions that enable specialized state-of-the-art medical educational content to be discovered, retrieved, shared, and re-purposed across European Institutions, targeting medical students, doctors, educators and health care professionals. Scenario-based evaluation for usability testing, complemented with data from online questionnaires and field notes of users' performance, was designed and utilized for the evaluation of these solutions. Objective: The objective of this work is twofold: (1) to describe one instantiation of the mEducator BPN solutions (mEducator3.0 - "MEdical Education LINnked Arena" MELINA+) with a focus on the metadata schema used, as well as on other aspects of the system that pertain to usability and acceptance, and (2) to present evaluation results on the suitability of the proposed metadata schema for searching, retrieving, and sharing of medical content and with respect to the overall usability and acceptance of the system from the target users. Methods: A comprehensive evaluation methodology framework was developed and applied to four case studies, which were conducted in four different countries (ie, Greece, Cyprus, Bulgaria and Romania), with a total of 126 participants. In these case studies, scenarios referring to creating, sharing, and retrieving medical educational content using mEducator3.0 were used. The data were collected through two online questionnaires, consisting of 36 closed-ended questions and two open-ended questions that referred to mEducator 3.0 and through the use of field notes during scenario-based evaluations. Results: The main findings of the study showed that even though the informational needs of the mEducator target groups were addressed to a satisfactory extent and the metadata schema supported content creation, sharing, and retrieval from an end-user perspective, users faced difficulties in achieving a shared understanding of the meaning of some metadata fields and in correctly managing the intellectual property rights of repurposed content. Conclusions: The results of this evaluation impact researchers, medical professionals, and designers interested in using similar systems for educational content sharing in medical and other domains. Recommendations on how to improve the search, retrieval, identification, and obtaining of medical resources are provided, by addressing issues of content description metadata, content description procedures, and intellectual property rights for re-purposed content.

Antunes, J. L. F., et al. (2008). "Inequalities in mortality of men by oral and pharyngeal cancer in Barcelona, Spain and Sao Paulo, Brazil, 1995-2003." International Journal for Equity in Health 7: 9.
	Background: Large inequalities of mortality by most cancers in general, by mouth and pharynx cancer in particular, have been associated to behaviour and geopolitical factors. The assessment of socioeconomic covariates of cancer mortality may be relevant to a full comprehension of distal determinants of the disease, and to appraise opportune interventions. The objective of this study was to compare socioeconomic inequalities in male mortality by oral and pharyngeal cancer in two major cities of Europe and South America. Methods: The official system of information on mortality provided data on deaths in each city; general censuses informed population data. Age-adjusted death rates by oral and pharyngeal cancer for men were independently assessed for neighbourhoods of Barcelona, Spain, and Sao Paulo, Brazil, from 1995 to 2003. Uniform methodological criteria instructed the comparative assessment of magnitude, trends and spatial distribution of mortality. General linear models assessed ecologic correlations between death rates and socioeconomic indices (unemployment, schooling levels and the human development index) at the inner-city area level. Results obtained for each city were subsequently compared. Results: Mortality of men by oral and pharyngeal cancer ranked higher in Barcelona (9.45 yearly deaths per 100,000 male inhabitants) than in Spain and Europe as a whole; rates were on decrease. Sao Paulo presented a poorer profile, with higher magnitude (11.86) and stationary trend. The appraisal of ecologic correlations indicated an unequal and inequitably distributed burden of disease in both cities, with poorer areas tending to present higher mortality. Barcelona had a larger gradient of mortality than Sao Paulo, indicating a higher inequality of cancer deaths across its neighbourhoods. Conclusion: The quantitative monitoring of inequalities in health may contribute to the formulation of redistributive policies aimed at the concurrent promotion of wellbeing and social justice. The assessment of groups experiencing a higher burden of disease can instruct health services to provide additional resources for expanding preventive actions and facilities aimed at early diagnosis, standardized treatments and rehabilitation.

Antunes, J. L. F., et al. (2003). "City-level gender differentials in the prevalence of dental caries and restorative dental treatment." Health & Place 9(3): 231-239.
	This study assesses gender differentials in the distribution of dental caries and restorative treatment at the city level ill order to discuss gender inequities in health. We retrieved data for caries prevalence and dental service utilisation by 11- and 12-year-old girls and boys in 131 towns in the state of Sao Paulo, Brazil, 1998. We also gathered aggregate population data for these towns, and information already held by the health authority regarding the provision of dental services. Results of data analysis indicated that girls presented higher caries indices in permanent teeth than boys of the same age, concurrent with a higher utilisation of dental care. When studying aggregate data at the city level, we gathered evidence reinforcing the hypothesis that the higher prevalence of caries in girls is attributable to their earlier eruption of permanent teeth, with no significant association between this excess and indices of socio-economic status at the city level. However, indices assessing the discrepant incorporation of dental services between genders were higher in towns with a poorer profile of socio-economic status. We also observed that towns whose public health service was more effective in providing dental care presented a more equitable gender distribution of dental services. Public resources destined to dental assistance contributed to reducing inequities in oral health by allowing an incorporation of restorative dental treatment more equitably distributed between girls and boys. (C) 2003 Elsevier Science Ltd. All rights reserved.

Anyaehie, U. S., et al. (2011). "Medical students' evaluation of physiology learning environments in two Nigerian medical schools." Advances in Physiology Education 35(2): 146-148.
	The expansion of biomedical knowledge and the pursuit of more meaningful learning have led to world-wide evidence-based innovative changes in medical education and curricula. The recent emphasis on problem-based learning (PBL) and student-centred learning environments are, however, not being implemented in Nigerian medical schools. Traditional didactic lectures thus predominate, and learning is further constrained by funding gaps, poor infrastructure, and increasing class sizes. We reviewed medical students' perceptions of their exposed learning environment to determine preferences, shortcomings, and prescriptions for improvements. The results confirm declining interest in didactic lectures and practical sessions with preferences for peer-tutored discussion classes, which were considered more interactive and interesting. This study recommends more emphasis on student-centered learning with alternatives to passive lecture formats and repetitive cookbook practical sessions. The institutionalization of student feedback processes in Nigerian medical schools is also highly recommended.

Aparicio, A. and C. E. Willis (2005). "The continued evolution of the credit system." Journal of Continuing Education in the Health Professions 25(3): 190-196.
	In its ongoing support of continuous physician professional development, the American Medical Association (AMA) for use in the AMA Physician's Recognition Award has adopted 2 new learning platforms: Performance Improvement (PI) and Internet Point of Care (PoC). This article highlights the process that led to their adoption and places these new forms of continuing and physician professional development in the framework of existing continuing medical education (CME). The article calls for new research that revisits existing data on physician learning and prepares to incorporate provider experience with "practice situated" forms of CME. The Conjoint Committee on CME may serve as an important contributor to this process by enabling valuable dialogue among stakeholder organizations.

Appelbaum, K. L., et al. (2002). "A university-state-corploration partnership for providing correctional mental health services." Psychiatric Services 53(2): 185-189.
	In September 1998 the University of Massachusetts Medical School, in partnership with a private vendor of correctional health care, began providing mental health services and other services to the Massachusetts Department of Correction. The experience with this partnership demonstrates that the involvement of a medical school with a correctional system has advantages for both. The correctional program benefits from enhanced quality of services, assistance with the recruitment and retention of skilled professionals, and expansion of training and continuing education programs. The medical school benefits by building its revenue base while providing a needed public service and through opportunities to extend its research and training activities. Successful collaboration requires that the medical school have an appreciation of security, needs, a sensitivity to fiscal issues, and a readiness to work with inmates who have severe mental disorders and,disruptive behavior. Correctional administrators, for their part, must support adequate treatment resources and must collaborate in the resolution of tensions between security and health care needs.

Apple, R. D. (2003). "Educating mothers: The Wisconsin Bureau of Maternal and Child Health." Womens History Review 12(4): 559-576.
	Health-care providers, social reformers, educators, and politicians were joined in a concerted effort to improve maternal and child health in the USA in the inter-war period. Identifying the critical role of mothers in this endeavor, their campaigns were designed to educate women in 'modern,' appropriate childcare practices predicated on middle-class standards for urban families with the financial and medical resources to carry out such health-care prescriptions. Mothers who could not afford a private physician were urged to visit clinics emerging in American cities. Few historians have examined in any great depth the day-to-day issues faced by mothers or the role of public health nurses in these extensive campaigns. Most particularly, the experiences of rural mothers are only now receiving much attention. This article analyzes the work of public health nurses employed by the Department of Maternal and Child Health in the state of Wisconsin, who endeavored to bring modern science and medicine to mothers. Yet, at the same time they were forced to cope with local and national politics and with the strictures of the US medical system, namely, the separation of 'public health' and 'private medicine' in which medical treatment remained in the hands of private physicians and the activities of public health nurses were limited to health education. Their writings show nurses struggling both with the problems of rural poverty and with the constraints of public health within contemporary gender relations.

Appleby, C. (1999). "Net gain or net loss? Health care consumers become Internet savvy." Trustee 52(2): 20-23.
	The Internet is overloaded with health care information, and consumers can't seem to get enough of it. As a result, patients are now more knowledgeable about their treatment options when they meet with doctors. That's the good news; the bad news is that the doctors themselves must sort through all the sometimes contradictory, sometimes inaccurate information.

Applegate, K. E. (2015). "PROTECTION OF PATIENTS IN DIAGNOSTIC AND INTERVENTIONAL MEDICAL IMAGING: COLLABORATION IS THE KEY." Health Physics 108(2): 221-241.
	The radiology community (medical physicists, radiologic technologists, radiologists, and interventional proceduralists) has led the educational and awareness efforts in the medical arena to reduce radiation dose to patients through effective collaborations that bridge traditional medical specialty silos to reach health worker stakeholders. These successful collaborations have also included both vendors and regulators, with the overarching goal of radiation protection of patients (justification, optimization, and use of dose reference levels). This focus on patients often raises overall safety awareness and lowers occupational radiation doses as well. It is critical that the entire radiology community continue to act as leaders in these radiation safety efforts for both employees and patients. In order to be successful, it is important to understand safety culture and the growing, worldwide, multimedia resources that are available. There is little time or budget to recreate or duplicate training materials or risk communication information that may already exist. Together with the increasingly fast-paced and demanding healthcare environment and sharp focus on quality, it has never been more important to understand how to achieve better quality care for radiology departments. It is also important to measure and report quality for many customers, including patients, referring providers, and many other stakeholders. This short report will briefly define safety culture and describe methods for using collective learning tools that document radiation protection of patients in diagnostic and interventional imaging. These tools include the use of imaging modality registries, such as the Computed Tomography Does Index Registry, peer review of imaging reports, the use of clinical decision support, and guidelines. Finally, the Image Gently and Image Wisely campaigns provide examples of cross-disciplinary collaboration to improve radiation protection of patients.

Appleton, S. and A. Nacht (2015). "Interdisciplinary Education from a College of Nursing and School of Medicine." Journal of Midwifery & Women's Health 60(6): 744-750.
	We examine a newly designed, interdisciplinary education program and clinical rotation for the first-year obstetrics and gynecology resident, implemented at the University of Colorado, Denver, Colorado, between the College of Nursing midwifery faculty and the School of Medicine Department of Obstetrics and Gynecology. The barriers to program development, along with the advantages and disadvantages of collaboration between nursing and medical schools, are reviewed. The clinical experience, consisting of 5 clinical shifts, was designed using the conceptual model of collaborative intelligence. A formal rotation with the midwife was constructed for the first-year resident on the labor and delivery unit, providing care to intrapartum and postpartum women and families. The program included didactic and clinical teaching, with an emphasis on the normal physiologic process of birth and introduction to the midwifery scope of practice and philosophy of care. Formative evaluation of the clinical rotation demonstrated strong interest for continuation of the program and an ability to appreciate midwifery components of care in a limited exposure. Moreover, program development was successful without requiring large curricular changes for the resident. Future planning includes expansion of the program with increased emphasis on the postpartum and breastfeeding woman and continued program evaluation. The long-term success of such collaborations will depend on the continued support of the American College of Nurse-Midwives and the American Congress of Obstetricians and Gynecologists in developing and improving interdisciplinary educational teams. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. Copyright © 2015 by the American College of Nurse-Midwives.

Arai, H., et al. (2015). "Japan as the front-runner of super-aged societies: Perspectives from medicine and medical care in Japan." Geriatrics & Gerontology International 15(6): 673-687.
	BackgroundThe demographic structure of a country changes dramatically with increasing trends toward general population aging and declining birth rates. In Japan, the percentage of the elderly population (aged 65 years) reached 25% in 2013; it is expected to exceed 30% in 2025 and reach 39.9% in 2060. The national total population has been decreasing steadily since its peak reached in 2008, and it is expected to fall to the order of 80 million in 2060. Of the total population, those aged 75 years accounted for 12.3% as of 2013, and this is expected to reach 26.9% in 2060. As the demographic structure changes, the disease structure changes, and therefore the medical care demand changes. To accommodate the medical care demand changes, it is necessary to secure a system for providing medical care. Japan has thus far attained remarkable achievements in medical care, seeking a better prognosis for survival; however, its medical care demand is anticipated to change both qualitatively and quantitatively. As diseases in the elderly, particularly in the old-old population, are often intractable, conventional medical care must be upgraded to one suitable for an aged society. What is required to this end is a shift from cure-seeking medical care focusing on disease treatment on an organ-specific basis to cure and support-seeking medical care with treatments reprioritized to maximize the quality of life (QOL) for the patient, or a change from hospital-centered medical care to community-oriented medical care in correlation with nursing care and welfare. Current situation and problem Necessity for a paradigm shift to cure-and-support seeking medical care In addition to the process of aging with functional deterioration of multiple organs, the elderly often suffer from systemically disordering diseases, such as lifestyle-related diseases, as well as geriatric syndrome and daily activity dysfunction; therefore, integrated and comprehensive medical care is required. In addition, with regard to diseases in the elderly, not only their acute stage, but also their chronic and intermediate stages must be emphasized in their treatment. Aiming to achieve a complete cure of disease by exploring the cause and implementing radical treatment, the conventional medical care model is difficult to apply to the medical care of the elderly; medical care suitable for the elderly is required. Spread of home-based care and the necessity for human resources development Many elderly people want to continue to live in their house and their community where they have been living for a long time, even with disease. There are increasing needs for QOL-emphasizing home-based care for patients in the intermediate stage after completion of acute stage treatment, or for end-of-life care. Hence, there is a demand for a shift to community-oriented medical care for providing comprehensive care supported with medical and nursing resources available in the community. As the percentage of the elderly population (aged 65 years) and the availability of medical care resources vary considerably among different regions, it is important that specialists in the fields of public health, medical care, nursing care, and welfare work on establishing a collaborative system suitable for the local characteristics of each region by making the best use of their own specialties. Necessity for establishing a department of gerontology or geriatric medicine at each medical school In line with the increasing number of elderly people, it is necessary to upgrade the systems for educating and nurturing physicians engaged in healthcare and nursing care for the elderly. It is also necessary to develop the organic cooperation with other medical and nursing care professionals, such as registered nurses and care workers. At present, just approximately 30% of medical schools in Japan have a department specializing in medical care for the elderly and relevant medical education; there is an urgent need to improve the situation, as the majority of universities do not provide any such education. Necessity for establishing a medical center for promoting medical care provider collaboration, multidisciplinary training and a means to increase public awareness In the medical care for the elderly, comprehensive care must be provided from the viewpoints of both healthcare and nursing care; to improve the quality of such care services, multidisciplinary collaboration and team-based medicine are indispensable. Therefore, physicians, nurses, therapists, pharmacists, dieticians, care managers, and other health care professionals who have thorough knowledge about medical care for the elderly are of utmost necessity. In reality, however, the collaboration of these health care professionals is unsatisfactory, and the degree of understanding of team-based medicine by each medical professional is low. Therefore, as in the case of the establishment of cancer centers within individual regions to promote medical care for cancer, there is a demand to nurture professionals engaged in medical care for the elderly, and to establish a core facility for the promotion of multidisciplinary collaboration and team-based medicine for each region. Do the people understand the paradigm shift? Currently, not only healthcare professionals, but also many citizens seek cure-seeking medical care aiming at a restoration of organ function; however, surveys of the elderly often show that they want to restore independent daily activity, rather than to achieve a cure. In contrast, in the actual medical care setting, contradictory situations prevail in which the public awareness of the shift to cure-and-support seeking medical care is unsatisfactory, including the fact that the majority of recipients of tertiary emergency care are elderly patients. (1)(2)(3)(4)(5) Contents of the proposalThe Science Council of Japan has the task to propose future visions for the Japanese aging society not only from the viewpoint of the health of each individual, but also from a broader perspective, taking into account the relationship between humans and society. Various issues related to general population aging are posing serious problems, which require prompt resolution. Although we made a number of proposals at the 21st Subcommittee for Aging, the situation has not changed satisfactorily. Accordingly, the present proposals on specific solutions were designed.<list list-type="custom" id="ggi12450-list-0002"> In a super-aged society, a paradigm shift to cure-and-support seeking medical care should be implemented A super-aged society will consist of an unprecedented demographic structure in which the percentage of only those people aged 75 years will increase in the entire population. Therefore, there is an urgent need to prepare for increasing populations of persons in need of long-term care and those who are likely to become in need of long-term care. Given the consideration that patients are not merely sick persons, but rather living persons, a paradigm shift from conventional cure-seeking medical care to cure and support-seeking medical care must be implemented. Facilitate a paradigm shift to community-oriented medical care, and promote the activity of female physicians in the medical care for the elderly A paradigm shift should be promptly facilitated by reorganizing hospital functions and establishing a community comprehensive care system for home-based care to promote the participation of the elderly by themselves in care-supporting society. To further promote the collaboration of medical care and welfare, not only persons in charge of actual regional settings, but also university schools of medicine and regional core medical institutions experienced in medical care for the elderly should take the initiative to promote home-based care and facilitate a paradigm shift to community-oriented medical care. In addition, programs should also be developed to re-educate female physicians who became housewives in order to nurture them to become facilitators of geriatric medicine. Physicians who are required at local medical facilities must be nurtured through the establishment of a department of gerontology or geriatric medicine at each medical school To facilitate efficient medical care services, medical education and research, and human resources development in support of expected paradigm shifts, it is considered that a department of gerontology or geriatric medicine should be established at each medical school. Furthermore, it is necessary to allocate dedicated teachers of medical care for the elderly to all medical schools, as well as to upgrade practice-participatory drills and to collaborate with a broad range of entities, including local medical institutions, and welfare and nursing care facilities. Efforts must be made to nurture locally wanted physicians through specific efforts concerning team-based medicine. Promote the establishment of centers for geriatrics and gerontology (provisional name) for medical care collaboration, multidisciplinary training, and a means to increase public awareness To promote the uniform accessibility of expertise on efficient medical care that is best suited for a super-aged society, it is necessary to build a post-graduation educational system under the initiatives of the Japan Geriatrics Society and the National Center for Geriatrics and Gerontology across the nation in cooperation with regional medical schools and the Japan Medical Association. Furthermore, at least one hospital serving as a center for geriatrics and gerontology should be established in each regional block (Hokkaido, Tohoku, Koshinetsu, Hokuriku/Tokai, Kinki, Chushikoku and Kyushu/Okinawa) by making the best use of existing hospitals. By establishing these centers, uniform accessibility for the quality of medical care for the elderly in each region is expected. Public awareness should be raised to adapt to the paradigm shifts It is necessary to stimulate nationwide discussion on the significance for each citizen of paradigm shifts, such as from cure-seeking medical care to cure and support-seeking medical care, and from restoration of organ function to the maintenance and restoration of daily activity. To make the arguments more fruitful, the Japan Geriatrics Society and the National Center for Geriatrics and Gerontology should take the initiative of carrying out awareness-raising activity, and not only the medical world, but also the mass media, administration and the educational sector, from elementary to higher education, should play their respective roles. Geriatr Gerontol Int 2015; 15: 673-687.

Araujo, A., et al. (2009). "Management of transfusional iron overload in Latin America: current outlook and expert panel recommendations." Hematology 14(1): 22-32.
	The results of a meeting of physicians convening in Latin America to develop expert opinions on the diagnosis, monitoring and treatment of iron overload are as follows. An accurate diagnosis can be obtained by neonatal screening for haemoglobinopathies, especially sickle cell disease and the thalassaemias. Disease-specific registries are needed to demonstrate the extent of the problem to health authorities. Disparities in the quantity and quality of blood products must be addressed, and uniform transfusion guidelines are necessary. Serum ferritin level is a feasible marker for iron overload in the region, while magnetic resonance imaging assessment can improve the diagnosis and monitoring of cardiac and liver iron content. Medical specialists, including radiologists, pathologists and others, and health authorities, can help to implement these methods and provide adequate resources. The recently available oral deferasirox can be used to conveniently administer iron chelation to transfusional iron-overloaded patients.

Arbel, R. and D. Greenberg (2016). "Rethinking cost-effectiveness in the era of zero healthcare spending growth." International Journal for Equity in Health 15: 7.
	Background: The global economic crisis imposes severe restrictions on healthcare budgets, limiting the coverage of new interventions, even when they are cost-effective. Our objective was to develop a tool that can assist decision-makers in comparing the impact of medical intervention alternatives on the entire target population, under a pre-specified budget constraint. Methods: We illustrated the tool by using a target population of 1,000 patients, and a budget constraint of $1,000,000. We compared two intervention alternatives: the current practice that costs $1,000 and adds 0.5 quality-adjusted-life-years (QALYs) per patient and a new technology that costs 100 % more, and provides 20 % more QALYs per patient. We also developed a formula for defining the maximum premium price for a higher-cost/higher-effectiveness intervention that can justify its adoption under a constrained budget. Results: Using the new therapy will add 300 QALYs, compared to 500 QALYS when using the lower-cost, lower-effective intervention, despite a favorable incremental cost-effectiveness ratio (ICER) of $ 10,000. The maximum price for the higher-efficacy therapy that will preserve the target population outcomes is 20 % higher than the lower-cost therapy. Conclusions: Although an intervention associated with higher costs and higher efficacy may have an acceptable ICER, it could provide inferior outcomes in the target population under budget constraints, depending on the relative effectiveness and costs of the interventions. The cost premium that can be justified for a higher-efficacy intervention is directly correlated to its effectiveness premium. Using the proposed tool may assist decision-makers in improving overall healthcare outcomes, especially in times of economic downturn.

Arbour, M. W., et al. (2015). "Innovative uses of technology in online midwifery education." Journal of Midwifery & Women's Health 60(3): 278-282.
	Women's health care in the United States is at a critical juncture. There is increased demand for primary care providers, including women's health specialists such as certified nurse-midwives/certified midwives, women's health nurse practitioners, and obstetrician-gynecologists, yet shortages in numbers of these providers are expected. This deficit in the number of women's health care providers could have adverse consequences for women and their newborns when women have to travel long distances to access maternity health care. Online education using innovative technologies and evidence-based teaching and learning strategies have the potential to increase the number of health care providers in several disciplines, including midwifery. This article reviews 3 innovative uses of online platforms for midwifery education: virtual classrooms, unfolding case studies, and online return demonstrations of clinical skills. These examples of innovative teaching strategies can promote critical and creative thinking and enhance competence in skills. Their use in online education can help enhance the student experience. More students, including those who live in rural and underserved regions and who otherwise might be unable to attend a traditional onsite campus, are provided the opportunity to complete quality midwifery education through online programs, which in turn may help expand the women's health care provider workforce. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. Copyright © 2015 by the American College of Nurse-Midwives.

Armstrong, B., et al. (2009). Technical and architectural issues in deploying electronic health records (EHRs) over the WWW. 2009 Conference on Advances in Information Technology and Communication in Health: Revolutionizing Health Care with Informatics - From Research to Practice, ITCH 2009, Victoria, BC.
	In this paper technical and architectural issues are described in deploying electronic health records (EHRs) over the WWW. The project described involved deployment of EHRs that have been designed to serve in the education of health professionals and health/biomedical informaticians. In order to allow for ubiquitous access to a range of EHRs remotely an architecture was designed with three layers: (a) the "Internet" or remote user access layer (2) the "Perimeter Network", or middle firewall security and authentication layer (3) the "HINF EHR Network", consisting of the internal servers hosting EHR applications and databases. The approaches allow for a large number of remote users running a range of operating systems to access the educational EHRs from any location remotely. Virtual machine (VM) technology is employed to allow multiple versions and platforms of operating systems to be installed side-by-side on a single server. Security, technical and budgetary considerations are described as well as past and current applications of the architecture for a number of projects for the education of health professionals in the area of electronic health records. © 2009 ITCH 2009 Steering Committee and IOS Press. All rights reserved.

Armstrong, E. G. and S. J. Barsion (2013). "Creating "Innovator's DNA" in Health Care Education." Academic Medicine 88(3): 343-348.
	Serious deficits in health care education have been identified recently, yet proposed solutions call for faculty skill sets not typically developed in health professional schools or in continuing professional development (CPD) programs. The authors propose that addressing the oft-cited problems in health care education (e.g., it is not learner-centered and does not take advantage of insights gained from the learning sciences) requires faculty to develop "innovator's skills" including the ability to facilitate organizational change. Given increased social responsibilities and decreased financial resources, it is imperative that more health care educators and health care delivery system leaders not only become innovators themselves but also develop systems that support the next generation of innovators. Dyer et al conducted a comprehensive study of successful innovators and found five behavioral and cognitive "discovery" skill sets that constitute the "innovator's DNA": associating, questioning, observing, networking, and experimenting. This article uses the prism of innovator's DNA to examine a CPD program for health care educators, the Harvard Macy Institute (HMI), whose overarching purpose is to develop innovation skills in participants so that they can build their own educational models customized for implementing changes in their home institutions. A retrospective review of HMI alumni from 1995 to 2010 suggests that innovator skills can be taught and applied. The conceptual framework of the innovator's DNA provides a useful model for other CPD program leaders seeking to enable health care educators to develop the capacity for successfully examining problems and then customizing and implementing organizational change to solve them.

Armstrong, K., et al. (2013). "Academic General Internal Medicine: A Mission for the Future." Journal of General Internal Medicine 28(6): 845-851.
	After five decades of growth that has included advances in medical education and health care delivery, value cohesion, and integration of diversity, we propose an overarching mission for academic general internal medicine to lead excellence, change, and innovation in clinical care, education, and research. General internal medicine aims to achieve health care delivery that is comprehensive, technologically advanced and individualized; instills trust within a culture of respect; is efficient in the use of time, people, and resources; is organized and financed to achieve optimal health outcomes; maximizes equity; and continually learns and adapts. This mission of health care transformation has implications for the clinical, educational, and research activities of divisions of general internal medicine over the next several decades.

Arora, C., et al. (2016). "The Intensive Care Lifeboat: a survey of lay attitudes to rationing dilemmas in neonatal intensive care." Bmc Medical Ethics 17: 9.
	Background: Resuscitation and treatment of critically ill newborn infants is associated with relatively high mortality, morbidity and cost. Guidelines relating to resuscitation have traditionally focused on the best interests of infants. There are, however, limited resources available in the neonatal intensive care unit (NICU), meaning that difficult decisions sometimes need to be made. This study explores the intuitions of lay people (non-health professionals) regarding resource allocation decisions in the NICU. Methods: The study design was a cross-sectional quantitative survey, consisting of 20 hypothetical rationing scenarios. There were 119 respondents who entered the questionnaire, and 109 who completed it. The respondents were adult US and Indian participants of the online crowdsourcing platform Mechanical Turk. Respondents were asked to decide which of two infants to treat in a situation of scarce resources. Demographic characteristics, personality traits and political views were recorded. Respondents were also asked to respond to a widely cited thought experiment involving rationing. Results: The majority of respondents, in all except one scenario, chose the utilitarian option of directing treatment to the infant with the higher chance of survival, higher life expectancy, less severe disability, and less expensive treatment. As discrepancy between outcomes decreased, however, there was a statistically significant increase in egalitarian responses and decrease in utilitarian responses in scenarios involving chance of survival (P = 0.001), life expectancy (P = 0.0001), and cost of treatment (P = 0.01). In the classic 'lifeboat' scenario, all but two respondents were utilitarian. Conclusions: This survey suggests that in situations of scarcity and equal clinical need, non-health professionals support rationing of life-saving treatment based on probability of survival, duration of survival, cost of treatment or quality of life. However, where the difference in prognosis or cost is very small, non-health professionals preferred to give infants an equal chance of receiving treatment.

Arrington, B., et al. (2008). "Building a local agenda for dissemination of research into practice." Journal of Public Health Management and Practice 14(2): 185-192.
	Across North America and in other parts of the world, there has been a growing Recognition that a large gap exists between public health knowledge generated through scientific discovery and its application in individual, community, organizational, and policy innovation. An academic-funder partnership sought to identify potential actions to improve the translation of public health Research to practice in Missouri. Concept mapping, a structured conceptualization process, was used to develop information to support a local action planning effort to improve Research translation to practice in Missouri. Nine conceptual clusters emerged: (1) provide education and training; (2) enhance capacity; (3) change incentives and accountability; (4) shift funding toward community needs; (5) support practice-based Research; (6) engage and collaborate with the community; (7) share knowledge; (8) engage influentials; and (9) sustain momentum; action plans were drafted to address priorities in each cluster. The project connected the ideas of a wide-ranging set of stakeholders, identified areas of high-level agreement among stakeholders, and supported shared agenda setting. © 2008 Lippincott Williams & Wilkins, Inc.

Arriola, K. R. J., et al. (2001). "A collaborative effort to enhance HIV/STI screening in five county jails." Public Health Reports 116(6): 520-529.
	Funding from the Centers for Disease Control and Prevention and the Health Resources and Services Administration (HRSA) supports collaborations among health departments (CA, FL, GA, IL, MA, NJ, NY), correctional facilities, and community-based organizations to improve services to HIV-infected inmates, particularly as they return to the community. Additionally, HRSA funded the Evaluation and Program Support Center to guide the implementation of a multi-site evaluation of the Corrections Demonstration Project (CDP). The authors present a model approach to the problem of health disparities that involves forging collaborations among federal funders, public health departments, corrections, community-based organizations, and the scientific research community. They show how such collaboration can promote the reduction of racial/ethnic health disparities. The authors examined disease screening activities in five county jails. Screening for HIV and other sexually transmitted infections (STIs) was offered during the medical intake process and during HIV prevention education sessions. One thousand twenty inmates were tested from July 1, 2000, through December 31, 2000, for HIV infection, and 171 (17%) positive cases were identified (largely due to confirmatory testing). Of HIV-positive inmates, 83 (49%) were started on antiretroviral treatment. Additionally, 2,160 were tested for chlamydia, 1,327 for gonorrhea (largely duplicated), and 937 (duplicated) for syphilis. Across all three STIs, 78% of those who tested positive were treated. The remaining 22% either declined treatment, were released prior to notification of results, or were released prior to starting treatment. The CDP offers a model approach for addressing the poor health status of members of racial/ethnic minority groups by developing collaborations between corrections, public health departments, community-based organizations, and academia. An outgrowth of this collaboration is the improved capacity to detect and treat disease, which is a necessary component of a comprehensive HIV risk reduction program.

Arrossi, S., et al. (2008). "Social inequality in Pap smear coverage: identifying under-users of cervical cancer screening in Argentina." Reproductive Health Matters 16(32): 50-58.
	In Argentina, the unequal distribution of the burden of cervical cancer is striking: the mortality rate of the province of Jujuy (15/100,000) is almost four times higher than that of the city of Buenos Aires (4/100,000). We aimed to establish the socio-demographic profile of women who were under-users of Pop smear screening, based on an analysis of a representative sample of Argentinean women from the First Notional Survey on Risk Factors in 2005. We found that in Argentina, women who are poor, unmarried, unemployed or inactive, with lower levels of education and reduced access to health care, and women over the age of 65, were under-users of screening. Screening must not remain opportunistic. Strategies must incorporate the needs and perceptions of socially disadvantaged women, and increase their access to screening. Of utmost importance is to provide good quality screening and treatment services that reach women who ore at risk. Pilot projects using new, alternative technologies should be encouraged in less developed parts of the country. Promotion among health professionals of the scientific basis and effectiveness of each screening modality is essential to reduce wasteful practices Such as annual screening and screening of young women that waste resources and fail to reduce cervical cancer incidence and mortality rates. (C) 2008 Reproductive Health Matters. All rights reserved.

Aryal, K. R. and J. Pereira (2014). "E Learning in Surgery." Indian Journal of Surgery 76(6): 487-493.
	E learning means use of electronic media and information technologies in education. Virtual learning environment (VLE) provides learning platforms consisting of online tools, databases and managed resources. This article is a review of use of E learning in medical and surgical education including available evidence favouring this approach. E learning has been shown to be more effective, less costly and more satisfying to the students than the traditional methods. E learning cannot however replace direct consultant supervision at their place of work in surgical trainees and a combination of both called blended learning has been shown to be most useful. As an example of university-based qualification, one such programme is presented to clarify the components and the process of E learning. Increasing use of E learning and occasional face to face focussed supervision by the teacher is likely to enhance surgical training in the future.

Asadzadeh, V. F., et al. (2011). "Opportunity for Breast Cancer Screening in Limited Resource Countries: a Literature Review and Implications for Iran." Asian Pacific Journal of Cancer Prevention 12(10): 2467-2475.
	Young age at occurrence and advanced tumour stage at diagnosis should urge health policy makers to focus on strategies that will help to reduce breast cancer burden in Iran. However, fundamental knowledge to select the optimal control strategy is limited. In this review paper we summarize considerations for launching a successful mass screening program in Iran using a thorough search of the literature focusing on screening activities for breast cancer in limited resource countries (LRCs). The Pubmed and Web of Knowledge databases were used for literature searches with the terms "breast neoplasm" and "screening" in combination with "limited resource countries", or "developing countries". In addition, the bibliographies of selected references were also searched and utilized. More than 200 articles were found from 2005 to June 2011, of which 96 met the inclusion criteria. Papers were reviewed and categorized as follows: necessity and adoption of screening guidelines in LRCs (n=44); pilot implementation and barriers to screening program in LRCs (n=25); knowledge and attitudes on breast cancer and screening behaviour in LRCs (n=27). The results of the reviewed studies show that the rising trend of breast cancer incidence in LRCs has made it a health priority. Financial constraints to implement mammography screening in LRCs promote the use of alternative but less accurate screening modalities such as physical breast examination. Starting a breast cancer screening program in LRCs faces several challenges related to country's resources status, health service capacity and community awareness. Conservative attitudes toward women, fatalism and misconception on breast cancer risk factors and screening behaviour could seriously prohibit women's participation. In conclusion, given the lack of quantitative information and implementation research on breast cancer control in Iran, our ability to give a clear advice for breast cancer screening in Iran is limited. Iran should adopt a tailor-made strategy for mass screening with great emphasis on reducing the number of advanced stage tumours or "down-staging". Combination of two approaches, clinical breast examination (CBE) and mammography would be promising given the increased competence of health care professional and public awareness. Equally important, a control plan should be started small and expanded gradually.

Asch, D. A., et al. (2014). "Insourcing health care innovation." New England Journal of Medicine 370(19): 1775-1777.
	
Asch, D. A. and D. F. Weinstein (2014). "Innovation in medical education." New England Journal of Medicine 371(9): 794-795.
	
Asemota, O. A. and P. Klatsky (2015). "Access to Infertility Care in the Developing World: The Family Promotion Gap." Seminars in Reproductive Medicine 33(1): 17-22.
	Infertility in resource-poor settings is an overlooked global health problem. Although scarce health care resources must be deployed thoughtfully, prioritization of resources may be different for recipient and donor countries, the latter of whom focus on maternal health care, prevention, and family planning. For women and couples with involuntary childlessness, the negative psychosocial, sociocultural, and economic consequences in low-income countries are severe, possibly more so than in most Western societies. Despite the local importance of infertility, few resources are committed to help advance infertility care in regions like sub-Saharan Africa. The worldwide prevalence of infertility is remarkably similar across low-, middle-, and high-income countries. The World Health Organization (WHO) recognizes infertility as a global health problem and established universal access to reproductive health care as one of the United Nation's Millennium Developmental Goals for 2015. Currently, access to infertility care is varied and is usually only attainable by the very wealthy in low-income countries. We provide an overview on the current state of access to infertility care in low-income countries such as in sub-Saharan Africa and a rationale for providing comprehensive reproductive care and possible solutions for providing cost-effective infertility services in these settings.

Asgari, M. M., et al. (2014). "Comparing characteristics of melanoma cases arising in health maintenance organizations with state and national registries." Melanoma Research 24(4): 381-387.
	Datasets from large health maintenance organizations (HMOs), particularly those with established cancer registries that report to the Surveillance, Epidemiology, and End Results program, are potentially excellent resources for studying melanoma epidemiology and outcomes. However, generalizability of the findings beyond HMO-based populations has not been well studied. We compared melanoma patient, tumor, and treatment characteristics at Kaiser Permanente Northern California and Henry Ford Healthcare Systems with those of corresponding regional, state, and national registry-reported melanoma databases. We identified all melanoma cases diagnosed at Kaiser Permanente Northern California (1996-2009) and Henry Ford Healthcare Systems (1996-2007) and ascertained patient (age, sex, race, and ethnicity), tumor (site, size, laterality, invasiveness, depth, ulceration, subtype, and stage), and treatment (surgery and radiation) variables from health system cancer registries. Registry data were obtained from Surveillance, Epidemiology, and End Results databases for the reporting period ending in November 2011. We found that melanoma cases arising in HMO settings generally have comparable patient, tumor, and treatment characteristics to regional, state, and national cases. An important difference included improved reporting of race information at HMO sites. Melanoma studies using data derived from select HMOs are potentially generalizable to local, state, and national populations, and may be better situated for studying racial-ethnic disparities. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

Asgary, R., et al. (2012). "Lack of patient risk counselling and a broader provider training affect malaria control in remote Somalia Kenya border: Qualitative assessment." Global Public Health 7(3): 240-252.
	Effectiveness of providing health education solely via mass media and the providers' targeted training in malaria control needs further exploration. During pre-epidemic season, we conducted a qualitative study of 40 providers and community leaders using focus groups, comprehensive semi-structured interviews and consultation observations. Interviews were transcribed, coded and analysed for major themes. Community leaders believe that they can acquire malaria from contaminated water, animal products, air or garbage. Consequently, they underutilise bed nets and other protective measures due to perceived continued exposure to other potential malaria sources. Practitioners do not provide individualised health counselling and risk assessment to patients during sick visits, leading to a range of misconceptions about malaria based on limited knowledge from rumours and mass media, and a strong belief in the curative power of traditional medicine. Providers overdiagnose malaria clinically and underutilise available tests due to time constraints, and the lack of training and resources to correctly diagnose other illnesses. Subsequently, misdiagnoses lead them to question the efficacy of recommended treatments. Promoting counselling during clinical encounters to address patient misconception and change risky behaviour is warranted. Wider-ranging ongoing training could enable providers to properly diagnose and manage differential diagnoses to manage malaria better.

Asgary, R. and E. Junck (2013). "New trends of short-term humanitarian medical volunteerism: professional and ethical considerations." Journal of Medical Ethics 39(10): 625-631.
	Short-term humanitarian medical volunteerism has grown significantly among both clinicians and trainees over the past several years. Increasingly, both volunteers and their respective institutions have faced important challenges in regard to medical ethics and professional codes that should not be overlooked. We explore these potential concerns and their risk factors in three categories: ethical responsibilities in patient care, professional responsibility to communities and populations, and institutional responsibilities towards trainees. We discuss factors increasing the risk of harm to patients and communities, including inadequate preparation, the use of advanced technology and the translation of Western medicine, issues with clinical epidemiology and test utility, difficulties with the principles of justice and clinical justice, the lack of population-based medicine, sociopolitical effects of foreign aid, volunteer stress management, and need for sufficient trainee supervision. We review existing resources and offer suggestions for future skill-based training, organisational responsibilities, and ethical preparation.

Ash, J. S. and D. W. Bates (2005). "Factors and forces affecting EHR system adoption: report of a 2004 ACMI discussion." Journal of the American Medical Informatics Association 12(1): 8-12.
	After the first session of the American College of Medical Informatics 2004 retreat, during which the history of electronic health records was reviewed, the second session served as a forum for discussion about the state of the art of EHR adoption. Adoption and diffusion rates for both inpatient and outpatient EHRs are low for a myriad of reasons ranging from personal physician concerns about workflow to broad environmental issues. Initial recommendations for addressing these issues include providing communication and education to both providers and consumers and alignment of incentives for clinicians.

Asher, L., et al. (2016). "Community-based Rehabilitation Intervention for people with Schizophrenia in Ethiopia (RISE): study protocol for a cluster randomised controlled trial." Trials [Electronic Resource] 17: 14.
	Background: Care for most people with schizophrenia is best delivered in the community and evidence-based guidelines recommend combining both medication and a psychosocial intervention, such as community-based rehabilitation. There is emerging evidence that community-based rehabilitation for schizophrenia is effective at reducing disability in middle-income country settings, yet there is no published evidence on the effectiveness in settings with fewer mental health resources. This paper describes the protocol of a study that aims to evaluate the effectiveness of community-based rehabilitation as an adjunct to health facility-based care in rural Ethiopia. Methods: This is a cluster randomised trial set in a rural district in Ethiopia, with sub-district as the unit of randomisation. Participants will be recruited from an existing cohort of people with schizophrenia receiving treatment in primary care. Fifty-four sub-districts will be randomly allocated in a 1: 1 ratio to facility-based care plus community-based rehabilitation (intervention arm) or facility-based care alone (control arm). Facility-based care consists of treatment by a nurse or health officer in primary care (antipsychotic medication, basic psychoeducation and follow-up) with referral to a psychiatric nurse-led outpatient clinic or psychiatric hospital when required. Trained community-based rehabilitation workers will deliver a manualised community-based rehabilitation intervention, with regular individual and group supervision. We aim to recruit 182 people with schizophrenia and their caregivers. Potential participants will be screened for eligibility, including enduring or disabling illness. Participants will be recruited after providing informed consent or, for participants without decision-making capacity, after the primary caregiver gives permission on behalf of the participant. The primary outcome is disability measured with the 36-item WHO Disability Assessment Schedule (WHODAS) version 2.0 at 12 months. The sample size will allow us to detect a 20 % difference in WHODAS 2.0 scores between treatment arms with 85 % power. Secondary outcomes include change in symptom severity, economic activity, physical restraint, discrimination and caregiver burden. Discussion: This is the first trial of community-based rehabilitation for schizophrenia and will determine, as a proof of concept, the added value of community-based rehabilitation compared to facility-based care alone in a low-income country with scarce mental health resources. Trial registration: Clinical Trials.gov Identifier NCT02160249. Registered on 3 June 2014.

Ashing, K., et al. (2014). "Towards developing a bilingual treatment summary and survivorship care plan responsive to Spanish language preferred breast cancer survivors." Journal of Cancer Survivorship 8(4): 580-594.
	Treatment summary and survivorship care plan studies are at the forefront of research priorities with precedence for ethnic minority inclusion. This preliminary study joined the advocacy, scientific, and medical communities to inform the development and evaluation of the Treatment Summary and Survivorship Care Plan (TSSCP-S) template targeted for Latino breast cancer patients (LCA). The development of the TSSCP-S began as modifications to the American Society of Cancer Oncology (ASCO) (TSSCP-ASCO) template via a transcreation process informed by 12 LCA survivors/advocates, and evaluated by 10 survivor/advocates and health professionals. The TSSCP-S template development was guided by the Shared Care, Psychooncology Models, and Contextual Model of Health Related Quality of Life. The bilingual TSSCP-S was independently evaluated by bilingual, survivor/advocates, and health professionals (n = 10). Preliminary analyses indicate that the TSSCP-S template was rated more favorably than the TSSCP-ASCO on the following domains: content (p = 0.02), clarity (p = 0.02), utility (p = 0.04), cultural and linguistic responsiveness (p = 0.03), and socioecological responsiveness (p = 0.01). Evaluators noted that the TSSCP-S template was more patient-centered, and endorsed the acceptability as well as the potential utility and applicability of the bilingual TSSCP-S template to appropriately guide surveillance and follow-up care. Our findings indicate that the TSSCP-S achieved clinical, cultural, and linguistic responsiveness relevant to Latinos. Patient-centered TSSCP that are presented in a bilingual format are necessary to achieve the intended goals of TSSCP including appropriate patient information, education, and resources pertaining to their treatment, potential side effects, and recommended surveillance and follow-up care for English language limited patients. Additionally, our culturally responsive TSSCP-S development framework offers a model for TSSCP template development for targeted and underserved populations, including ethnic and linguistic minority cancer survivors. These data support the development and evaluation of a TSSCP targeted to an underserved, high-risk population, LCAs. Identifying methods to improve surveillance and follow-up guideline adherence may lead to improved clinical cancer outcomes and quality of life.

Ashing-Giwa, K. L. T., et al. (2010). "Diagnostic and Therapeutic Delays Among a Multiethnic Sample of Breast and Cervical Cancer Survivors." Cancer 116(13): 3195-3204.
	BACKGROUND: Several publications reporting on health disparities document that ethnic minorities disproportionately experience delays in healthcare access, delivery, and treatment. However, few studies examine factors underlying access and receipt of healthcare among cancer survivors. from the patient perspective. This study explores diagnostic and therapeutic care delays among a multiethnic sample of breast and cervical cancer survivors and examines contextual factors influencing diagnostic and therapeutic care delays. METHODS: Population-based sampling and a cross-sectional design were used to recruit 1377 survivors (breast cancer, n=698; cervical cancer, n=679). This multiethnic sample included 449 European American, 185 African American, 468 Latina American, and 275 Asian American survivors. RESULTS: Latina Americans were more likely to report diagnostic delays (P=.003), whereas African Americans were more likely to report therapeutic delays (P=.007). In terms of cancer type, cervical cancer survivors were more likely to report diagnostic (P=.004) and therapeutic delays (P=.000) compared with breast cancer survivors. "Fear of finding cancer" was the most frequently cited reason for diagnostic delays, and "medical reasons" were most frequently cited for therapeutic delays. CONCLUSIONS: Due in part to a higher proportion of diagnostic and therapeutic delays, ethnic minorities endure greater cancer burden, including poorer survival and survivorship outcomes. The medical community must recognize the impact of existing psychological and cultural dimensions on diagnostic care, as well as the personal and healthcare system level barriers that contribute to therapeutic delays. Cancer 2010;116:3195-204. (C) 2010 American Cancer Society.

Ashkenazy, R. and M. J. Abrahamson (2006). "Medicare coverage for patients with diabetes - A national plan with individual consequences." Journal of General Internal Medicine 21(4): 386-392.
	The prevalence of diabetes in the U.S. Medicare population is growing at an alarming rate. From 1980 to 2004, the number of people aged 65 or older with diagnosed diabetes increased from 2.3 million to 5.8 million. According to the Centers for Medicare and Medicaid (CMS), 32% of Medicare spending is attributed to the diabetes population. Since its inception, Medicare has expanded medical coverage of monitoring devices, screening tests and visits, educational efforts, and preventive medical services for its diabetic enrollees. However, oral antidiabetic agents and insulin were excluded from reimbursement. In 2003, Congress passed the Medicare Modernization Act that includes a drug benefit to be administered either through Medicare Advantage drug plans or privately sponsored prescription drug plans for implementation in January 2006. In this article we highlight key patient and drug plan characteristics and resources that providers may focus upon to assist their patients choose a coverage plan. Using a case example, we illustrate the variable financial impact the adoption of Medicare part D may have on beneficiaries with diabetes due to their economic status. We further discuss the potential consequences the legislation will have on diabetic patients enrolled in Medicare, their providers, prescribing strategies, and the diabetes market.

Ashton, D. M., et al. (2009). "Surgeon General's Conference on the Prevention of Preterm Birth." Obstetrics and Gynecology 113(4): 925-930.
	To address the serious and seemingly intractable problem of preterm birth, the Surgeon General's Conference on the Prevention of Preterm Birth convened many of the country's experts from the public and private sectors of research, public health, and health care delivery to discuss preventive strategies. The purpose of the conference was to increase awareness of preterm birth in the United States, review key findings and reports issued by experts in the field, and establish an agenda for activities in both the public and private sectors to mitigate the problem. The six work groups created focused on biomedical research, epidemiological research, psychosocial and behavioral factors in preterm birth, professional education and training, outreach and communication, and quality of care and health services. Several crosscutting issues between the work groups were identified, and the conference concluded with the request to the Surgeon General to make the prevention of preterm birth a national public health priority. Reaching this goal through the implementation of the conference recommendations will require new resources to create broad-based research capacity, a vigorous national vital records system, multidisciplinary intervention programs, careful study of factors contributing to racial and ethnic disparities, reinvigorated health professional and consumer education programs, and access to high-quality preconception and perinatal healthcare for all Americans. Clinicians must be adequately informed to initiate activities to prevent this serious problem. Recommendations from this conference will inform Congress and create a national agenda to address the identification of the causes, risk factors, prevention, and treatment of preterm birth.

Ashton, E. and J. Riek (2013). "Advanced MR techniques in multicenter clinical trials." Journal of Magnetic Resonance Imaging 37(4): 761-769.
	MRI has had a place in the clinical trials process for more than 20 years. However, for much of that time MRI has been used primarily for subjective interpretation and relatively straightforward structural measurements. More advanced MR techniques have been considered too difficult to implement consistently across multiple sites in a single trial - this despite the fact that these techniques often provide the best window into the direct effects of targeted therapeutics. As an example, numerous compounds are currently under development whose principle effect is to temporarily or permanently alter tumor microvasculature. Changes induced by these compounds typically manifest as reductions in blood flow and vascular permeability within tumors. These changes can be measured directly using dynamic contrast-enhanced MRI. Early studies using this technique were limited to single centers, limiting both the overall size of the studies and the rate at which they were able to accrue patients. Recent efforts, however, have demonstrated that with sufficient attention to protocol design, imaging site selection and training, and analysis standardization, it is possible to obtain consistent and high quality results using even relatively complex acquisition protocols. This article will briefly review both the benefits and the drawbacks of including advanced MR techniques in clinical trial protocols. It will then review in detail the challenges presented by the need to deploy these techniques both to large research institutions and to community imaging centers which may have little or no familiarity with them at the outset of the trial. © 2012 Wiley Periodicals, Inc.

Ashton, K., et al. (2013). "Pilot evaluation of a substance abuse prevention group intervention for at-risk bariatric surgery candidates." Surgery for Obesity and Related Diseases 9(3): 462-467.
	Background: Concerns have been raised about an increased incidence of substance abuse after bariatric surgery. Alcohol use after surgery may be particularly problematic because of changes in pharmacokinetics leading to greater intoxication. The present study evaluated a substance abuse prevention group pilot intervention for at-risk bariatric surgery candidates Methods: Patients with a history of substance abuse/dependence or at-risk substance use applying for weight loss surgery (WLS; N = 86) were referred to a single-session 90-minute intervention (67.4% female; 65.1% Caucasian; mean age 46.2 years; mean body mass index 48.77 kg/m(2)). The session included education about the health effects of alcohol/substances on WLS outcomes, developing alternative coping strategies, identifying warning signs of misuse, and providing treatment resources. Patients completed a preintervention and postintervention questionnaire measuring knowledge of substance use health effects, the Alcohol Use Disorders Identification Test-Consumption Items, and items on motivation for abstinence. Results: Patients reported a significant increase in knowledge regarding the negative effects of substance abuse after surgery (t = 42.34; P < .001). Patients also reported more healthy alternative coping strategies after the intervention (t = 18.96; P < .001). In addition, a significant number of patients reported a lower intention of consuming alcohol after surgery (chi(2) = 16.18; P < .001) and were more likely to report health reasons as motivation to abstain (chi(2) = 102.89; P < .001). Conclusions: At-risk patients applying for weight loss surgery may benefit from a substance abuse prevention intervention. More research will be needed to see if such benefits can be sustained over time and if interventions affect postsurgical behaviors. (C) 2013 American Society for Metabolic and Bariatric Surgery. All rights reserved.

Asmonga, D. (2009). "ARRA opportunities and omissions." Journal of the American Health Information Management Association 80(5): 16-18.
	
Association of Departments of Family, M., et al. (2009). "Impact of expanding use of health information technologies on medical student education in family medicine." Annals of Family Medicine 7(5): 470-471.
	
Asthana, S., et al. (2004). "The pursuit of equity in NHS resource allocation: should morbidity replace utilisation as the basis for setting health care capitations?" Social Science & Medicine 58(3): 539-551.
	Although the English NHS has been described as a world leader in pioneering methods of distributing expenditure in relation to population needs, concerns about the legitimacy of using the current utilisation-based model to allocate health service resources are mounting. In this paper, we present a critical review of NHS resource allocation in England and demonstrate the feasibility and impact of using direct health estimates as a basis for setting health care capitations. Comparing target allocations for the inpatient treatment of coronary heart disease in a sample of 34 primary care trusts in contrasting locations in England, we find that a morbidity-based model would result in a significant shift in hospital resources away from deprived areas, towards areas with older demographic profiles and towards rural areas. Discussing the findings in relation to a wider policy context that is generally concerned to direct more health care resources towards the poor, the paper concludes by calling for greater clarity between the goals of health care equity and health equity. Whilst the former demands that the legitimate needs of demographically older populations for more health care resources are acknowledged, the goal of health equity requires real political commitment to resource broader social policy initiatives. (C) 2003 Elsevier Science Ltd. All rights reserved.

Atack, L. and R. Luke (2012). "The impact of validated, online health education resources on patient and community members' satisfaction and health behaviour." Health Education Journal 71(2): 211-218.
	Objective: While access to health education information has become easier, the quality of information retrieved from the Internet varies considerably. In response to the need for accessible, quality health information that is tailored to meet individual patient needs, a patient education website, called PEPTalk, was developed. The site houses text and video material that has been validated by practicing clinicians. A study was conducted to examine patient and community members' satisfaction with PEPTalk and the impact of the health education materials on their health behaviour. Community staff and health providers' experiences with the new technology were also examined. Design and method: A descriptive study using surveys and interviews was conducted with 57 patients, community participants and clinicians living in a large Canadian city and First Nations communities in Northern Ontario. Results: Participants' PEPTalk Satisfaction scores ranged from moderately to highly satisfied. Participants found the information presented on PEPTalk useful and relevant, had improved their knowledge of health, and in most cases, altered health behaviour. Clinicians and community staff who referred participants to the PEPTalk website reported that the site provided reliable, evidence-based information that they were comfortable sharing with their patients and community members. Conclusion: There is an emerging role for tools that provide tailored health education. The health provider's role regarding interpretation, discussion and follow-up remains essential, and tools such as PEPTalk need to be part of an overall health education strategy.

Athyros, V. G., et al. (2009). "Initiative for a new diabetes therapeutic approach in a Mediterranean country: The INDEED study." Current Medical Research and Opinion 25(8): 1931-1940.
	Aim: To assess the efficacy of a strategy to improve vascular risk management in patients with type 2 diabetes mellitus (T2DM). Methods: This was a pilot best practice implementation enhancement programme that enrolled 578 patients with T2DM. A baseline visit was followed by a concerted effort from previously trained physicians to improve adherence to lifestyle advice and optimise drug treatment for all vascular risk factors. The patients were followed-up for 6 months. The UKPDS risk engine was used to estimate vascular risk in patients without established coronary heart disease (CHD) (n = 279). Results: There was an improvement in compliance to lifestyle measures and increased prescription of evidence-based medication. In patients without established CHD there was a 37% reduction in estimated risk for CHD, 44% for fatal CHD, 10% for stroke and 25% for fatal stroke (p ≤ 0.003 for all comparisons vs. baseline). There was also a substantial increase in the proportion of patients with established CHD who achieved their vascular risk factor targets. Conclusions: This is the first study to increase the adherence to multiple interventions in patients with T2DM in both primary care and hospital settings. Education of physicians and patients, distribution of guidelines/brochures, and the completion of a one-page form, motivated both physicians and patients to achieve multiple vascular risk factor goals. © 2009 Informa UK Ltd. All rights reserved.

Atkins, D., et al. (2014). "Health equity research in the veterans health administration: We've come far but aren't there yet." American Journal of Public Health 104(SUPPL. 4): S525-S526.
	
Atkins, M. S., et al. (2008). "Teacher Key Opinion Leaders and Mental Health Consultation in Low-Income Urban Schools." Journal of Consulting and Clinical Psychology 76(5): 905-908.
	Diffusion theory posits that information is disseminated throughout a social network by the persuasion of key opinion leaders (KOLs). This study examined the relative and combined influence of peer-identified KOL teachers (n = 12) and mental health providers (n = 21) on classroom teachers' (n = 61) self-reported use of commonly recommended classroom practices for children with attention-deficit/hyperactivity disorder in 6 low-income urban African American communities, relative to teachers (n = 54) at 4 matched schools who received mental health provider consultation only. Mixed-effects regression models showed that KOLs in collaboration with mental health providers promoted higher rates of teachers' self-reported use of recommended strategies than mental health providers alone, and that these effects were mediated by KOL support but not by mental health provider support. The results suggest an expanded role for KOL teachers as indigenous and natural supports for the dissemination and implementation of school-based mental health programs. © 2008 American Psychological Association.

Atkinson, N. L. (2007). "Developing a questionnaire to measure perceived attributes of eHealth innovations." American Journal of Health Behavior 31(6): 612-621.
	OBJECTIVE: To design a valid and reliable questionnaire to assess perceived attributes of technology-based health education innovations.
METHODS: College students in 12 personal health courses reviewed a prototype eHealth intervention using a 30-item instrument based upon diffusion theory's perceived attributes of an innovation.
RESULTS: Principal components analysis found 5 factors accounted for 44.4% of the variance: 29.0% (relative advantage), 9.6% (simplicity), 6.5% (trialability), 5.0% (observability), and 4.4% (translatability). Internal consistency reliability ranged from .66 to .91 for the 5 factors.
CONCLUSION: The instrument can help eHealth developers determine and improve the adoption potential of their applications throughout the development cycle.

Atkinson, N. L., et al. (2010). "Assets, Challenges, and the Potential of Technology for Nutrition Education in Rural Communities." Journal of Nutrition Education and Behavior 42(6): 410-416.
	Objective: To examine assets of and challenges to getting adequate nutrition and physical activity among low-income rural residents, and the potential for technology to provide health education. Methods: Environmental scans and community stakeholder interviews were conducted in 5 rural counties in Maryland. During environmental scans, stakeholders guided tours around each county to explore community services and resources for nutrition, physical activity and technology. In-depth interviews with stakeholders (n = 58) focused on nutrition, physical activity, and technology issues. Results: Low-income residents both benefit from and face challenges in rural settings. Besides attitude and knowledge barriers, lack of affordable resources and public transportation contributed to inattention to nutrition and physical activity. Stakeholders' reactions to a proposed Internet-based intervention were mostly favorable, but questions emerged about providing computers and Internet to individual families. Conclusions and Implications: Internet-based education may be a viable option to help low-income rural residents overcome barriers to nutrition and physical activity.

Attwood, C. A. and K. E. Wellik (2012). "Collaboration, Collegiality, and Cooperation: Consumer Health Library Services and the American Cancer Society Navigator Role." Clinical Journal of Oncology Nursing 16(5): 487-490.
	Patients and family members are overwhelmed by the diagnosis of cancer and often do not know where to look for answers, information on the treatment options, or community resources for support during the cancer journey. A unique relationship was forged with a patient and health education librarian at the Mayo Clinic in Arizona and an American Cancer Society navigator, which encouraged collaboration to better meet the informational and supportive healthcare needs of patients. This article addresses the background of the project, the steps taken to establish the relationship, space allocation, and need for confidentiality. The innovations produced by this partnership also are discussed, including development of cancer pathfinders and cancer communication blogs for patients, as well as comarketing of services.

Atun, R. and J. Bataringaya (2011). "Building a Durable Response to HIV/AIDS: Implications for Health Systems." Jaids-Journal of Acquired Immune Deficiency Syndromes 57: S91-S95.
	The remarkable rise in investments for HIV control programs in 2003-2010 enabled an unprecedented expansion of access to HIV services in low-income and middle-income countries. By the end of 2010, more than 5.2 million people were receiving antiretroviral therapy (ART), which transformed HIV infection, once a death sentence, into a long-term illness. The rapid expansion in the number of persons receiving ART means that health systems must continue to provide acute life-saving care for those with advanced HIV/AIDS although also providing chronic care services to expanding cohorts of more stable patients who are doing well on ART. This expansion also means a transition from an emergency response to the epidemic, characterized by a public health approach, to a more integrated and durable approach to HIV prevention, care, and treatment services that fosters individualized care for those requiring long-term antiretroviral treatment. Yet most low-income and middle-income countries, which have weak health systems, are poorly prepared to make this transition. In this article, we highlight the challenges health systems face in developing a sustained and durable response to HIV/AIDS. The article analyses the readiness of health systems to combine rapid expansion of ART access with long-term treatment and continuity of care for a growing cohort of patients. We argue that effective management of a transition from an emergency AIDS response to long-term programatic strategies will require a paradigm shift that enables leveraging investments in HIV to build sustainable health systems for managing large cohorts of patients receiving ART although meeting the immediate needs of those who remain without access to HIV treatment and care.

Atun, R., et al. (2015). "Expanding global access to radiotherapy." The Lancet Oncology 16(10): 1153-1186.
	Radiotherapy is a critical and inseparable component of comprehensive cancer treatment and care. For many of the most common cancers in low-income and middle-income countries, radiotherapy is essential for effective treatment. In high-income countries, radiotherapy is used in more than half of all cases of cancer to cure localised disease, palliate symptoms, and control disease in incurable cancers. Yet, in planning and building treatment capacity for cancer, radiotherapy is frequently the last resource to be considered. Consequently, worldwide access to radiotherapy is unacceptably low. We present a new body of evidence that quantifies the worldwide coverage of radiotherapy services by country. We show the shortfall in access to radiotherapy by country and globally for 2015-35 based on current and projected need, and show substantial health and economic benefits to investing in radiotherapy. The cost of scaling up radiotherapy in the nominal model in 2015-35 is US$26.6 billion in low-income countries, $62.6 billion in lower-middle-income countries, and $94.8 billion in upper-middle-income countries, which amounts to $184.0 billion across all low-income and middle-income countries. In the efficiency model the costs were lower: $14.1 billion in low-income, $33.3 billion in lower-middle-income, and $49.4 billion in upper-middle-income countries-a total of $96.8 billion. Scale-up of radiotherapy capacity in 2015-35 from current levels could lead to saving of 26.9 million life-years in low-income and middle-income countries over the lifetime of the patients who received treatment. The economic benefits of investment in radiotherapy are very substantial. Using the nominal cost model could produce a net benefit of $278.1 billion in 2015-35 ($265.2 million in low-income countries, $38.5 billion in lower-middle-income countries, and $239.3 billion in upper-middle-income countries). Investment in the efficiency model would produce in the same period an even greater total benefit of $365.4 billion ($12.8 billion in low-income countries, $67.7 billion in lower-middle-income countries, and $284.7 billion in upper-middle-income countries). The returns, by the human-capital approach, are projected to be less with the nominal cost model, amounting to $16.9 billion in 2015-35 (-$14.9 billion in low-income countries; -$18.7 billion in lower-middle-income countries, and $50.5 billion in upper-middle-income countries). The returns with the efficiency model were projected to be greater, however, amounting to $104.2 billion (-$2.4 billion in low-income countries, $10.7 billion in lower-middle-income countries, and $95.9 billion in upper-middle-income countries). Our results provide compelling evidence that investment in radiotherapy not only enables treatment of large numbers of cancer cases to save lives, but also brings positive economic benefits. © 2015 Elsevier Ltd.

Atun, R., et al. (2012). "Innovative financing for health: what is truly innovative?" Lancet 380(9858): 2044-2049.
	Development assistance for health has increased every year between 2000 and 2010, particularly for HIV/AIDS, tuberculosis, and malaria, to reach US$26.66 billion in 2010. The continued global economic crisis means that increased external financing from traditional donors is unlikely in the near term. Hence, new funding has to be sought from innovative financing sources to sustain the gains made in global health, to achieve the health Millennium Development Goals, and to address the emerging burden from non-communicable diseases. We use the value chain approach to conceptualise innovative financing. With this framework, we identify three integrated innovative financing mechanisms-GAVI, Global Fund, and UNITAID-that have reached a global scale. These three financing mechanisms have innovated along each step of the innovative finance value chain-namely resource mobilisation, pooling, channelling, resource allocation, and implementation-and integrated these steps to channel large amounts of funding rapidly to low-income and middle-income countries to address HIV/AIDS, malaria, tuberculosis, and vaccine-preventable diseases. However, resources mobilised from international innovative financing sources are relatively modest compared with donor assistance from traditional sources. Instead, the real innovation has been establishment of new organisational forms as integrated financing mechanisms that link elements of the financing value chain to more effectively and efficiently mobilise, pool, allocate, and channel financial resources to low-income and middle-income countries and to create incentives to improve implementation and performance of national programmes. These mechanisms provide platforms for health funding in the future, especially as efforts to grow innovative financing have faltered. The lessons learnt from these mechanisms can be used to develop and expand innovative financing from international sources to address health needs in low-income and middle-income countries.

Atun, R. A., et al. (2006). "Introducing a complex health innovation-Primary health care reforms in Estonia (multimethods evaluation)." Health Policy 79(1): 79-91.
	All post-Soviet countries are trying to reform their primary health care (PHC) systems. The success to date has been uneven. We evaluated PHC reforms in Estonia, using multimethods evaluation: comprising retrospective analysis of routine health service data from Estonian Health Insurance Fund and health-related surveys; documentary analysis of policy reports, laws and regulations; key informant interviews. We analysed changes in organisational structure, regulations, financing and service provision in Estonian PHC system as well as key informant perceptions on factors influencing introduction of reforms. Estonia has successfully implemented and scaled-up multifaceted PHC reforms, including new organisational structures, user choice of family physicians (FPs), new payment methods, specialist training for family medicine, service contracts for FPs, broadened scope of services and evidence-based guidelines. These changes have been institutionalised. PHC effectiveness has been enhanced, as evidenced by improved management of key chronic conditions by FPs in PHC setting and reduced hospital admissions for these conditions. Introduction of PHC reforms - a complex innovation - was enhanced by strong leadership, good co-ordination between policy and operational level, practical approach to implementation emphasizing simplicity of interventions to be easily understood by potential adopters, an encircling strategy to roll-out which avoided direct confrontations with narrow specialists and opposing stakeholders in capital Tallinn, careful change-management strategy to avoid health reforms being politicized too early in the process, and early investment in training to establish a critical mass of health professionals to enable rapid operationalisation of policies. Most importantly, a multifaceted and coordinated approach to reform - with changes in laws; organisational restructuring; modifications to financing and provider payment systems; creation of incentives to enhance service innovations; investment in human resource development - was critical to the reform success. © 2005 Elsevier Ireland Ltd. All rights reserved.

Audet, A. M., et al. (2014). "Where are we on the diffusion curve? Trends and drivers of primary care physicians' use of health information technology." Health Services Research 49(1 PART 2): 347-360.
	Objective To describe trends in primary care physicians' use of health information technology (HIT) between 2009 and 2012, examine practice characteristics associated with greater HIT capacity in 2012, and explore factors such as delivery system and payment reforms that may affect adoption and functionality. Data. We used data from the 2012 and 2009 Commonwealth Fund International Health Policy Surveys of Primary Care Physicians. The data were collected in both years by postal mail between March and July among a nationally representative sample of primary care physicians in the United States. Study Design. We compared primary care physicians' HIT capacity in 2009 and 2012. We employed multivariable logistic regression to analyze whether participating in an integrated delivery system, sharing resources and support with other practices, and being eligible for financial incentives were associated with greater HIT capacity in 2012. Principal Findings. Primary care physicians' HIT capacity has significantly expanded since 2009, although solo practices continue to lag. Practices that are part of an integrated delivery system or share resources with other practices have higher rates of electronic medical record (EMR) adoption, multifunctional HIT, electronic information exchange, and electronic access for patients. Receiving or being eligible for financial incentives is associated with greater adoption of EMRs and information exchange. Conclusions. Federal efforts to increase adoption have coincided with a rapid increase in HIT capacity. Delivery system and payment reforms and federally funded extension programs could offer promising pathways for further diffusion. © 2014 Health Research and Educational Trust.

Audrey, S., et al. (2004). "The development and implementation of a peer-led intervention to prevent smoking among secondary school students using their established social networks." Health Education Journal 63(3): 266-284.
	Objective: To design, implement and evaluate a peer-led intervention to reduce smoking amongst secondary school students. Design A health promotion intervention combining peer education with diffusion of innovation theory, to be rigorously evaluated by means of a cluster randomised controlled trial with concurrent process and economic evaluations. Setting: Year 8 students (12/13 year olds) in 30 secondary schools in south-west England and south Wales. Method: Approximately 15 per cent of students, identified by their peers as being influential within the school, were trained to intervene in everyday situations and encourage their fellow students not to smoke. These 'peer supporters' received two days of intensive training from a team of trainers led by professional health educators at training venues and four follow-up sessions back at school. The training aimed to equip the peer supporters with the knowledge, skills and confidence to encourage their peers not to smoke. Results: The intervention proved feasible and acceptable to schools. 10,731 Year 8 students were recruited to the trial at baseline. Retention of peer supporters throughout the ten-week intervention period was high. Eighty-two per cent (687 of 835) of students who consented to act as peer supporters completed the programme and fulfilled the role. The average cost per school of delivering the intervention was £4,702. Conclusion: The costs of implementing this programme were sizeable but, if effective, it could yield substantial long-term health gains and contribute to a reduction in health inequalities.

Australian Medical Workforce Advisory, C. (2000). "Innovations in medical education to meet workforce challenges." Australian Health Review 23(4): 43-59.
	The winds of change world-wide have swept medical education in the last fifteen years. Today, Australia's medical students are older and drawn from more diverse socio-economic, ethnic and geographic backgrounds than twenty years ago, and there is now an equal mix of men and women in medical school. Admission policies have been rewritten to broaden access with a range of entry options now available including direct entry from high school and graduate entry following a first degree. Curricula have been revised and modes of learning transformed. This paper describes these changes and discusses the implications for medical schools and for planning the future workforce.

Avan, B. I., et al. (2016). "District decision-making for health in low-income settings: a feasibility study of a data-informed platform for health in India, Nigeria and Ethiopia." Health Policy and Planning 31: ii3-ii11.
	Low-resource settings often have limited use of local data for health system planning and decision-making. To promote local data use for decision-making and priority setting, we propose an adapted framework: a data-informed platform for health (DIPH) aimed at guiding coordination, bringing together key data from the public and private sectors on inputs and processes. In working to transform this framework from a concept to a health systems initiative, we undertook a series of implementation research activities including background assessment, testing and scaling up of the intervention. This first paper of four reports the feasibility of the approach in a district health systems context in five districts of India, Nigeria and Ethiopia. We selected five districts using predefined criteria and in collaboration with governments. After scoping visits, an in-depth field visit included interviews with key health stakeholders, focus group discussions with service-delivery staff and record review. For analysis, we used five dimensions of feasibility research based on the TELOS framework: technology and systems, economic, legal and political, operational and scheduling feasibility. We found no standardized process for data-based district level decision-making, and substantial obstacles in all three countries. Compared with study areas in Ethiopia and Nigeria, the health system in Uttar Pradesh is relatively amenable to the DIPH, having relative strengths in infrastructure, technological and technical expertise, and financial resources, as well as a district-level stakeholder forum. However, a key challenge is the absence of an effective legal framework for engagement with India's extensive private health sector. While priority-setting may depend on factors beyond better use of local data, we conclude that a formative phase of intervention development and pilot-testing is warranted as a next step.

Avery, E., et al. (2010). "Diffusion of Social Media Among Public Relations Practitioners in Health Departments Across Various Community Population Sizes." Journal of Public Relations Research 22(3): 336-358.
	This study reports findings from a survey of 281 public relations practitioners in public health departments serving 4 distinct sizes of communitiesurban, suburban, large town, and ruralin 48 states. Based on diffusion of innovations theory, the overall purpose of the study is to examine the extent to which social media are adopted within public health agencies and moderators of adoption. Findings demonstrate overall low adoption rates for social media tools. However, significant differences were observed for adoption based on size of communities, with urban communities exhibiting highest adoption rates, followed by suburban, large town, and rural communities. The most frequently cited barrier practitioners named for why they don't think constituents would benefit from health information distributed online was lack of home access to the Internet. Among the 17 percent of practitioners who indicate they use social media to disseminate health information, the most commonly used tools are social networking sites followed by the new media release, blogs, and discussion boards. Rural areas, although lowest in overall social media use, report highest use of podcasting. Implications regarding health and health information disparities are discussed, a potentially new motivation for innovation adoption is introduced, and future studies to follow the S-shaped adoption curve are proposed.

Avidan, A. Y., et al. (2013). "The Current State of Sleep Medicine Education in US Neurology Residency Training Programs: Where Do We Go from Here?" Journal of Clinical Sleep Medicine 9(3): 281-286.
	Objective: To evaluate the current state of sleep medicine educational resources and training offered by US neurology residency programs. Methods: In 2010, a 20-item peer reviewed Sleep Education Survey (SES) was sent to neurology residency program directors surveying them about sleep medicine educational resources used in teaching residents. Pearson product momentum correlation was used to determine correlation of program attributes with resident interest in pursuing a career in sleep medicine. Results: Of the programs completing the survey, 81% listed a formal sleep rotation and 24% included a forum for sleep research. A variety of innovative approaches for teaching sleep medicine were noted. Program directors noted that 5.7% residents entered sleep medicine fellowship training programs in the preceding 5 years. Programs that had a more substantial investment in sleep medicine teaching resources were more likely to report residents entering a sleep medicine training program. Conclusion: This is the first report providing an analysis of the current state of sleep medicine training in US Neurology Residency Programs. Our data provide evidence that investment by the residency program in sleep education may enhance the ultimate decision by the neurology trainee to pursue a career in sleep medicine.

Awata, S. (2010). "New national health program against dementia in Japan: The medical center for dementia." Psychogeriatrics 10(2): 102-106.
	Herein, the Medical Center for Dementia, which was introduced in 2008 as a new national health program in Japan, is reviewed from the perspective of the recent history of the national provision against dementia and the findings of a series of studies on the current status of medical care for dementia. The Medical Center for Dementia was developed to provide special medical services for dementia and connect with other community resources in order to contribute to building a comprehensive support network for demented patients. Specifically, the Medical Center for Dementia provides the following: (i) special medical consultation; (ii) differential diagnosis and early intervention; (iii) medical treatment for the acute stage of behavioral and psychological symptoms of dementia and concurrent medical conditions; (iv) education for general practitioners and other community professionals; (v) network meetings for the establishment of medical-medical and medical-care connection; and (vi) provision of information regarding dementia to the public. Special Medical Consultation Rooms would play an important role in the efficient functioning of the Medical Center for Dementia. In cooperation with municipal governments, the Medical Center for Dementia is also expected to play an important role in policy making and to improve the local status of medical care for people with dementia.

Aydin, S. (2009). "THE ROLE OF BIOMEDICAL ENGINEERING PROFESSIONS IN MEDICAL EDUCATION." Biomedical Engineering-Applications Basis Communications 21(4): 265-270.
	In the present study, the important role of biomedical engineering (BME) professions in medical education (ME) is highlighted. We propose that BME and ME should be integrated in a joint department to provide high-quality occupational education in medicine. Then, we illustrate the basic connections and close relations between BME and ME with respect to the universal subfields of each scientific branch. As this regard, the proposed joint department in medical faculty would guide the medicine to use innovative educational tools such as humanistic models, realistic simulations, video games, web-based online resources, etc. in both basic and clinical ME. In addition, the combination of two disciplines would prepare the initiative facilities for multidisciplinary original research studies improving human health. Moreover, new trends in instructional evaluation could be captured by studying together in teams.

Ayres, R. (2007). "From serendipity to technology: use of a web-based information and booking system to improve clinical attachments at a district general hospital." Medical Teacher 29(5): 457-463.
	Background: Clinical attachments form a vital part of the learning experience for medical students but may vary in educational value. This paper describes a project intended to improve the quality of attachments at a District General Hospital in Devon, UK after negative feedback was received from students. Aims: To improve educational quality by providing information and choice for students. Method: The intervention was to set up a web-based system that allowed students to view before arrival all educational opportunities available, not only in the hospital but in the surrounding district. Students were contacted by email 2 weeks before their attachment and were then able to construct their own timetable from the menu of opportunities available. Results: The system was popular with students, recruited new providers of learning opportunities and also integrated learning across primary and secondary care. Conclusions: The intervention encouraged a sense of ownership of the learning experience as well as maximising the use of available learning resources.

Ayyoubi, M. T., et al. (2010). "Status of blood banking and the blood supply in Afghanistan." Transfusion 50(3): 566-574.
	BACKGROUND: As a result of more than 20 years of war in Afghanistan, its blood supply system has been damaged. We carried out an assessment of that blood supply system to determine the type and extent of assistance needed to increase blood availability and safety. STUDY DESIGN AND METHODS: An assessment tool was developed, daily activities in Afghanistan were observed, and key personnel were interviewed. RESULTS: Because there was no donor recruitment organization, most blood was obtained by the family replacement system. There was an inadequate supply of stored blood, which led to use of blood before screening test results for transfusion-transmitted disease were complete. Whole blood was provided but blood components were not produced. Blood was tested intermittently for human immunodeficiency virus Types 1 and 2, hepatitis B surface antigen, hepatitis C virus, and syphilis using agglutination-based screening methods. CONCLUSIONS: A dedicated staff is in place but to strengthen the blood supply system in Afghanistan, it will be important to address infrastructure and facilities, organization, standard operating methods, supplies and equipment, training, quality assurance, and transfusion medicine education.

Azer, S. A. (2012). "Can "YouTube" help students in learning surface anatomy?" Surgical and Radiologic Anatomy 34(5): 465-468.
	In a problem-based learning curriculum, most medical students research the Internet for information for their "learning issues." Internet sites such as "YouTube" have become a useful resource for information. This study aimed at assessing YouTube videos covering surface anatomy. A search of YouTube was conducted from November 8 to 30, 2010 using research terms "surface anatomy," "anatomy body painting," "living anatomy," "bone landmarks," and "dermatomes" for surface anatomy-related videos. Only relevant video clips in the English language were identified and related URL recorded. For each videotape the following information were collected: title, authors, duration, number of viewers, posted comments, and total number of days on YouTube. The data were statistically analyzed and videos were grouped into educationally useful and non-useful videos on the basis of major and minor criteria covering technical, content, authority, and pedagogy parameters. A total of 235 YouTube videos were screened and 57 were found to have relevant information to surface anatomy. Analysis revealed that 15 (27%) of the videos provided useful information on surface anatomy. These videos scored (mean +/- A SD, 14.0 +/- A 0.7) and mainly covered surface anatomy of the shoulder, knee, muscles of the back, leg, and ankle, carotid artery, dermatomes, and anatomical positions. The other 42 (73%) videos were not useful educationally, scoring (mean +/- A SD, 7.4 +/- A 1.8). The total viewers of all videos were 1,058,634. Useful videos were viewed by 497,925 (47% of total viewers). The total viewership per day was 750 for useful videos and 652 for non-useful videos. No video clips covering surface anatomy of the head and neck, blood vessels and nerves of upper and lower limbs, chest and abdominal organs/structures were found. Currently, YouTube is an inadequate source of information for learning surface anatomy. More work is needed from medical schools and educators to add useful videos on YouTube covering this area.

Azer, S. A. (2015). "Is Wikipedia a reliable learning resource for medical students? Evaluating respiratory topics." Advances in Physiology Education 39(1): 5-14.
	The aim of the present study was to critically evaluate the accuracy and readability of English Wikipedia articles on the respiratory system and its disorders and whether they can be a suitable resource for medical students. On April 27, 2014, English Wikipedia was searched for articles on respiratory topics. Using a modified DISCERN instrument, articles were independently scored by three assessors. The scoring targeted content accuracy, frequency of updating, and quality of references. The readability of articles was measured using two other instruments. The mean DISCERN score for the 40 articles identified was 26.4 +/- 6.3. Most articles covered causes, signs and symptoms, prevention, and treatment. However, several knowledge deficiencies in the pathogenesis of diseases, investigations needed, and treatment were observed. The total number of references for the 40 articles was 1,654, and the references varied from 0 to 168 references, but several problems were identified in the list of references and citations made. The readability of articles was in the range of 9.4 +/- 1.8 to 22.6 +/- 10.7 using the Flesch-Kincaid Grade Level instrument and 10.0 +/- 2.6 to 19.6 +/- 8.3 using the Readability Coleman-Liau index. A strong correlation was found between the two instruments (r(2) = 0.744, P < 0.001). The agreement between the assessors had mean kappa scores in the range of 0.712-0.857. In conclusion, despite the effort placed in creating Wikipedia respiratory articles by anonymous volunteers (wikipedians), most articles had knowledge deficiencies, were not accurate, and were not suitable for medical students as learning resources.

Azer, S. A., et al. (2012). "Nervous system examination on YouTube." BMC Medical Education 12: 8.
	Background: Web 2.0 sites such as YouTube have become a useful resource for knowledge and are used by medical students as a learning resource. This study aimed at assessing videos covering the nervous system examination on YouTube. Methods: A research of YouTube was conducted from 2 November to 2 December 2011 using the following key words "nervous system examination", "nervous system clinical examination", "cranial nerves examination", "CNS examination", "examination of cerebellum", "balance and coordination examination". Only relevant videos in the English language were identified and related URL recorded. For each video, the following information was collected: title, author/s, duration, number of viewers, number of posted comments, and total number of days on YouTube. Using criteria comprising content, technical authority and pedagogy parameters, videos were rated independently by three assessors and grouped into educationally useful and non-educationally useful. Results: A total of 2240 videos were screened; 129 were found to have relevant information to nervous system examination. Analysis revealed that 61 (47%) of the videos provided useful information on the nervous system examination. These videos scored (mean +/- SD, 14.9 +/- 0.2) and mainly covered examination of the whole nervous system (8 videos, 13%), cranial nerves (42 videos, 69%), upper limbs (6 videos, 10%), lower limbs (3 videos, 5%), balance and co-ordination (2 videos, 3%). The other 68 (53%) videos were not useful educationally; scoring (mean +/- SD, 11.1 +/- 3.0). The total viewers of all videos was 2,189,434. Useful videos were viewed by 1,050,445 viewers (48% of total viewers). The total viewership per day for useful videos was 1,794.5 and for non-useful videos 1,132.0. The differences between the three assessors were insignificant (less than 0.5 for the mean and 0.3 for the SD). Conclusions: Currently, YouTube provides an adequate resource for learning nervous system examination, which can be used by medical students. However, there were deficiencies in videos covering examination of the cerebellum and balance system. Useful videos can be used as learning resources to medical students.

Azer, S. A., et al. (2013). "Evaluation of the Educational Value of YouTube Videos About Physical Examination of the Cardiovascular and Respiratory Systems." Journal of Medical Internet Research 15(11): 13.
	Background: A number of studies have evaluated the educational contents of videos on YouTube. However, little analysis has been done on videos about physical examination. Objective: This study aimed to analyze YouTube videos about physical examination of the cardiovascular and respiratory systems. It was hypothesized that the educational standards of videos on YouTube would vary significantly. Methods: During the period from November 2, 2011 to December 2, 2011, YouTube was searched by three assessors for videos covering the clinical examination of the cardiovascular and respiratory systems. For each video, the following information was collected: title, authors, duration, number of viewers, and total number of days on YouTube. Using criteria comprising content, technical authority, and pedagogy parameters, videos were rated independently by three assessors and grouped into educationally useful and non-useful videos. Results: A total of 1920 videos were screened. Only relevant videos covering the examination of adults in the English language were identified (n=56). Of these, 20 were found to be relevant to cardiovascular examinations and 36 to respiratory examinations. Further analysis revealed that 9 provided useful information on cardiovascular examinations and 7 on respiratory examinations: scoring mean 14.9 (SD 0.33) and mean 15.0 (SD 0.00), respectively. The other videos, 11 covering cardiovascular and 29 on respiratory examinations, were not useful educationally, scoring mean 11.1 (SD 1.08) and mean 11.2 (SD 1.29), respectively. The differences between these two categories were significant (P<.001 for both body systems). The concordance between the assessors on applying the criteria was 0.89, with a kappa score >.86. Conclusions: A small number of videos about physical examination of the cardiovascular and respiratory systems were identified as educationally useful; these videos can be used by medical students for independent learning and by clinical teachers as learning resources. The scoring system utilized by this study is simple, easy to apply, and could be used by other researchers on similar topics.

Azer, S. A., et al. (2015). "Accuracy and readability of cardiovascular entries on Wikipedia: are they reliable learning resources for medical students?" BMJ Open 5(10): 14.
	Objective To evaluate accuracy of content and readability level of English Wikipedia articles on cardiovascular diseases, using quality and readability tools. Methods Wikipedia was searched on the 6 October 2013 for articles on cardiovascular diseases. Using a modified DISCERN (DISCERN is an instrument widely used in assessing online resources), articles were independently scored by three assessors. The readability was calculated using Flesch-Kincaid Grade Level. The inter-rater agreement between evaluators was calculated using the Fleiss scale. Results This study was based on 47 English Wikipedia entries on cardiovascular diseases. The DISCERN scores had a median=33 (IQR=6). Four articles (8.5%) were of good quality (DISCERN score 40-50), 39 (83%) moderate (DISCERN 30-39) and 4 (8.5%) were poor (DISCERN 10-29). Although the entries covered the aetiology and the clinical picture, there were deficiencies in the pathophysiology of diseases, signs and symptoms, diagnostic approaches and treatment. The number of references varied from 1 to 127 references; 25.929.4 (mean +/- SD). Several problems were identified in the list of references and citations made in the articles. The readability of articles was 14.3 +/- 1.7 (mean +/- SD); consistent with the readability level for college students. In comparison, Harrison's Principles of Internal Medicine 18th edition had more tables, less references and no significant difference in number of graphs, images, illustrations or readability level. The overall agreement between the evaluators was good (Fleiss 0.718 (95% CI 0.57 to 0.83). Conclusions The Wikipedia entries are not aimed at a medical audience and should not be used as a substitute to recommended medical resources. Course designers and students should be aware that Wikipedia entries on cardiovascular diseases lack accuracy, predominantly due to errors of omission. Further improvement of the Wikipedia content of cardiovascular entries would be needed before they could be considered a supplementary resource.

Bachman, J. A. and K. H. Hsueh (2008). "Evaluation of Online Education About Diabetes Management in the School Setting." The Journal of School Nursing 24(3): 151-157.
	There are a variety of initiatives to provide education to improve the quality of care for children with diabetes in the school setting. This study piloted and evaluated an online continuing education program for school nurses about diabetes management for children in schools using current practice principles. The evaluation determined if objectives of the program were met, if participants believed the education provided would enhance their ability to manage children with diabetes, and participants’ opinions about the online delivery method. Nineteen participants were recruited from among school nurses unable to attend statewide face-to-face diabetes workshops. The majority reported that the objectives were met, and 91% reported the education would enhance their ability to manage students with diabetes. Whereas 33% preferred online continuing education, 17% preferred face-to-face education, and 50% were unsure. Because of the increasing prevalence of diabetes in children, it is important that school nurses have access to continuing education that provides current principles for diabetes management for children. The method of delivery should be determined by the learner’s learning style preferences. © 2008, SAGE Publications. All rights reserved.

Bachman, S. S., et al. (2012). "Access to Oral Health Care and Self-Reported Health Status Among Low-Income Adults Living with HIV/AIDS." Public Health Reports 127: 55-64.
	Objective. We identified factors associated with improved self-reported health status in a sample of people living with HIV/AIDS (PLWHA) following enrollment in oral health care. Methods. Data were collected from 1,499 enrollees in the Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance Innovations in Oral Health Care Initiative. Data were gathered from 2007-2010 through in-person interviews at 14 sites; self-reported health status was measured using the SF-8 (TM) Health Survey's physical and mental health summary scores. Utilization records of oral health-care services provided to enrollees were also obtained. Data were analyzed using general estimating equation linear regression. Results. Between baseline and follow-up, we found that physical health status improved marginally while mental health status improved to a greater degree. For change in physical health status, a decrease in oral health problems and lack of health insurance were significantly associated with improved health status. Improved mental health status was associated with a decrease in oral health problems at the last available visit and no pain or distress in one's teeth or gums at the last available visit. Conclusion. For low-income PLWHA, engagement in a program to increase access to oral health care was associated with improvement in overall wellbeing as measured by change in the SF-8 Health Survey. These results contribute to the knowledge base about using the SF-8 to assess the impact of clinical interventions. For public health practitioners working with PLWHA, findings suggest that access to oral health care can help promote well-being for this vulnerable population.

Bacigalupe, G. and S. F. Askari (2013). "E-Health innovations, collaboration, and healthcare disparities: developing criteria for culturally competent evaluation." Families, Systems, & Health 31(3): 248-263.
	E-Health alters how health care clinicians, institutions, patients, caregivers, families, advocates, and researchers collaborate. Few guidelines exist to evaluate the impact of social technologies on furthering family health and even less on their capacity to ameliorate health disparities. Health social media tools that help develop, sustain, and strengthen the collaborative health agenda may prove useful to ameliorate health care inequities; the linkage should not, however, be taken for granted. In this article we propose a classification of emerging social technologies in health care with the purpose of developing evaluative criteria that assess their ability to foster collaboration and positively impact health care equity. The findings are based on systematic Internet ethnographic observations, a qualitative analysis of e-health tool exemplars, and a review of the literature. To triangulate data collection and analysis, the research team consulted with social media health care experts in making recommendations for evaluation criteria. Selected cases illustrate the analytical conclusions. Lines of research that are needed to accurately rate and reliably measure the ability of social media e-health offerings to address health disparities are proposed.Copyright (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Backer, T. E., et al. (2005). "Writing with Ev - Words to transform science into action." Journal of Health Communication 10(4): 289-302.
	
Backer, T. E. and E. M. Rogers (1998). "Diffusion of innovations theory and work-site AIDS programs." Journal of Health Communication 3(1): 17-28.
	Four case studies of the adoption of work-site AIDS programs are investigated, two of which were modifications of the Centers for Disease Control and Prevention's Business Responds to AIDS (BRTA) program. AIDS work-site programs were mainly initiated by the four study companies as a result of the efforts of a champion (defined as an individual who gains attention and resources for an issue in a system) or the occurrence of a tragic event, such as a company employee contracting AIDS. The BRTA program is an innovation that has not yet reached critical mass, which is the point after which further rates of adoption occur rapidly in a self-sustaining process.

Bacon, T. J. and W. P. Newton (2014). "Innovations in the education of health professionals." North Carolina Medical Journal 75(1): 22-27.
	Dramatic and unprecedented changes in health care have altered the health care landscape and have significant implications for health professions education. This issue of the NCMJ explores these changes and highlights innovative models across the health professions that are designed to prepare graduates to practice in the emerging health care system and to deliver high-quality care in a cost-effective manner. These new educational programs--which include training for future doctors, nurses, dentists, pharmacists, and various allied health professionals--aim to prepare providers to meet the needs of North Carolina communities, and they use new educational models to give graduates the competencies they need to practice in health care teams and to contribute in other ways to improved health outcomes for the people of the state.

Baer, T. E., et al. (2013). "Addressing social determinants of health in the adolescent medical home." Current Opinion in Pediatrics 25(4): 447-453.
	Purpose of reviewTo provide a framework for addressing the social determinants of health (SDH) in the adolescent medical home.Recent findingsThere has been recent recognition worldwide that SDH affect health throughout the life-course. Adolescents are a vulnerable population, with health behaviors, access, and outcomes shaped by social and environmental contexts. Medical homes have aimed to reduce the health inequities by facilitating connections with community resources. Interventions have been described in the literature for triaging social needs, connecting patients to resources, and utilizing multidisciplinary team members.SummarySDH should be incorporated into the routine adolescent healthcare. Screening tools and referral programs should be developed and evaluated in the adolescent population. Programs utilizing multidisciplinary team members would be effective in reaching adolescents and facilitating connections to resources.

Baez-Feliciano, D. V., et al. (2005). "Changes in the AIDS epidemiologic situation in Puerto Rico following health care reform and the introduction of HAART." Revista Panamericana De Salud Publica-Pan American Journal of Public Health 17(2): 92-101.
	Objectives. To compare the occurrence of AIDS as well as the sociodemographic and clinical profiles of AIDS patients in Puerto Rico before and after the introduction of highly active antiretroviral therapy (HAART) and the privatization of the island's public health care system. Methods. We compared the incident AIDS cases for two three-year periods, 1992-1994 and 1998-2000, in four populations: (1) entire United States, (2) Puerto Rico, (3) Bayamon Health Region (located in north-central Puerto Rico, it includes 11 of the island's 78 municipalities), and (4) an HIV cohort enrolled at the Universidad Central del Caribe (UCC) School of Medicine. The UCC is located in Bayamon, Puerto Rico, within an academic medical complex that houses the teaching hospital (Ramon Ruiz Arnau University Hospital), the ambulatory health care facilities (Immunology Clinics)for patients with HIV, and administrative buildings. This represents the major government-sponsored health care infrastructure within the Bayamon Health Region. Results. Incident AIDS declined substantially between the two periods in each of the four populations studied. The 48.1% decline in Puerto Rico exceeded the 40.9% decline in the United States. The decline in Puerto Rico likely resulted from increased availability and implementation of HAART and the delivery of health care to HIV/AIDS patients in an integrated fashion within each regional ambulatory clinic. In spite of this improvement, the absolute number of patients with AIDS on the island remains high. Substantial resources for treatment and prevention are required. The proportion of new AIDS cases was lower among women, persons 40 years of age or older, the less educated, and those living alone. Injection drug use remains the predominant mode of transmission in Puerto Rico. Conclusions. Further gains in Puerto Rico's fight against AIDS will depend on the island's ability to reduce the transmission that occurs through injection drug use; the use of HAART on a larger number of vulnerable patients, particularly intravenous drug users; educational interventions to improve medication compliance in certain risk groups; and specific measures aimed at decreasing the rate of injection drug use.

Bagala, J. P., et al. (2014). "Implementation of the medical education partnership initiative: Medical students' perspective." Academic Medicine 89(8 SUPPL.): S32-S34.
	The Medical Education Partnership Initiative (MEPI) is contributing to the transformation of medical training in Africa. In this paper, medical students present their perspective on how MEPI initiatives have influenced five key areas related to African medical trainees: educational infrastructure, information technology, community-based training, scientific research, and professional outlook and goals. They propose three new areas of focus that could further assist MEPI in bettering medical training in Africa.

Baig, A. A., et al. (2014). "Integrating Diabetes Self-Management Interventions for Mexican-Americans into the Catholic Church Setting." Journal of Religion & Health 53(1): 105-118.
	Churches provide an innovative and underutilized setting for diabetes self-management programs for Latinos. This study sought to formulate a conceptual framework for designing church-based programs that are tailored to the needs of the Latino community and that utilize church strengths and resources. To inform this model, we conducted six focus groups with mostly Mexican-American Catholic adults with diabetes and their family members (N = 37) and found that participants were interested in church-based diabetes programs that emphasized information sharing, skills building, and social networking. Our model demonstrates that many of these requested components can be integrated into the current structure and function of the church. However, additional mechanisms to facilitate access to medical care may be necessary to support community members' diabetes care.

Baik, S., et al. (2010). "Conducting cost-effectiveness analyses of type 2 diabetes in low- and middle-income countries: can locally generated observational study data overcome methodological limitations?" Diabetes Research and Clinical Practice 88: S17-S22.
	In low- and middle-income countries, the high personal and economic burden of type 2 diabetes is further compounded by inadequate resources for diabetes care when compared with high-income countries. Health technology assessments (HTAs) aim to inform policy decision makers in their efforts to achieve more effective allocation of resources by providing evidence-based input on new technologies. Within the hierarchy of evidence, randomized controlled trials (RCTs) remain the 'gold standard' used to inform HTAs, but are limited by poor external validity (ie, generalizability to real-world populations). Unlike RCTs, observational studies are able to enrol broader patient populations, but their design renders such studies vulnerable to confounding factors and selection bias. However, it is increasingly recognized that observational studies can complement RCTs by supporting and extending efficacy findings from RCTs to real-world clinical practice, particularly across geographical populations. They can also provide locally relevant baseline and disease natural history data to populate health economic models. Thus, observational data are likely to be of considerable informative value to policy makers in developing countries reaching decisions on diabetes care within art environment of scarce resources. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Bailey, H. R. (2001). "A lifetime of learning." Diseases of the Colon & Rectum 44(8): 1144-1147.
	
Bailey, M. B., et al. (2011). "San Francisco Hep B Free: A Grassroots Community Coalition to Prevent Hepatitis B and Liver Cancer." Journal of Community Health 36(4): 538-551.
	Chronic hepatitis B is the leading cause of liver cancer and the largest health disparity between Asian/Pacific Islanders (APIs) and the general US population. The Hep B Free model was launched to eliminate hepatitis B infection by increasing hepatitis B awareness, testing, vaccination, and treatment among APIs by building a broad, community-wide coalition. The San Francisco Hep B Free campaign is a diverse public/private collaboration unifying the API community, health care system, policy makers, businesses, and the general public in San Francisco, California. Mass-media and grassroots messaging raised citywide awareness of hepatitis B and promoted use of the existing health care system for hepatitis B screening and follow-up. Coalition partners reported semi-annually on activities, resources utilized, and system changes instituted. From 2007 to 2009, over 150 organizations contributed approximately $1,000,000 in resources to the San Francisco Hep B Free campaign. 40 educational events reached 1,100 healthcare providers, and 50% of primary care physicians pledged to screen APIs routinely for hepatitis B. Community events and fairs reached over 200,000 members of the general public. Of 3,315 API clients tested at stand-alone screening sites created by the campaign, 6.5% were found to be chronically infected and referred to follow-up care. A grassroots coalition that develops strong partnerships with diverse organizations can use existing resources to successfully increase public and healthcare provider awareness about hepatitis B among APIs, promote routine hepatitis B testing and vaccination as part of standard primary care, and ensure access to treatment for chronically infected individuals.

Bailie, R., et al. (2013). "A systems-based partnership learning model for strengthening primary healthcare." Implementation Science 8(1).
	Background: Strengthening primary healthcare systems is vital to improving health outcomes and reducing inequity. However, there are few tools and models available in published literature showing how primary care system strengthening can be achieved on a large scale. Challenges to strengthening primary healthcare (PHC) systems include the dispersion, diversity and relative independence of primary care providers; the scope and complexity of PHC; limited infrastructure available to support population health approaches; and the generally poor and fragmented state of PHC information systems.Drawing on concepts of comprehensive PHC, integrated quality improvement (IQI) methods, system-based research networks, and system-based participatory action research, we describe a learning model for strengthening PHC that addresses these challenges. We describe the evolution of this model within the Australian Aboriginal and Torres Strait Islander primary healthcare context, successes and challenges in its application, and key issues for further research.Discussion: IQI approaches combined with system-based participatory action research and system-based research networks offer potential to support program implementation and ongoing learning across a wide scope of primary healthcare practice and on a large scale. The Partnership Learning Model (PLM) can be seen as an integrated model for large-scale knowledge translation across the scope of priority aspects of PHC. With appropriate engagement of relevant stakeholders, the model may be applicable to a wide range of settings. In IQI, and in the PLM specifically, there is a clear role for research in contributing to refining and evaluating existing tools and processes, and in developing and trialling innovations. Achieving an appropriate balance between funding IQI activity as part of routine service delivery and funding IQI related research will be vital to developing and sustaining this type of PLM.Summary: This paper draws together several different previously described concepts and extends the understanding of how PHC systems can be strengthened through systematic and partnership-based approaches. We describe a model developed from these concepts and its application in the Australian Indigenous primary healthcare context, and raise questions about sustainability and wider relevance of the model. © 2013 Bailie et al.; licensee BioMed Central Ltd.

Baingana, F., et al. (2015). "Global research challenges and opportunities for mental health and substance-use disorders." Nature 527(7578): S172-S177.
	The research agenda for global mental health and substance-use disorders has been largely driven by the exigencies of high health burdens and associated unmet needs in low-and middle-income countries. Implementation research focused on context-driven adaptation and innovation in service delivery has begun to yield promising results that are improving the quality of, and access to, care in low-resource settings. Importantly, these efforts have also resulted in the development and augmentation of local, in-country research capacities. Given the complex interplay between mental health and substance-use disorders, medical conditions, and biological and social vulnerabilities, a revitalized research agenda must encompass both local variation and global commonalities in the impact of adversities, multi-morbidities and their consequences across the life course. We recommend priorities for research - as well as guiding principles for context-driven, intersectoral, integrative approaches - that will advance knowledge and answer the most pressing local and global mental health questions and needs, while also promoting a health equity agenda and extending the quality, reach and impact of scientific enquiry.

Bakal, D., et al. (2009). "TEACHING PHYSICIANS, NURSES, AND MENTAL HEALTH PROFESSIONALS ABOUT MEDICALLY UNEXPLAINED SYMPTOMS: A COURSE ON THE MINDFUL BODY AT THE UNIVERSITY OF CALGARY." Explore-the Journal of Science and Healing 5(2): 121-123.
	Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to Dr Sierpina at vssierpi@utnib. edu or Dr Kreitzer at kreit003@umn.edu. Submissions should be no more than 500 to 1,500 words. Please include any Web site or other resource that is relevant, as well as contact information.

Baker, E. A., et al. (2008). "Translating and disseminating research- and practice-based criteria to support evidence-based intervention planning." Journal of Public Health Management and Practice 14(2): 124-130.
	Evidence-based public health is a decision-making process To determine the best intervention approach for addressing a particular health issue, population, and setting. The decision-making process involves the identification and evaluation of criteria supporting or Refuting use of intervention approaches based on previous work in the field. OBJECTIVE: The purpose of this article is to describe the identification and evaluation of Research- and practice-based evidence criteria. METHODS: These criteria were derived through literature Review and expert panel interviews. RESULTS AND CONCLUSIONS: These evidence criteria provide the foundation for the translation and dissemination of evidence-based intervention planning processes through a Web-based technical advisement system for public healthcare practitioners. Limitations and future directions are considered. © 2008 Lippincott Williams & Wilkins, Inc.

Baker, E. L., et al. (2001). "Reducing health disparities through community-based research." Public Health Reports 116(6): 517-519.
	
Baker, G. R., et al. (1998). "Collaborating for improvement in health professions education." Quality Management in Health Care 6(2): 1-11.
	Continual improvement efforts have been slower in health professions education than in health care delivery. This article identifies the lessons learned by teams working in an Interdisciplinary Professional Education Collaborative in overcoming barriers to carrying out continual improvement efforts in these educational organizations.

Baker, K. F., et al. (2016). "Use of structured musculoskeletal examination routines in undergraduate medical education and postgraduate clinical practice - a UK survey." BMC Medical Education 16: 6.
	Background: Structured examination routines have been developed as educational resources for musculoskeletal clinical skills teaching, including Gait-Arms-Legs-Spine (GALS), Regional Examination of the Musculoskeletal System (REMS) and paediatric GALS (pGALS). In this study, we aimed to assess the awareness and use of these examination routines in undergraduate medical teaching in UK medical schools and UK postgraduate clinical practice. Methods: Electronic questionnaires were distributed to adult and paediatric musculoskeletal teaching leads at UK medical schools and current UK doctors in training. Results: Responses were received from 67 tutors representing teaching at 22/33 [67 %] of all UK medical schools, and 70 trainee doctors across a range of postgraduate training specialities. There was widespread adoption, at responding medical schools, of the adult examination routines within musculoskeletal teaching (GALS: 14/16 [88 %]; REMS: 12/16 [75 %]) and assessment (GALS: 13/16 [81 %]; REMS: 12/16 [75 %]). More trainees were aware of GALS (64/70 [91 %]) than REMS (14/67 [21 %]). Of the 39 trainees who used GALS in their clinical practice, 35/39 [90 %] reported that it had improved their confidence in musculoskeletal examination. Of the 17/22 responding medical schools that included paediatric musculoskeletal examination within their curricula, 15/17 [88 %] used the pGALS approach and this was included within student assessment at 4 medical schools. Conclusions: We demonstrate the widespread adoption of these examination routines in undergraduate education and significant uptake in postgraduate clinical practice. Further study is required to understand their impact upon clinical performance.

Baker, P. R., et al. (2005). "Cost-effectiveness analysis of a kidney and cardiovascular disease treatment program in an Australian aboriginal population." Advances in Chronic Kidney Disease 12(1): 22-31.
	The objective of the study was to assess, from a health service perspective, whether a systematic program to modify kidney and cardiovascular disease reduced the costs of treating end-stage kidney failure. The participants in the study were 1,800 aboriginal adults with hypertension, diabetes with microalbuminuria or overt albuminuria, and overt albuminuria, living on two islands in the Northern Territory of Australia during 1995 to 2000. Perindopril was the primary treatment agent, and other medications were also used to control blood pressure. Control of glucose and lipid levels were attempted, and health education was offered. Evaluation of program resource use and costs for follow-up periods was done at 3 and 4.7 years. On an intention-to-treat basis, the number of dialysis starts and dialysis-years avoided were estimated by comparing the fate of the treatment group with that of historical control subjects, matched for disease severity, who were followed in the before the treatment program began. For the first three years, an estimated 11.6 person-years of dialysis were avoided, and over 4.7 years, 27.7 person-years of dialysis were avoided. The net cost of the program was $1,210 more per person per year than status quo care, and dialyses avoided gave net savings of $1.0 million at 3 years and $3.4 million at 4.6 years. The treatment program provided significant health benefit and impressive cost savings in dialysis avoided. (C) 2005 by the National Kidney Foundation, Inc.

Baker, S. R. (2009). "Applying Andersen's behavioural model to oral health: what are the contextual factors shaping perceived oral health outcomes?" Community dentistry and oral epidemiology 37(6): 485-494.
	Objectives: Andersen's revised behavioural model provides a framework for understanding the factors which influence utilization of health services and key health outcomes. To date, there have been few studies that have explicitly tested the model in relation to oral health. The aim of this study was to test the model and to examine the direct and mediated pathways between social, attitudinal and behavioural factors and perceived oral health outcomes. Methods: The model was tested in a general population sample with data from the UK adult dental health survey (N = 3815) using the two-stage process of structural equation modelling. Results: Structural equation modelling indicated support in line with the hypotheses within the model; enabling resources (oral health education advice, type of dental service, finding NHS treatment expensive, dental anxiety) predicted need (number of decayed or unsound teeth and perceived treatment need); enabling resources and need predicted personal health practices and use of services (frequency of toothbrushing, recent dental attendance, attendance orientation) which, in turn, predicted perceived oral health outcomes (oral health quality of life). Both enabling resources and need also predicted perceived oral health outcomes. The impact of predisposing factors (social class, qualifications, income) on need, personal health practices and use of services, and oral health outcomes was indirect; that is, mediated by intervening factors. In the final model, 26%, 37%, 49% and 21% of the variance was accounted for in enabling resources, treatment need, personal health practices and use of services and perceived oral health outcomes respectively. Conclusion: The results provide support for Andersen's behavioural model as applied to perceived oral health. Further conceptual development of the model is discussed.

Baker, T. (2009). "Pediatric emergency and critical care in low-income countries." Pediatric Anesthesia 19(1): 23-27.
	The United Nations' Millennium Development Goal 4 is to reduce the global under-five mortality rate by two-thirds by 2015. Achieving this goal requires substantial strengthening of health systems in low-income countries. Emergency and critical care services are often one of the weakest parts of the health system and improving such care has the potential to significantly reduce mortality. Introducing effective triage and emergency treatments, establishing hospital systems that prioritize the critically ill and ensuring a reliable oxygen delivery system need not be resource intensive. Improving intensive care units, training health staff in the fundamentals of critical care concentrating on ABC - airway, breathing, and circulation - and developing guidelines for the management of common medical emergencies could all improve the quality of inpatient pediatric care. Integration with obstetrics, adult medicine and surgery in a combined emergency and critical care service would concentrate resources and expertise.

Bakerjian, D. and J. E. Scherger (2009). "Are You on the Health Information Technology Bandwagon?" Journal of the American Medical Directors Association 10(6): 368-369.
	
Bakken, S., et al. (2008). "A nursing informatics research agenda for 2008-18: Contextual influences and key components." Nursing Outlook 56(5): 206-214.e203.
	The context for nursing informatics research has changed significantly since the National Institute of Nursing Research-funded Nursing Informatics Research Agenda was published in 1993 and the Delphi study of nursing informatics research priorities reported a decade ago. The authors focus on 3 specific aspects of context-genomic health care, shifting research paradigms, and social (Web 2.0) technologies-that must be considered in formulating a nursing informatics research agenda. These influences are illustrated using the significant issue of healthcare associated infections (HAI). A nursing informatics research agenda for 2008-18 must expand users of interest to include interdisciplinary researchers; build upon the knowledge gained in nursing concept representation to address genomic and environmental data; guide the reengineering of nursing practice; harness new technologies to empower patients and their caregivers for collaborative knowledge development; develop user-configurable software approaches that support complex data visualization, analysis, and predictive modeling; facilitate the development of middle-range nursing informatics theories; and encourage innovative evaluation methodologies that attend to human-computer interface factors and organizational context. © 2008 Mosby, Inc. All rights reserved.

Bakr, M. M., et al. (2016). "Digital Cadavers: Online 2D Learning Resources Enhance Student Learning in Practical Head and Neck Anatomy within Dental Programs." Education Research International: 10.
	Head and neck anatomy provides core concepts within preclinical dental curricula. Increased student numbers, reduced curricula time, and restricted access to laboratory-based human resources have increased technology enhanced learning approaches to support student learning. Potential advantages include cost-effectiveness, off-campus access, and self-directed review or mastery opportunities for students. This study investigated successful student learning within a first-year head and neck anatomy course at the School of Dentistry and Oral Health, Griffith University, Australia, taught by the same teaching team, between 2010 and 2015. Student learning success was compared, for cohorts before and after implementation of a supplementary, purpose-designed online digital library and quiz bank. Success of these online resources was confirmed using overall students' performance within the course assessment tasks and Student Evaluation of Course surveys and online access data. Engagement with these supplementary 2D online resources, targeted at improving laboratory study, was positively evaluated by students (mean 85%) and significantly increased their laboratory grades (mean difference 6%, P < 0.027), despite being assessed using cadaveric resources. Written assessments in final exams were not significantly improved. Expanded use of supplementary online resources is planned to support student learning and success in head and neck anatomy, given the success of this intervention.

Bal, B. S. and L. H. Brenner (2014). "Medicolegal sidebar: Physician competence and skill part II: Hospital corporate responsibility and new technologies." Clinical Orthopaedics and Related Research 472(7): 2023-2027.
	
Balabanova, D., et al. (2004). "Health service utilization in the former Soviet Union: Evidence from eight countries." Health Services Research 39(6): 1927-1949.
	Background. In the past decade, the countries that emerged from the Soviet Union have experienced major changes in the inherited Soviet model of health care, which was centrally planned and provided universal, free access to basic care. The underlying principle of universality remains, but coexists with new funding and delivery systems and growing out-of-pocket payments. Objective. To examine patterns and determinants of health care utilization, the extent of payment for health care, and the settings in which care is obtained in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine. Methods. Data were derived from cross-sectional surveys, representative of adults aged 18 and over in each country, conducted in 2001. Multistage random sample of 18,428 individuals, stratified by region and area, was obtained. Instrument contained extensive data on demographic, economic, and social characteristics, administered face-to-face. The analysis explored the health seeking behavior of users and nonusers (those reporting an episode of illness but not consulting). Results. In the preceding year, over half of all respondents visited a medical professional, ranging from 65.7 percent in Belarus to 24.4 percent in Georgia, mostly at local primary care facilities. Of those reporting an illness, 20.7 percent of all did not consult although they felt they should have done so, varying from 9.4 percent in Belarus to 42.4 percent in Armenia and 49 percent in Georgia. The main reason for not seeking care was lack of money to pay for treatment (45.2 percent), self-treatment with home-produced remedies (32.9 percent), and purchase of nonprescribed medicine (21.8 percent). There are marked differences between countries; unaffordability was a particularly common factor in Armenia, Georgia, and Moldova (78 percent, 70 percent, 54 percent), and much lower in Belarus and Russia. In Georgia and Armenia, 65 percent and 56 percent of those who had consulted paid out-of-pocket, in the form of money, gifts, or both; these figures were 8 percent and 19 percent in Belarus and Russia respectively and 31.2 percent overall. The probability of not consulting a health professional when seriously ill was significantly higher among those over age 65, and with lower education. Use of health care was markedly lower among those with fewer household assets or a shortage of money, and those dissatisfied with their material resources, factors that explained some of the effects of age. A lack of social support (formal and informal) decreases further the probability of not consulting, adding to the consequences of poor financial status. The probability of seeking care for common conditions varies widely among countries (persistent fever: 56 percent in Belarus; 16 percent in Armenia) and home remedies, alcohol, and direct purchase of pharmaceuticals are commonly used. Informal coping strategies, such as use of connections (36.7 percent) or offering money to health professionals (28.5 percent) are seen as acceptable. Conclusions. This article provides the first comparative assessment of inequalities in access to health care in multiple countries of the former Soviet Union, using rigorous methodology. The emerging model across the region is extremely diverse. Some countries (Belarus, Russia) have managed to maintain access for most people, while in others the situation is near collapse (Armenia, Georgia). Access is most problematic in health systems characterized by high levels of payment for care and a breakdown of gate-keeping, although these are seen in countries facing major problems such as economic collapse and, in some, a legacy of civil war. There are substantial inequalities within each country and even where access remains adequate there are concerns about its sustainability.

Balabanova, D., et al. (2013). "Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening." Lancet 381(9883): 2118-2133.
	In 1985, the Rockefeller Foundation published Good health at low cost to discuss why some countries or regions achieve better health and social outcomes than do others at a similar level of income and to show the role of political will and socially progressive policies. 25 years on, the Good Health at Low Cost project revisited these places but looked anew at Bangladesh, Ethiopia, Kyrgyzstan, Thailand, and the Indian state of Tamil Nadu, which have all either achieved substantial improvements in health or access to services or implemented innovative health policies relative to their neighbours. A series of comparative case studies (2009-11) looked at how and why each region accomplished these changes. Attributes of success included good governance and political commitment, effective bureaucracies that preserve institutional memory and can learn from experience, and the ability to innovate and adapt to resource limitations. Furthermore, the capacity to respond to population needs and build resilience into health systems in the face of political unrest, economic crises, and natural disasters was important. Transport infrastructure, female empowerment, and education also played a part. Health systems are complex and no simple recipe exists for success. Yet in the countries and regions studied, progress has been assisted by institutional stability, with continuity of reforms despite political and economic turmoil, learning lessons from experience, seizing windows of opportunity, and ensuring sensitivity to context. These experiences show that improvements in health can still be achieved in countries with relatively few resources, though strategic investment is necessary to address new challenges such as complex chronic diseases and growing population expectations.

Balakrishnan, R., et al. (2016). "Continuum of Care Services for Maternal and Child Health using mobile technology - a health system strengthening strategy in low and middle income countries." Bmc Medical Informatics and Decision Making 16: 8.
	Background: Mobile phone technology is utilized for better delivery of health services worldwide. In low-and-middle income countries mobile phones are now ubiquitous. Thus leveraging mHealth applications in health sector is becoming popular rapidly in these countries. To assess the effectiveness of the Continuum of Care Services (CCS) mHealth platform in terms of strengthening the delivery of maternal and child health (MCH) services in a district in Bihar, a resource-poor state in India. Methods: The CommCare mHealth platform was customized to CCS as one of the innovations under a project funded by the Bill and Melinda Gates Foundation to improve the maternal and newborn health services in Bihar. The intervention was rolled out in one project district in Bihar, during July 2012. More than 550 frontline workers out of a total of 3000 including Accredited Social Health Activists, Anganwadi Workers, Auxilliary Nurse Midwives and Lady Health Supervisors were trained to use the mHealth platform. The service delivery components namely early registration of pregnant women, three antenatal visits, tetanus toxoid immunization of the mother, iron and folic acid tablet supply, institutional delivery, postnatal home visits and early initiation of breastfeeding were used as indicators for good quality services. The resultant coverage of these services in the implementation area was compared with rest of Bihar and previous year statistics of the same area. The time lag between delivery of a service and its record capture in the maternal and child tracking system (MCTS) database was computed in a random sample of 16,000 beneficiaries. The coverage of services among marginalized and non-marginalized castes was compared to indicate equity of service delivery. Health system strengthening was viewed from the angle of coverage, quality, equity and efficiency of services. Results: The implementation blocks had higher coverage of all the eight indicator services compared to rest of Bihar and the previous year. There was equity of services across castes for all the indicators. Timely capture of data was also ensured compared to paper-based reporting. Conclusion: By virtue of its impact on quality, efficiency and equity of service delivery, health care manpower efficiency and governance, the mHealth inclusion at service provision level can be one of the potential strategy to strengthen the health system.

Balalian, A. A., et al. (2014). "Adapting continuing medical education for post-conflict areas: assessment in Nagorno Karabagh - a qualitative study." Human Resources for Health 12: 6.
	Background: One of the major challenges in the current century is the increasing number of post-conflict states where infrastructures are debilitated. The dysfunctional health care systems in post-conflict settings are putting the lives of the populations in these zones at increased risk. One of the approaches to improve such situations is to strengthen human resources by organizing training programmes to meet the special needs in post-conflict zones. Evaluations of these training programmes are essential to assure effectiveness and adaptation to the health service needs in these conditions. Methods: A specialized qualitative evaluation was conducted to assess and improve a post-conflict continuing medical education (CME) programme that was conducted in Nagorno Karabagh. Qualitative research guides were designed for this post-conflict zone that included focus group discussions with physician programme participants and semi-structured in-depth interviews with directors of hospitals and training supervisors. Results: Saturation was achieved among the three participating groups in the themes of impact of participation in the CME and obstacles to application of obtained skills. All respondents indicated that the continuing medical education programme created important physician networks absent in this post-conflict zone, updated professional skills, and improved professional confidence among participants. However, all respondents indicated that some skills gained were inapplicable in Nagorno Karabagh hospitals and clinics due to lack of appropriate medical equipment, qualified supporting human resources and facilities. Conclusion: The qualitative research methods evaluation highlighted the fact that the health care human resources training should be closely linked to appropriate technologies, supplies, facilities and human resources available in post-conflict zones and identified the central importance of creating health professional networks and professional confidence among physicians in these zones. The qualitative research approach most effectively identifies these limitations and strengths and can directly inform the optimal adjustments for effective CME planning in these difficult areas of greatest need.

Balanzar, G. G. (2010). "Neurosurgery in Latin America." World Neurosurgery 74(1): 41-42.
	
Balas, E. A., et al. (1998). "Effect of linking practice data to published evidence. A randomized controlled trial of clinical direct reports." Medical Care 36(1): 79-87.
	OBJECTIVES: The purpose of this study was to evaluate the effect of clinical direct reports (practice data with pertinent evidence from the literature) on dialysis modality selection for patients with end-stage renal disease.
METHODS: A randomized controlled clinical trial was conducted at five dialysis centers. Five of the 10 physician participants were assigned through centralized computerized randomization to the intervention group (who received 12 center-specific clinical direct reports encouraging the consideration of peritoneal dialysis), and five were assigned to the control group, who received usual information but no similar report. One hundred fifty-two patients were eligible for monitoring.
RESULTS: The number of patients allocated to peritoneal dialysis was significantly higher in the intervention group than in the control group (15.3% versus 2.4%; P = 0.044). Due to a need for transient initial hemodialysis by some patients, the percentage of patients receiving peritoneal dialysis further increased through the end of the 3-month follow-up (18.0% versus 4.9%, P = 0.041).
CONCLUSIONS: There were no significant differences between the intervention and control groups in meeting patient preferences, metabolic status, and complication rates. The results of this study show that linking pertinent published evidence to actual practice data can support the implementation of practice recommendations and influence the selection of dialysis treatment for new patients.

Balasubramanian, E. P., et al. (2008). "Advanced payload concepts and system architecture for emerging services in Indian National Satellite Systems." Acta Astronautica 63(1-4): 185-191.
	Over the past two decades Indian Space Research Organization (ISRO) has developed and operationalized satellites to generate a large capacity of transponders for telecommunication service use in INSAT system. More powerful on-board transmitters are built to usher-in direct-to-home broadcast services. These have transformed the Satcom application scenario in the country. With the proliferation of satellite technology, a shift in the Indian market is witnessed today in terms of demand for new services like Broadband Internet, Interactive Multimedia, etc. While it is imperative to pay attention to market trends, ISRO is also committed towards taking the benefits of technological advancement to all round growth of our population, 70% of which dwell in rural areas. The initiatives already taken in space application related to telemedicine, tele-education and Village Resource Centres are required to be taken to a greater height of efficiency. These targets pose technological challenges to build a large capacity and cost-effective satellite system. This paper addresses advanced payload concepts and system architecture along with the trade-off analysis on design parameters in proposing a new generation satellite system capable of extending the reach of the Indian broadband structure to individual users, educational and medical institutions and enterprises for interactive services. This will be a strategic step in the evolution of INSAT system to employ advanced technology to touch every human face of our population. (C) 2008 Elsevier Ltd. All rights reserved.

Balatsouras, D., et al. (2003). "Newborn hearing screening resources on the Internet." International Journal of Pediatric Otorhinolaryngology 67(4): 333-340.
	Starting as a small military and academic network, the Internet has gradually evolved into a worldwide web, which connects most local networks as well as millions of personal computers from individual users. It is of interest to the medical practitioner, that ever more biomedical resources are becoming available on-line to assist in clinical medicine, research and education. In this paper a detailed list of the World Wide Web sites accessible through the Internet is provided, in which data about newborn hearing screening may be found. Web resources of medical equipment and suppliers and sites including otoacoustic emissions topics, are presented as well. This review is intended to present the wealth of the accessible information on the Internet and to promote further presentation on the web of any available hearing screening data from hospitals and Audiology Departments in which such programs are implemented. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

Balduf, L. M. and T. M. Farrell (2008). "Attitudes, beliefs, and referral patterns of PCPs to bariatric surgeons." Journal of Surgical Research 144(1): 49-58.
	Background. As severe obesity (BMI > 40kg/m(2)) and its surgical treatment rise, primary care physicians (PCPs) will more frequently evaluate, refer, and oversee the long-term medical management of bariatric patients. A cross-sectional mail survey was conducted to assess the attitudes, knowledge, and bariatric referral practices among family and internal medicine physicians in North Carolina. Materials and methods. Forty-seven percent of 611 randomly chosen PCPs returned a self-completed questionnaire. The effect of demographics, PCP attitudes, and PCP knowledge on referral practices was evaluated. Results. Over 85% (221) of PCPs have treated operated bariatric patients within the last year and 76% (203) have referred patients for surgical evaluation. Thirty-five percent of practitioners felt unprepared to provide good quality long-term medical care to operated patients, and just 45% felt competent to address medical complications of bariatric surgery. Compared with nonreferring PCPs, referring physicians provided medical care to a greater number of severely obese (mean 9.9 versus 7.5, P < 0.001) and postoperative (mean 4.6 and 2.3, P < 0.001) bariatric patients. Referring providers were younger (46 versus 49, P = 0.02), had higher BMI (25.3 versus 23.5, P = 0.001), were more familiar with NIH guidelines (14.7% versus 3.0%, P = 0.02), and had completed more bariatric continuing medical education (49.8% versus 34.9%, P = 0.03). Also, they reported better resources (71.4% versus 35.4%, P < 0.001) and competency to provide good quality long-term care to postoperative bariatric patients (54.2% versus 15.4%, P < 0.001) than nonreferring peers. Conclusions. Bariatric surgeons will optimize referrals and postoperative care for patients by working cooperatively with PCPs and by providing educational resources. (c) 2008 Elsevier Inc. All rights reserved.

Baldwin, A., et al. (2011). "Provision of electronic learning resources by UK medical schools for final year students." Medical Teacher 33(4): 325-327.
	The widespread availability of the internet and development of online learning technology has seen electronic learning become a key part of medical education. This study examines the current situation in the delivery of e-learning solely to final year medical students by UK medical schools. A total of 25 UK medical schools were surveyed with responses received from 21. Seventy-one percent of respondents provided e-learning to final year students (15/21). Requirements for this form of educational delivery are likely to increase but further analysis of their use is required.

Baldwin, C. D., et al. (2004). "Meeting the computer technology needs of community faculty: Building new models for faculty development." Ambulatory Pediatrics 4(1): 113-116.
	Objective.-We aimed to identify the evolving computer technology needs and interests of community faculty in order to design an effective faculty development program focused on computer skills: the Teaching and Learning Through Educational Technology (TeLeTET) program. Methodology.-Repeated surveys were conducted between 1994 and 2002 to assess computer resources and needs in a pool of over 800 primary care physician-educators in community practice in East Texas. Based on the results, we developed and evaluated several models to teach community preceptors about computer technologies that are useful for education. Results.-Before 1998, only half of our community faculty identified a strong interest in developing their technology skills. As the revolution in telecommunications advanced, however, preceptors' needs and interests changed, and the use of this technology to support community-based teaching became feasible. In 1998 and 1999, resource surveys showed that many of our community teaching sites had computers and Internet access. By 2001, the desire for teletechnology skills development was strong in a nucleus of community faculty, although lack of infrastructure, time, and skills were identified barriers. The TeLeTET project developed several innovative models for technology workshops and conferences, supplemented by online resources, that were well attended and positively evaluated by 181 community faculty over a 3-year period. Conclusions.-We have identified the evolving needs of community faculty through iterative needs assessments, developed a flexible faculty development curriculum, and used open-ended, formative evaluation techniques to keep the TeLeTET program responsive to a rapidly changing environment for community-based education in computer technology.

Balkrishnan, R., et al. (2013). "Global comparative healthcare effectiveness research: Evaluating sustainable programmes in low & middle resource settings." Indian Journal of Medical Research 137: 494-501.
	The need to focus healthcare expenditures on innovative and sustainable health systems that efficiently use existing effective therapies are the major drivers stimulating Comparative Effectiveness Research (CER) across the globe. Lack of adequate access and high cost of essential medicines and technologies in many countries increases morbidity and mortality and cost of care that forces people and families into poverty due to disability and out-of-pocket expenses. This review illustrates the potential of value-added global health care comparative effectiveness research in shaping health systems and health care delivery paradigms in the "global south". Enabling the development of effective CER systems globally paves the way for tangible local and regional definitions of equity in health care because CER fosters the sharing of critical assets, resources, skills, and capabilities and the development of collaborative of multi-sectorial frameworks to improve health outcomes and metrics globally.

Balla, J. I., et al. (2009). "A model for reflection for good clinical practice." Journal of Evaluation in Clinical Practice 15(6): 964-969.
	Rationale and aim The rapidly changing knowledge base of clinical practice highlights the need to keep abreast of knowledge changes that are most relevant for the practitioner. We aimed to develop a model for reflection on clinical practice that identified the key elements of medical knowledge needed for good medical practice. Method The dual theory of cognition, an integration of intuitive and analytic processes, provided the framework for the study. The design looked at the congruence between the clinical thinking process and the dual theory. A one-year study was conducted in general practice clinics in Oxfordshire, UK. Thirty-five general practitioners participated in 20-minute interviews to discuss how they worked through recently seen clinical cases. Over a one-year period 72 cases were recorded from 35 interviews. These were categorized according to emerging themes, which were manually coded and substantiated with verbatim quotations. Results There was a close fit between the dual theory and participants' clinical thinking processes. This included instant problem framing, consistent with automatic intuitive thinking, focusing on the risk and urgency of the case. Salient features accounting for these choices were recognizable. There was a second reflective phase, leading to the review of initial judgements. Conclusions The proposed model highlights the critical steps in decision making. This allows regular recalibration of knowledge that is most critical at each of these steps. In line with good practice, the model also links the crucial knowledge used in decision making, to value judgments made in relation to the patient. © 2009 Blackwell Publishing Ltd.

Ballew, P., et al. (2013). "Developing web-based training for public health practitioners: what can we learn from a review of five disciplines?" Health Education Research 28(2): 276-287.
	During a time when governmental funding, resources and staff are decreasing and travel restrictions are increasing, attention to efficient methods of public health workforce training is essential. A literature review was conducted to inform the development and delivery of web-based trainings for public health practitioners. Literature was gathered and summarized from five disciplines: Information Technology, Health, Education, Business and Communications, following five research themes: benefits, barriers, retention, promotion and evaluation. As a result, a total of 138 articles relevant to web-based training design and implementation were identified. Key recommendations emerged, including the need to conduct formative research and evaluation, provide clear design and layout, concise content, interactivity, technical support, marketing and promotion and incentives. We conclude that there is limited application of web-based training in public health. This review offers an opportunity to learn from other disciplines. Web-based training methods may prove to be a key training strategy for reaching our public health workforce in the environment of limited resources.

Banazak, D. A. (1996). "Late-life depression in primary care - How well are we doing?" Journal of General Internal Medicine 11(3): 163-167.
	OBJECTIVE: To discover primary care physicians' attitudes toward their abilities to detect and treat depression in the elderly. DESIGN: A self-administered questionnaire sent to 1,000 primary care physicians in the state of Michigan. SETTING: The survey was sent to physicians who practice general internal medicine or family medicine. PARTICIPANTS: The questionnaire was sent to 500 MD and 500 DO physicians: equal representation was given to general internal medicine and family medicine, Of all 1,000 physicians, 60% (n = 604) responded, 51% (n = 309) were MD's, 48% (n = 295) were DO's, 41% (n = 245) were general internists, and 59% (n = 359) were family medicine physicians. MEASUREMENTS AND MAIN RESULTS: Despite positive attitudes about their skills for detecting and treating depression in the elderly, only one quarter of the respondents routinely used a screening tool in practice, Forty-one percent of all physicians were not aware of depression practice guidelines, Family physicians were more confident about their treatment skills than were general internists (85% vs 50%; chi(2) = 11.42, p less than or equal to .003). Male physicians more often endorsed pharmacologic treatment, while female physicians more frequently used counseling and exercise techniques to treat depressed older patients, Half of all physicians felt knowledgeable about community resources to treat older depressed patients. CONCLUSIONS: This survey identified several perceived needs for future targeted interventions: (1) additional Agency for Health Care Policy and Research guideline exposure for all primary care physicians, (2) targeted counseling skip intervention for male physicians and medication management for female physicians, and (3) additional continuing medical education intervention for practicing general internists, Further research is needed to correlate physician attitudes with ensuing behaviors to fully appreciate the nature of late-life depression treatment within the primary care arena.

Bandiera, G., et al. (2013). "Integration and timing of basic and clinical sciences education." Medical Teacher 35(5): 381-387.
	Background: Medical education has traditionally been compartmentalized into basic and clinical sciences, with the latter being viewed as the skillful application of the former. Over time, the relevance of basic sciences has become defined by their role in supporting clinical problem solving rather than being, of themselves, a defining knowledge base of physicians. Methods: As part of the national Future of Medical Education in Canada (FMEC MD) project, a comprehensive empirical environmental scan identified the timing and integration of basic sciences as a key pressing issue for medical education. Using the literature review, key informant interviews, stakeholder meetings, and subsequent consultation forums from the FMEC project, this paper details the empirical basis for focusing on the role of basic science, the evidentiary foundations for current practices, and the implications for medical education. Findings: Despite a dearth of definitive relevant studies, opinions about how best to integrate the sciences remain strong. Resource allocation, political power, educational philosophy, and the shift from a knowledge-based to a problem-solving profession all influence the debate. There was little disagreement that both sciences are important, that many traditional models emphasized deep understanding of limited basic science disciplines at the expense of other relevant content such as social sciences, or that teaching the sciences contemporaneously rather than sequentially has theoretical and practical merit. Innovations in integrated curriculum design have occurred internationally. Less clear are the appropriate balance of the sciences, the best integration model, and solutions to the political and practical challenges of integrated curricula. Discussion: New curricula tend to emphasize integration, development of more diverse physician competencies, and preparation of physicians to adapt to evolving technology and patients' expectations. Refocusing the basic/clinical dichotomy to a foundational/applied model may yield benefits in training widely competent future physicians.

Banerjee, S. K., et al. (2015). "Expanding availability of safe abortion services through private sector accreditation: a case study of the Yukti Yojana program in Bihar, India." Reproductive Health 12: 11.
	Background: Recognizing the need to increase access to safe abortion services to reduce maternal mortality and morbidity, the state government of Bihar, India introduced an innovative mechanism of accrediting private health care facilities. The program, Yukti Yojana ('a scheme for solution'), accredits eligible health facilities and supports them in providing abortion-related services free of charge to rural and low-income urban women. This paper describes implementation of Yukti Yojana. Methods: A descriptive analysis of abortion services provided under the Yukti Yojana program was conducted using four data sources: 1) assessment of accredited facilities over 6 months; 2) induced and incomplete abortion service registers; 3) client exit interviews and associated direct observation of client-provider interaction for a sample of accredited facilities; and 4) in-depth interviews with providers and key stakeholders responsible for providing or influencing abortion services. These analyses assessed characteristics of women receiving abortion services, quality of care and client satisfaction, and barriers and facilitating factors of a successful accreditation process. Results: Forty-nine private facilities were accredited during the first two years of the program, and 84 % had begun providing abortion services, in all 27,724 women were served. Overall, 53 % of beneficiaries reported holding a "Below Poverty Line" card, while 71 % had low living standard. The majority of women (n = 569) reported satisfaction (90 %) with their care, while 68 % perceived good quality of services. Having a government-led initiative was considered a key element of success, while stringent requirements for site approval, long waiting time for accreditation, complicated and delayed reimbursement process and low reimbursement fees for abortion services were identified as barriers to implementation. Conclusions: Yukti Yojana provides a model for successfully involving private OB/GYNs and general physicians to deliver safe abortion services to poor women on a large scale and offers additional evidence that public-private partnerships can be used to ensure availability of high-quality maternal health services to women in low-income countries. Private facility accreditation also offers a promising solution to the limited availability of safe abortion services in low resource settings such as Bihar, India.

Bangser, M. (2007). "Strengthening public health priority-setting through research on fistula, maternal health, and health inequities." International Journal of Gynecology & Obstetrics 99: S16-S20.
	Objective: Findings from 4 studies conducted by the Women's Dignity Project and partners on the subjects of obstetric fistula, maternal mortality and morbidity, and health inequities are presented. Methods: The studies include qualitative and quantitative research, a survey, and an analysis of secondary data that examine women's experiences of fistula; constraints in service delivery for fistula treatment; factors shaping women's access to delivery care and constraints health workers face in providing care; and health inequities. Results: Findings from the studies are being used to improve fistula prevention and management, strengthen access to and provision of quality maternity care, and redress the health inequities that so adversely affect the poor. Conclusion: The studies provide policy makers, program managers, and service providers with evidence and the impetus to re-equitibrate policies, financial and human resources, and services in the interest of those in greatest need: women Living in poverty. (C) 2007 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. ALL rights reserved.

Banteyerga, H. (2011). "Ethiopia's Health Extension Program: Improving health through community involvement." MEDICC review 13(3): 46-49.
	The Health Extension Program is one of the most innovative community-based health programs in Ethiopia. It is based on the assumption that access to and quality of primary health care in rural communities can be improved through transfer of health knowledge and skills to households. Since it became operational in 2004-2005, the Program has had a tangible effect on the thinking and practices of rural people regarding disease prevention, family health, hygiene and environmental sanitation. It has enabled Ethiopia to increase primary health care coverage from 76.9% in 2005 to 90% in 2010.

Banura, C., et al. (2012). "Universal routine HPV vaccination for young girls in Uganda: a review of opportunities and potential obstacles." Infectious Agents and Cancer 7: 6.
	This article reviews the existing realities in Uganda to identify opportunities and potential obstacles of providing universal routine HPV vaccination to young adolescent girls. Cervical cancer is a public health priority in Uganda where it contributes to about 50-60% of all female malignancies. It is associated with a dismal 5-year relative survival of approximately 20%. With adequate financial resources, primary prevention through vaccination is feasible using existing education and health infrastructure. Cost-effectiveness studies show that at a cost of US$2 per dose, the current vaccines would be cost effective. With optimal (>= 70%) coverage of the target population, the lifetime risk of cervical cancer could be reduced by >50%. Uganda fulfils 4 out of the 5 criteria set by the WHO for the introduction of routine HPV vaccination to young adolescent girls. The existing political commitment, community support for immunization and the favorable laws and policy environment all provide an opportunity that should not be missed to introduce this much needed vaccine to the young adolescent girls. However, sustainable financing by the government without external assistances remains a major obstacle. Also, the existing health delivery systems would require strengthening to cope with the delivery of HPV vaccine to a population that is normally not targeted for routine vaccination. Given the high incidence of cervical cancer and in the absence of a national screening program, universal HPV vaccination of Ugandan adolescent girls is critical for cervical cancer prevention.

Baquet, C. R., et al. (2004). "Healthcare disparities and models for change." American Journal of Managed Care 10: SP5-SP11.
	With Healthy People 2010 making the goal of eliminating health disparities a national priority, policymakers, researchers, medical centers, managed care organizations (MCOs), and advocacy organizations have been called on to move beyond the historic documentation of health disparities and proceed with an agenda to translate policy recommendations into practice. Working models that have successfully reduced health disparities in managed care settings were presented at the National Managed Health Care Congress Inaugural Forum on Reducing Racial and Ethnic Disparities in Health Care on March 10-11, 2003, in Washington, DC. These models are being used by federal, state, and municipal governments, as well as private, commercial, and Medicaid MCOs. Successful models and programs at all levels reduce health disparities by forming partnerships based on common goals to provide care, to educate, and to rebuild healthcare systems. Municipal models work in collaboration with state and federal agencies to integrate patient care with technology. Several basic elements of MCOs help to reduce disparities through emphasis on preventive care, community and member health education, case management and disease management tracking, centralized data collection, and use of sophisticated technology to analyze data and coordinate services. At the community level, there are leveraged funds from the Health Resources and Services Administration's Bureau of Primary Health Care. Well-designed models provide seamless monitoring of patient care and outcomes by integrating human and information system resources.

Baquet, C. R., et al. (2006). "Maryland's Special Populations Network - A model for cancer disparities research, education, and training." Cancer 107(8): 2061-2070.
	The unequal burden of cancer in minority and underserved communities nationally and in Maryland is a compelling crisis. The Maryland Special Populations Cancer Research Network (MSPN) developed an infrastructure covering Maryland's 23 jurisdictions and Baltimore City through formal partnerships between the University of Maryland School of Medicine, University of Maryland Statewide Health Network, University of Maryland Eastern Shore, and community partners in Baltimore City, rural Eastern Shore, rural Western Maryland, rural Southern Maryland, and Piscataway Conoy Tribe and statewide American Indians. Guided by the community-based participatory framework, the MSPN undertook a comprehensive assessment (of needs, strengths, and resources available) that laid the foundation for programmatic efforts in community-initiated cancer awareness and education, research, and training. The MSPN infrastructure was used to implement successful and innovative community-based cancer education interventions and technological solutions; conduct education and promotion of clinical trials, cancer health disparities research, and minority faculty cancer research career development; and leverage additional resources for sustainability. MSPN engaged in informed advocacy among decision- and policyrnakers at state and national levels, and its community-based clinical trials program was recognized by the U.S. Department of Health and Human Services as a Best Practice Award. The solutions to reduce and eliminate cancer health disparities are complex and require comprehensive and focused multidisciplinary cancer health disparities research, training, and education strategies implemented through robust community-academic partnerships.

Barash, P., et al. (2015). "Game changers: The 20 most important anesthesia articles ever published." Anesthesia and Analgesia 120(3): 663-670.
	
Barclay, G., et al. (2014). "Population health and technology: Placing people first." American Journal of Public Health 104(12): 2246-2247.
	
Barker, K. (2004). "Diffusion of innovations: A world tour." Journal of Health Communication 9(SUPPL. 1): 131-137.
	This contribution to the 40th Anniversary celebration of the Diffusion of Innovations Theory discusses three health communication projects which applied the tenets of Diffusion of Innovation Theory with differing results: 1. Using voodoo practitioners to pave the way for HIV/AIDS education in Haiti. 2. A food-based approach to improving Vitamin A nutrition in Nepal. 3. Diffusion at the horizon of life: The difficulties of communicating reproductive health to youth in Mali. The article illustrates a spectrum of circumstances in which diffusion theory has been applied, in order to show the application of the theory with different populations or target groups, in different sectors, and in different regions of the world.

Barnes, B. E. (1998). "Creating the practice-learning environment: Using information technology to support a new model of continuing medical education." Academic Medicine 73(3): 278-281.
	Many of the traditional approaches to providing continuing medical education (CME) have failed to improve physician performance and health care outcomes. In the current health care environment, physicians are being held to unprecedented levels of accountability to patients, payers, and society at large. A greater emphasis is being placed on measuring and improving the clinical and fiscal outcomes of medical care. If they are to help physicians practice more effectively and efficiently, CME developers must reformulate the missions and goals of their programs. CME must become a means for improving patient outcomes through enhanced physician performance. The author describes how a neu practice-learning model for CME might be implemented using currently available information technology. She also discusses how CME programs, with the help of information technology, can help physicians identify learning opportunities, find the best resources for learning, and apply learning to practice. She then briefly discusses during programs that have begun to utilize information technology to expand the scope of CME: the Maintenance of Competence Program in Canada, the Stanford Health Information Network for Education, and a computer-simulation program at the Indiana University School of Medicine.

Barnes, E. R., et al. (2015). "Impact of the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention on adherence to national obesity clinical practice guidelines in a primary care centre." Journal of Evaluation in Clinical Practice 21(2): 300-306.
	Rationale, aims and objectivesObesity is significantly underdiagnosed and undertreated in primary care settings. The purpose of this clinical practice change project was to increase provider adherence to national clinical practice guidelines for the diagnosis and treatment of obesity in adults. MethodsBased upon the National Institutes of Health guidelines for the diagnosis and treatment of obesity, a clinical change project was implemented. Guided by the theory of planned behaviour, the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention includes education sessions, additional provider resources for patient education, a provider reminder system and provider feedback. ResultsPrimary care providers did not significantly increase on documentation of diagnosis and planned management of obesity for patients with body mass index (BMI) greater than or equal to 30. Medical assistants increased recording of height, weight and BMI in the patient record by 13%, which was significant. ConclusionsDocumentation of accurate BMI should lead to diagnosis of appropriate weight category and subsequent care planning. Future studies will examine barriers to adherence to clinical practice guidelines for obesity. Interventions are needed that include inter-professional team members and may be more successful if delivered separately from routine primary care visits.

Barnett, N. L., et al. (2016). "Patient-centred management of polypharmacy: a process for practice." European Journal of Hospital Pharmacy-Science and Practice 23(2): 113-117.
	Medicines are the most common intervention to improve health. The number of medicines taken by older people in the UK has been steadily increasing for the last three decades. Polypharmacy is a term that refers to either the prescribing or taking many medicines. Concerns about the risks of polypharmacy in primary and secondary care are growing, supported by evidence which associates polypharmacy with increased adverse drug events, hospital admissions, increased healthcare costs and non-adherence. In the UK, this can largely be attributed, over the last 20years, to the greater availability of evidence-based treatments promoted through therapeutic guidelines which are designed for single conditions, rather than addressing the multimorbidity that affects many older people. There is also currently a paucity of evidence-based national guidance around reducing and stopping medication and incorporating the patient perspective. This paper reviews current UK literature around polypharmacy including a description of four key resources which all make use of international literature and all focus on the medication aspects of polypharmacy from a clinician's perspective. The patient-centred approach combines both clinical health professionals and patient perspective. Developed using existing resources, it is designed to assist with collaborative (patient and clinician based) medication review to inform decisions around deprescribing and address polypharmacy as part of overall strategies to optimise medicines for the patient. Presented as a diagrammatic representation in seven steps, it also includes guidance on points to consider, actions to take and questions to ask in order to reduce polypharmacy and undertake deprescribing safely.

Barnett, S., et al. (1999). "Pediatricians' response to the demand for school health programming." Pediatrics 103(4): 7.
	Objective. Because of the broad and increasing interest in school health, the American Academy of Pediatrics (AAP) surveyed its members to determine their awareness of school health education/programs, their level of participation, their desire to participate, and their resource needs to participate more effectively. Methods. Self-administered questionnaires were mailed to a randomized representative sample of AAP members (N = 1602). Overall response rate was 64.5%. Some responses were stratified for analysis by gender; age (>45 years or less than or equal to 45 years); practice area (urban, suburban, or rural); practice setting (solo, group, or hospital); and type of practice (general versus specialty). chi(2) Tests were used to compare responses. Results. Greater than half of the pediatricians who responded to the questionnaire were aware of school health education curriculum on risky adolescent behaviors in their community, counseling services (58%), school nursing services (63%), and screening services (71%); however, more than half were not aware of curriculum on injury/violence prevention, fitness, or whether a school health advisory council was available. Most pediatricians supported comprehensive school health education (pregnancy prevention, 82%; violence prevention, 77%; mental health, 56%). Also, respondents supported services (counseling, 76%; nutrition, 65%; screening/referral, 58%; school-based primary care, 58%). Although 22% of AAP pediatricians are currently working with local school programs, >70% wanted to become involved or more involved and needed information on how they may be able to participate. Only 25% believed they were adequately prepared. Two thirds believed school-based clinics were one of the best ways to reach underserved children and adolescents and should include preteens. Conclusion. AAP pediatricians want to become more involved with comprehensive school health programs. The ways in which they want to participate vary substantially. Most pediatricians thought they needed additional education. The AAP has developed recommendations for graduate medical education and continuing medical education for pediatricians to participate in integrated school health services.

Barnighausen, T. and D. E. Bloom (2009). ""Conditional scholarships" for HIV/AIDS health workers: Educating and retaining the workforce to provide antiretroviral treatment in sub-Saharan Africa." Social Science & Medicine 68(3): 544-551.
	Without large increases in the number of health workers to treat HIV/AIDS (HAHW) many countries in sub-Saharan Africa will be unable to achieve universal coverage with antiretroviral treatment (ART), leading to large numbers of avoidable deaths among people living with HIV/AIDS. We conduct a cost-benefit analysis of a health care education scholarship that is conditional on the recipient committing to work for several years after graduation delivering ART in sub-Saharan Africa. Such a scholarship could address two of the main reasons for the low numbers of health workers in sub-Saharan Africa: low education rates and high emigration rates. We use Markov Monte Carlo microsimulation to estimate the expected net present value (eNPV) of "conditional scholarships" in sub-Saharan Africa. The scholarships are highly eNPV-positive under a wide range of assumptions. Conditional scholarships for a HAHW team sufficient to provide ART for 500 patients have an eNPV of 1.24 million year-2000 US dollars, assuming that the scholarship recipients are in addition to the health workers who would have been educated without scholarships and that the scholarships reduce annual HAHW emigration probabilities from 15% to 5% for five years. The eNPV of the education effect of the scholarships is larger than eNPV of the migration effect. Policy makers should consider implementing "conditional scholarships" for HAHW, especially in countries where health worker education capacity is currently underutilized or can be rapidly expanded. (C) 2008 Elsevier Ltd. All rights reserved.

Barnighausen, T., et al. (2007). "Human resources for treating HIV/AIDS: Needs, capacities, and gaps." Aids Patient Care and Stds 21(11): 799-812.
	Despite recent international efforts to scale-up antiretroviral treatment (ART), more than 5 million people needing ART in low- and middle-income countries (LMIC) do not receive it. Limited human resources to treat HIV/AIDS (HRHA) are one of the main constraints to achieving universal ART coverage. We model the gap between needed and available HRHA to quantify the challenge of achieving and sustaining universal ART coverage by 2017. We estimate the HRHA gap in LMIC using recently published estimates of ART coverage, HIV incidence, health-worker emigration rates, mortality rates of people needing ART, and numbers of HRHA needed to treat 1000 ART patients (based on review studies, 2006). We project the HRHA gap in 10 years (2017) using a simple discrete-time model with a health worker pool replenished through education and depleted through emigration/death; a population needing ART replenished with a given HIV incidence rate; and higher survival rates for treated populations. We analyze the effects of varying assumptions about HRHA inflows and outflows and the evolution of the HIV pandemic in three different regional base cases (sub-Saharan Africa, non-sub-Saharan African LMIC, and South Africa). Current ART coverage for LMIC is around 28%-32% and, other things equal, will drop to 16%-19% by 2017 with constant current HRHA production rates. A naive model, ignoring the increased survival probability resulting from ART, suggests that approximately the current number of HRHA in ART services needs to be added every year for the next ten years to achieve universal coverage by 2017. In a model accounting for increased survival of treated patients, outcomes vary by region; sub-Saharan Africa requires two times, non-sub-Saharan African LMIC require 1.5 times and South Africa requires more than three times their respective current HRHA population to be added every year for the next 10 years to achieve universal coverage by 2017. Even if achieved by 2017, sustaining universal coverage requires further HRHA increases until the system reaches steady state. ART coverage is sensitive to HRHA inflow and emigration. Our model quantifies the challenge of closing the HRHA gap in LMIC. It shows that strategies to achieve universal ART coverage must account for feedback due to higher survival probabilities of people receiving ART. It suggests that universal ART coverage is unlikely to be achieved and sustained with increased HRHA inflows alone, but will require decreased HRHA outflows, substantially reduced HIV incidence, or changes in the nature or organization of care. Means to decrease HRHA emigration outflows include scholarships for healthcare education that are conditional on the recipient delivering ART in a country with high ART need for a number of years, training health workers who are not internationally mobile, or changing recruitment policies in countries receiving health workers from the developing world. Effective organizational changes include those that reduce the number of HRHA required to treat a fixed number of patients. Given the large number of health workers that even optimistic assumptions suggest will be needed in ART services in the coming decades, policymakers must ensure that the flow of workers into ART programs does not jeopardize the provision of other important health services.

Barnsteiner, J. H., et al. (2010). "Promoting evidence-based practice and translational research." Nursing Administration Quarterly 34(3): 217-225.
	Evidence-based practice (EBP) is an evolutionary step in the nursing model of excellence in professional practice at the Hospital of the University of Pennsylvania. A healthcare culture focused on excellence and world-class patient care requires that nursing research and EBP are integrated into the professional practice model and nursing care delivery. To achieve this, it requires the development of staff expertise, time allocation for staff to participate in scholarly activities, resources that support EBP and research, and expert consultants in EBP and nursing translational research. This article describes the systems and structures in place to provide staff with resources in order to translate research and deliver EBP and the multiple initiatives in disseminating evidence to the point of care. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Barrows, H. S. (2008). "Innovations without appropriate assessment are of limited usefulness." Teaching & Learning in Medicine 20(4): 287.
	
Barry Hultquist, T., et al. (2015). "Partnering With Community-Dwelling Individuals With Diabetes for Health Behavior Change Using Action Plans: An Innovation in Health Professionals Education and Practice." Health Promotion Practice 16(6): 906-915.
	Health care practitioners support or hinder an individual's attempts to self-manage health behavior. Practitioners must understand an individual's health needs and goals to effectively partner for behavior change. Self-management support (SMS) promote efforts toward positive health behavior change. Practitioners need training to provide effective SMS, beginning with their formal education. The purpose of this educational practice project was to integrate an evidence-based intervention (SMS using action plans) into a nursing curriculum. Three sequential steps included (1) providing foundational SMS education, (2) SMS application with students' personal action plans, and (3) implementing SMS with community-dwelling individuals with diabetes. Students (n = 130) partnered with participants (n = 85), developing short- (n = 240) and long-term (n = 99) action plans during home visits. The average baseline Diabetes Empowerment Scale score measuring participant's perceived psychosocial diabetes management self-efficacy was 4.3 (1-5 scale, SD = 0.51, n = 83). Most common short-term actions related to physical activity (n = 100, 42%) and healthy eating (n = 61, 25%). Average participant confidence level was 7.7 (SD = 1.9, 0-10 scale). Short-term goal evaluation (n = 209) revealed 66% (n = 137) were met more than 50% of the time. Both participants (99%) and students (99%) expressed satisfaction with home visit and action plan experiences. This teaching-learning experience is replicable and applicable to any professional health care student. Copyright © 2015 Society for Public Health Education.

Barry, M. (2004). "What did they know? And when did they know it? Progress in helping clinicians reach decisions." Medical Reference Services Quarterly 23(4): 75-85.
	In the past three decades, knowledge professionals have made remarkable strides toward achieving clinicians' decision-support dream of immediately available short answers. Medical evidence, what is truly known about health care effects and ready to be applied in patient care, can now much more easily be identified. Today's information delivery tools enable clinicians to seek answers to many more of their questions and to find the answers when patient encounters and teachable moments are occurring. Excerpted from a state health sciences library association presentation, this paper highlights efforts to speed clinician adoption of health care discoveries into routine patient care. [References: 30]

Barsoum, R. S., et al. (2015). "Fifty Years of Dialysis in Africa: Challenges and Progress." American Journal of Kidney Diseases 65(3): 502-512.
	This review addresses the development of dialysis services in Africa in the face of past and contemporary challenges. Maintenance dialysis treatment programs developed in 29 countries over the past 50 years, usually many years after their independence and the end of subsequent territorial and civil wars. Eight countries had the resources to launch national dialysis programs, conventionally defined as those accommodating at least 100 patients per million population. Additionally, based on information obtained from international and local publications, conference proceedings, and personal communications, it appears that limited short-term dialysis therapy currently is available in most African countries. Currently, the prevalence of and outcomes associated with dialysis in Africa are influenced significantly by the following: (1) local health indexes, including the prevalence of undernutrition and chronic infections; (2) per capita gross domestic product; (3) national expenditures on health and growth of these expenditures with incremental demand; (4) availability and adequate training of health care providers; and (5) literacy. In an attempt to reduce the socioeconomic burden of maintenance dialysis treatment, 12 countries have adopted active transplantation programs and 5 are striving to develop screening and prevention programs. Our recommendations based on these observations include optimizing dialysis treatment initiatives and integrating them with other health strategies, as well as training and motivating local health care providers. These steps should be taken in collaboration with regulatory authorities and the public. (C) 2015 by the National Kidney Foundation, Inc.

Bartholomew, L. K., et al. (2000). "Maximizing the impact of the cystic fibrosis family education program: Factors related to program diffusion." Family & Community Health 22(4): 27-47.
	The impact of a health education program to help families manage chronic disease will be determined not only by the demonstrated effectiveness of the intervention but also by the quality and breadth of program implementation. A theory-based intervention is evaluated that diffuses the Cystic Fibrosis Family Education Program (CF FEP) to approximately 20,000 families nationwide. Surveys of 106 Cystic Fibrosis Foundation-certified CF centers are used in a cross-sectional study of the theory-based determinants of diffusion. Results describe: (1) the proportion of CF centers targeted who adopted and implemented the CF FEP; (2) the perceptions of program or center characteristics associated with program use, fidelity and maintenance/institutionalization; and (3) the relationship between the method of decision-making used by the center to adopt the program and program use, fidelity, and maintenance/institutionalization.

Barton, M. B., et al. (2006). "Role of radiotherapy in cancer control in low-income and middle-income countries." Lancet Oncology 7(7): 584-595.
	More than half the cases of cancer in the world arise in people in low-income and middle-income countries. This proportion will rise to 70% by 2020. These are regions where the annual gross national income per person is less than US$9386. Radiotherapy is an essential part of the treatment of cancer. In high-income countries, 52% of new cases of cancer should receive radiotherapy at least once and up to 25% might receive a second course. Because of the different distribution of tumour types worldwide and of the advanced stage at presentation, patients with cancer in low-income and middle-income regions could have a greater need for radiotherapy than those in high-income countries. Radiotherapy for cure or palliation has been shown to he cost effective. Many countries of low or middle income have limited access to radiotherapy, and 22 African and Asian countries have no service at all. In Africa in 2002, the actual supply of megavoltage radiotherapy machines (cobalt or linear accelerator) was only 155, 18% of the estimated need. In the Asia-Pacific region, nearly 4 million cases of cancer arose in 2002. In 12 countries with available data, 1147 megavoltage machines were available for an estimated demand of nearly 4000 megavoltage machines. Eastern Europe and Latin America showed similar shortages. Strategies for developing services need planning at a national level and substantial investment for staff training and equipment. Safe and effective development of services would benefit from: links with established facilities in other countries, particularly those within the same region; access to information, such as free online journal access; and better education of all medical staff about the roles and benefits of radiotherapy.

Bartsch, S. M., et al. (2016). "Global Economic Burden of Norovirus Gastroenteritis." PLoS ONE [Electronic Resource] 11(4): 16.
	Background Despite accounting for approximately one fifth of all acute gastroenteritis illnesses, norovirus has received comparatively less attention than other infectious pathogens. With several candidate vaccines under development, characterizing the global economic burden of norovirus could help funders, policy makers, public health officials, and product developers determine how much attention and resources to allocate to advancing these technologies to prevent and control norovirus. Methods We developed a computational simulation model to estimate the economic burden of norovirus in every country/area (233 total) stratified by WHO region and globally, from the health system and societal perspectives. We considered direct costs of illness (e.g., clinic visits and hospitalization) and productivity losses. Results Globally, norovirus resulted in a total of $4.2 billion (95% UI: $3.2-5.7 billion) in direct health system costs and $60.3 billion (95% UI: $44.4-83.4 billion) in societal costs per year. Disease amongst children < 5 years cost society $39.8 billion, compared to $20.4 billion for all other age groups combined. Costs per norovirus illness varied by both region and age and was highest among adults >= 55 years. Productivity losses represented 84-99% of total costs varying by region. While low and middle income countries and high income countries had similar disease incidence (10,148 vs. 9,935 illness per 100,000 persons), high income countries generated 62% of global health system costs. In sensitivity analysis, the probability of hospitalization had the largest impact on health system cost estimates ($2.8 billion globally, assuming no hospitalization costs), while the probability of missing productive days had the largest impact on societal cost estimates ($35.9 billion globally, with a 25% probability of missing productive days). Conclusions The total economic burden is greatest in young children but the highest cost per illness is among older age groups in some regions. These large costs overwhelmingly are from productivity losses resulting from acute illness. Low, middle, and high income countries all have a considerable economic burden, suggesting that norovirus gastroenteritis is a truly global economic problem. Our findings can help identify which age group(s) and/or geographic regions may benefit the most from interventions.

Basch, C. E. (2011). "Vision and the Achievement Gap Among Urban Minority Youth." Journal of School Health 81(10): 599-605.
	OBJECTIVES: To outline the prevalence and disparities of vision problems among school-aged urban minority youth, causal pathways through which vision problems adversely affects academic achievement, and proven or promising approaches for schools to address these problems. METHODS: Literature review. RESULTS: More than 20% of school-aged youth have some kind of vision problem. In a nationally representative sample of more than 48,000 youth under age 18, those from lower income families were less likely to have diagnosed eye conditions than White children and children living in higher income families. When diagnosed with eye care problems, Black youth living in poverty received fewer and less intensive services. Causal pathways through which vision problems adversely affect academic achievement include sensory perceptions, cognition, and school connectedness. Vision screening is widespread in the nation's schools, but the educational (and public health) benefits from these efforts are jeopardized by lack of follow-up and coordination of efforts. CONCLUSIONS: Vision problems are highly and disproportionately prevalent among school-aged urban minority youth, have a negative impact on academic achievement through their effects on sensory perceptions, cognition, and school connectedness, and effective practices are available for schools to address these problems. School-based vision screening programs are a logical approach for the early detection and treatment of vision problems affecting youth and are widely implemented in the nation's schools. To more fully realize the educational (and public health) benefits of current investments in screening, programs will require improved follow-up and coordination between and among agencies conducting screening, school nurses, teachers and parents, and in some cases community resources.

Bashshur, R. L., et al. (2002). "Telemedicine/telehealth: an international perspective. Executive summary." Telemedicine Journal & E-Health 8(1): 95-107.
	
Basri, C., et al. (2009). "Sustainable scaling up of good quality health worker education for tuberculosis control in Indonesia: a case study." Human Resources for Health 7: 9.
	Background: In 2000, an external review mission of the National Tuberculosis Control Programme of Indonesia identified suboptimal results of TB control activities. This led to a prioritization on human resource capacity building representing a major shift in the approach following the recommendations of the external review team. Case description: The National Tuberculosis Control Programme (NTP) used a systematic process to develop and implement two strategic action plans focussing on competence development based on specific job descriptions. The approach was a change from only focussing on training, to a broader, long term approach to human resource development for comprehensive TB control. A structured plan for capacity building, including standardized competency based training modules and curricula, was developed in the first phase. This was supported by an organisational system comprised of a training focal point, master trainers, and regional training centres in which nationwide training of supervisors was implemented. Training was expanded to the health service delivery level in the second phase, as well as broadened in the scope of activities beyond training to also include other aspects of human resource development. Discussion and evaluation: The result was improved technical and managerial capacity of health workers for TB control at all levels. The impact on case detection and treatment outcome was spectacular, with major improvements in quality of all aspects of service delivery. Conclusion: The strategic decision by the NTP in 2000 to put the highest priority on capacity building has resulted in impressive progress towards TB control targets, a progress that despite many challenges has been sustained.

Bass, D., et al. (2015). "The Pocket Psychiatrist: Tools to enhance psychiatry education in family medicine." International Journal of Psychiatry in Medicine 50(1): 6-16.
	Primary care is the setting where the majority of patients seek assistance for their mental health problems. To assist family medicine residents in providing effective care to patients for mental health problems during residency and after graduation, it is essential they receive training in the assessment, diagnosis, and treatment of common mental health conditions. While there is some limited education time with a psychiatrist in our department, residents need tools and resources that provide education during their continuity clinics even when the psychiatrist is not available. Information on two tools that were developed is provided. These tools include teaching residents a brief method for conducting a psychiatric interview as well as a means to access evidence-based information on diagnosis and treatment of mental health conditions through templates available within our electronic medical record.

Bastawrous, A. and M. J. Armstrong (2013). "Mobile health use in low- and high-income countries: an overview of the peer-reviewed literature." Journal of the Royal Society of Medicine 106(4): 130-142.
	The evolution of mobile phone technology has introduced new possibilities to the field of medicine. Combining technological advances with medical expertise has led to the use of mobile phones in all healthcare areas including diagnostics, telemedicine, research, reference libraries and interventions. This article provides an overview of the peer-reviewed literature, published between 1 August 2006 and 1 August 2011, for the application of mobile/cell phones (from basic text-messaging systems to smartphones) in healthcare in both resource-poor and high-income countries. Smartphone use is paving the way in high-income countries, while basic text-messaging systems of standard mobile phones are proving to be of value in low- and middle-income countries. Ranging from infection outbreak reporting, anti-HIV therapy adherence to gait analysis, resuscitation training and radiological imaging, the current uses and future possibilities of mobile phone technology in healthcare are endless. Multiple mobile phone based applications are available for healthcare workers and healthcare consumers; however, the absolute majority lack an evidence base. Therefore, more rigorous research is required to ensure that healthcare is not flooded with non-evidence based applications and is maximized for patient benefit.

Bastos, M. H., et al. (2007). "Promoting evidence-based maternity care in middle-income countries: challenges and opportunities." Midwifery 23(2): 111-112.
	
Basu, P. S., et al. (2003). "Visual inspection with acetic acid and cytology in the early detection of cervical neoplasia in Kolkata, India." International Journal of Gynecological Cancer 13(5): 626-632.
	Visual inspection of the cervix after application of 3-5% acetic acid (VIA) is a potential alternative to cytology for screening in low-resource countries. The present study evaluated the performance of VIA, magnified visual inspection after application of acetic acid (VIAM), and cytology in the detection of high-grade cervical cancer precursor lesions in Kolkata (Calcutta) and suburbs in eastern India. Trained health workers with college education concurrently screened 5881 women aged 30-64 years with VIA, VIAM, and conventional cervical cytology. Detection of well-defined, opaque acetowhite lesions close to the squamocolumnar junction; well-defined, circumorificial acetowhite lesions; or dense acetowhitening of ulceroproliferative growth on the cervix constituted a positive VIA or VIAM. Cytology was considered positive if reported as mild dysplasia or worse lesions. All screened women (N = 5881) were evaluated by colposcopy, and biopsies were directed in those with colposcopic abnormalities (N = 1052, 17.9%). The final diagnosis was based on histology (if biopsies had been taken) or colposcopic findings, which allowed direct estimation of sensitivity, specificity, and predictive values. Moderate or severe dysplasia or carcinoma in situ (CIN 2-3 disease) was considered as true positive disease for the calculation of sensitivity, specificity, and predictive values of screening tests. 18.7%, 17.7% and 8.2% of the women tested positive for VIA, VIAM, and cytology. One hundred twenty two women had a final diagnosis of CIN 2-3 lesions. The sensitivities of VIA and VIAM to detect CIN 2-3 lesions were 55.7% and 60.7%, respectively; the specificities were 82.1% and 83.2%, respectively. The sensitivity and specificity of cytology were 29.5% and 92.3%, respectively. All the tests were associated with negative predictive values above 98%. VIA and VIAM had significantly higher sensitivity than cytology in our study; the specificity of cytology was higher than that of VIA and VIAM.

Bateman, C. (2012). "Answering when opportunity knocks - SATS goes global." South African Medical Journal 102(3): 121-122.
	
Bates, J., et al. (2008). ""Mind the gap": seven key issues in aligning medical education and healthcare policy." Healthcare Policy = Politiques de sante 4(2): 46-58.
	To ensure an adequate supply of physicians for the future, Canadian faculties of medicine have been expanding and modifying physician training at the undergraduate and postgraduate levels with the intention of producing more physicians and addressing long-standing challenges in the Canadian physician workforce. While these medical education initiatives may partly address these goals, the lack of alignment between health services policy and education policy may well lead to failures and disappointing results. The authors argue that changes in related healthcare policy are required both to support the intended outcomes and to sustain innovations in medical education. From their perspective as medical educators, the authors describe seven key gaps in this alignment, identify those who are in a position to address them and call for ongoing opportunities to identify, discuss and address alignment of policy with other initiatives at the national and provincial levels.Copyright © 2008 Longwoods Publishing.

Batt, R. E. (2007). "Jordan Matthew Phillips, MD: visionary, founder of the American Association of Gynecologic Laparoscopists, organizational genius." Journal of Minimally Invasive Gynecology 14(5): 536-537.
	
Bauer, M. S. (2002). "A review of quantitative studies of adherence to mental health clinical practice guidelines." Harvard Review of Psychiatry 10(3): 138-153.
	Mental health clinical practice guidelines have proliferated, but there is little evidence regarding the degree to which they are actually implemented in clinical practice. The goal of this study was to locate and review all peer-reviewed reports published through 2000 that provide quantitative information on rates of adherence to specific mental health guidelines. A literature search yielded 41 pertinent studies. These studies were of three types: 26 were cross-sectional investigations performed after the release of guidelines, six were conducted before and after release of guidelines without any specific intervention (pre/post), and nine involved a controlled trial of a specific intervention. Only 37% were conducted in the mental health specialty sector. Adequate adherence was found in 27% of the cross-sectional and pre/post studies but in 67% of the controlled trials. Successful interventions tended to be complex, involving system redesign or additional resources. Only six of 13 investigations (46%) that also measured patient outcome found that better outcome was associated with greater guideline adherence. Several studies showed that after cessation of interventions, adherence rates returned to preintervention levels. Thus, evidence indicates that guideline adherence is not high without specific intervention, but that certain interventions (typically multifaceted and resource-intensive ones) improve adherence. However, the public health challenge is to design and implement interventions that are sustainable in general clinical practice.

Bauer, S., et al. (2014). "Promoting a standard for assistive technology service delivery." Technology and Disability 26(1): 39-48.
	BACKGROUND: The Assistive Technology Service Method (ATSM) is an innovative evidence-based process standard to support the provision of person centered, evidence-based, and interdisciplinary assistive technology services. OBJECTIVE: This paper defines challenges with adoption of innovative practices and discusses strategies to diffuse the ATSM for training, education, and gathering knowledge. METHOD: Important central components for the diffusion of innovations are reviewed to include strategies for transferring the evidence into practice and other outcomes of the process. RESULTS: This paper discusses key issues and challenges to professional practice for assistive technology services, presents data on the current state of practice, and delivers strategies to promote innovative interventions and techniques. CONCLUSION: Strategies to implement the adoption of an interdisciplinary service delivery method must consider provider knowledge and awareness of need with development of tools for effective use of the innovation. © 2014 - IOS Press and the authors. All rights reserved.

Baumbusch, J. L., et al. (2008). "Pursuing common agendas: A collaborative model for knowledge translation between research and practice in clinical settings." Research in Nursing and Health 31(2): 130-140.
	There is an emerging discourse of knowledge translation that advocates a shift away from unidirectional research utilization and evidence-based practice models toward more interactive models of knowledge transfer. In this paper, we describe how our participatory approach to knowledge translation developed during an ongoing program of research concerning equitable care for diverse populations. At the core of our approach is a collaborative relationship between researchers and practitioners, which underpins the knowledge translation cycle, and occurs simultaneously with data collection/analysis/synthesis. We discuss lessons learned including: the complexities of translating knowledge within the political landscape of healthcare delivery, the need to negotiate the agendas of researchers and practitioners in a collaborative approach, and the kinds of resources needed to support this process.© 2008 Wiley Periodicals, Inc.

Baumgart, A. J. (1996). "Promoting nursing practice through nursing research." International Nursing Review 43(2): 45-48+57.
	ICN is convinced of the importance of nursing research as a means of improving professional education and practice and generating health policies and systems that assure cost-effective use of resources. To this end, ICN is investing heavily in programmes and projects that strengthen the capabilities of ICN and its members to exercise research leadership. Below, three dimensions of research leadership that are important in today's health environment: 1) Fostering research-based practice; 2) Documenting the work and worth of nursing: and 3) Enhancing public understanding of nursing work.

Bawany, N. Z. and J. A. Shamsi (2015). "Smart City Architecture: Vision and Challenges." International Journal of Advanced Computer Science and Applications 6(11): 246-255.
	The concept of smart city was born to provide improved quality of life to citizens. The key idea is to integrate information system services of each domain, such as health, education, transportation, power grid etc., of the city to provide public services to citizens efficiently and ubiquitously. These expectations induce massive challenges and requirements. This research is aimed to highlight key ICT (Information and Communication Technology) challenges related to adaptation of smart city. Realizing the significance of effective data collection, storage, retrieval, and efficient network resource provisioning, the research proposes a high level architecture for smart city. The proposed framework is based on a hierarchical model of data storage and defines how different stakeholders will be communicating and offering services to citizens. The architecture facilitates step by step implementation towards a smart city, integrating services, as they are developed in a timely manner.

Bays, H. E., et al. (2016). "National Lipid Association Annual Summary of Clinical Lipidology 2016." Journal of Clinical Lipidology 10(1): S1-S43.
	The National Lipid Association (NLA) Annual Summary of Clinical Lipidology is a yearly updated summary of principles important to the patient-centered evaluation, management, and care of patients with dyslipidemia. This summary is intended to be a "living document," with future annual updates based on emerging science, clinical considerations, and new NLA Position, Consensus, and Scientific Statements, thus providing an ongoing resource that applies the latest in medical science towards the clinical management of patients with dyslipidemia. Topics include the NLA Recommendations for Patient-Centered Management of Dyslipidemia, genetics, Familial Hypercholesterolemia, secondary causes of dyslipidemia, biomarkers and advanced lipid testing, nutrition, physical activity, obesity, adiposopathy, metabolic syndrome, diabetes mellitus, lipid pharmacotherapy, lipid-altering drug interactions, lipoprotein apheresis, dyslipidemia management and treatment based upon age (children, adolescents, and older individuals), dyslipidemia considerations based upon race, ethnicity and gender, dyslipidemia and human immune virus infection, dyslipidemia and immune disorders, adherence strategies and collaborative care, and lipid-altering drugs in development. Hyperlinks direct the reader to sentinel online tables, charts, and figures relevant to lipidology, access to online atherosclerotic cardiovascular disease risk calculators, worldwide lipid guidelines, recommendations, and position/scientific statements, as well as links to online audio files, websites, slide shows, applications, continuing medical education opportunities, and patient information. (C) 2016 National Lipid Association. All rights reserved.

Bazargani, Y. T., et al. (2014). "Selection of oncology medicines in low- and middle-income countries." Annals of Oncology 25(1): 270-276.
	Background: High cancer mortality rates in low-and middle-income countries (LMICs) have raised concerns regarding access to oncology medicines. Essential medicines are those which satisfy the primary health care needs and provide a basis for public procurement or reimbursement decisions in LMICs. We explored selection of oncology medicines in LMICs through investigating national essential medicines lists (NEMLs) for cancer treatments. Methods: Recently updated NEMLs were retrieved for 76 countries. Oncology medicines were classified based on therapeutic categories. Countries were clustered based on geographic regions, income levels and burden of cancer (mortality and morbidity). Indicators of frequency (number of medicines), diversity (number of therapeutic (sub) categories) and more importantly absence were measured and compared across countries using parametric and nonparametric tests. Results: The overall median number of oncology medicines on NEMLs was 16 (interquartile range = 23) chosen predominantly from subcategories of 'antineoplastic agents', with substantial variation across regions and income groups. Five countries did not select any oncology medicine and 68% did not have any 'hormones and related agents' on their NEMLs. Newer technologies like targeted therapies were infrequently incorporated. The cluster of countries suffering most from the burden of cancer selected more essential oncology medicines and diversified further. Conclusion: The observed selection of oncology essential medicines can reflect insufficiencies and inequalities in access to cancer treatments at least in the public sector of LMICs. Further resources need to be allocated from governments and international organizations to tackle the problem of access to oncology medicines in these countries.

Bazargani, Y. T., et al. (2015). "Essential medicines for breast cancer in low and middle income countries." Bmc Cancer 15: 8.
	Background: Breast cancer is the most common type of cancer among women worldwide. In low and middle-income countries (LMICs), appropriate selection of medicines on national essential medicines lists (NEMLs) is a first step towards adequate access to treatment. We studied selection of systemic treatments for breast cancer on NEMLs and assessed its alignment with treatment guidelines for different types of early and advanced breast cancer. Furthermore, influence of country characteristics on the selection was investigated. Method: NEMLs from 75 LMICs were studied for inclusion of all components of therapy in each stage of breast cancer according to international consensus guidelines. The results were then grouped by income level, WHO region and the NEMLs' release date. Non parametric tests were used for statistical analysis. Results: Unlike HER2-targeted therapies (<10 %), aromatase inhibitors (12 %) and taxanes (28 %); tamoxifen and first generation chemotherapeutic regimens (e.g., anthracycline-based regimens) were frequently found in the NEMLs (71-78 %). Consequently, all components of treatment for "Luminal A" early breast cancer and non HER2 overexpressed advanced breast cancer were found on the NEMLs of over 70 % of countries. However, 40 % of the low income countries did not have all the components of therapy for any type of early breast cancer in their NEMLs, and adequate treatment of HER2 overexpressed breast cancer was hardly possible with the current selections. Recent NEMLs were more aligned with the guidelines (p < 0.05). Eastern Mediterranean and African regions less frequently incorporated all components of breast cancer treatment in their NEMLs. Conclusion: Alignment of selection with guidelines' recommendations was inconsistent for different types of early and advanced breast cancer in NEMLs. Regular updates and more attention to clinical guidelines is therefore recommended.

Bazell, C., et al. (2004). "The Undergraduate Medical Education for the 21st Century (UME-21) project: The federal government perspective." Family Medicine 36: S15-S19.
	The Undergraduate Medical Education for the 21st Century (UME-21) project was implemented by the Division of Medicine, Bureau of Health Professions, Health Resources and Services Administration (HRSA) to encourage medical schools to collaborate with managed care organizations and others. The purpose of the collaboration was to ensure that medical students are prepared to provide quality patient care and manage that care in an integrated health care system in which the cost of care and use of empirically justified care are important elements. The UME-21 project represents a continuation of HRSA's interest in the managed care arena. The UME-21 project involved the collaboration of eight partner schools and 10 associate partner schools, together with 50 external partners, to develop innovative curricula that integrated UME-21 content from nine special areas as learning objectives. This project demonstrated that concerted efforts by the leadership in medical education can bring about innovative change in medical school curricula. It is also demonstrated that faculty of the three primary care disciplines of family medicine, general internal medicine, and general pediatrics were able to cooperate to accomplish such change by working together to allocate clerkship time and content. An important lesson learned in this project was that significant innovations in medical school curricula could be accomplished with a broad-based commitment and involvement of both faculties across the three primary care disciplines and top administrative officials of the medical school. It is uncertain, however, if the innovations achieved will produce further changes or if those changes achieved can be sustained without continued funding.

Bazell, C. and R. Kahn (2001). "From the primary care organizations consortium's proposal to the Interdisciplinary Generalist Curriculum Project." Academic Medicine 76(4): S13-S18.
	The Interdisciplinary Generalist Curriculum (IGC) Project was one element of an overall federal government strategy designed to promote primary care education. This project, undertaken by the Division of Medicine and Dentistry (DMD), Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services, was the first large-scale medical education contract initiated by DMD. The IGC Project was based on a model proposed by the Primary Care Organizations Consortium (PCOC). The PCOC thesis was that "if students are to decide to pursue a generalist career they must have the opportunity to be taught by generalists." The PCOC Program required an explicit curriculum focusing on generalist knowledge and skills with an emphasis on technology, in the context of education that required training in ambulatory office-based settings. The PCOC Program specified that responsibility for the program's planning, implementation, and evaluation be shared by the three generalist physician faculties of family medicine, general internal medicine, and general pediatrics. In implementation of this demonstration project in ten medical schools across the nation, several lessons have been learned relative to enhancement of generalist education. Among these lessons is that seed money targeted to initiate modest change can act as a catalyst and improve the knowledge and skills afforded medical students concerning generalist practice. Limited funds provided over a sufficient period of time can induce schools to undertake significant curricular change.

Beaglehole, R., et al. (2008). "Alma-Ata: Rebirth and revision 3 - Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care." Lancet 372(9642): 940-949.
	The burden of chronic diseases, such as heart disease, cancer, diabetes, and mental disorders is high in low-income and middle-income countries and is predicted to increase with the ageing of populations, urbanisation, and globalisation of risk factors. Furthermore, HIV/AIDS is increasingly becoming a chronic disorder. An integrated approach to the management of chronic diseases, irrespective of cause, is needed in primary health care. Management of chronic diseases is fundamentally different from acute care, relying on several features: opportunistic case finding for assessment of risk factors, detection of early disease, and identification of high risk status; a combination of pharmacological and psychosocial interventions, often in a stepped-care fashion; and long-term follow-up with regular monitoring and promotion of adherence to treatment. To meet the challenge of chronic diseases, primary health care will have to be strengthened substantially. In the many countries with shortages of primary-care doctors, non-physician clinicians will have a leading role in preventing and managing chronic diseases, and these personnel need appropriate training and continuous quality assurance mechanisms. More evidence is needed about the cost-effectiveness of prevention and treatment strategies in primary health care. Research on scaling-up should be embedded in large-scale delivery programmes for chronic diseases with a strong emphasis on assessment.

Beale, S., et al. (2015). "A scoping study to explore the cost-effectiveness of next-generation sequencing compared with traditional genetic testing for the diagnosis of learning disabilities in children." Health Technology Assessment 19(46): I-90.
	Background: Learning disability (LD) is a serious and lifelong condition characterised by the impairment of cognitive and adaptive skills. Some cases of LD with unidentified causes may be linked to genetic factors. Next-generation sequencing (NGS) techniques are new approaches to genetic testing that are expected to increase diagnostic yield. Objectives: This scoping study focused on the diagnosis of LD in children and the objectives were to describe current pathways that involve the use of genetic testing; collect stakeholder views on the changes in service provision that would need to be put in place before NGS could be used in clinical practice; describe the new systems and safeguards that would need to be put in place before NGS could be used in clinical practice; and explore the cost-effectiveness of using NGS compared with conventional genetic testing. Methods: A research advisory group was established. This group provided ongoing support by e-mail and telephone through the lifetime of the study and also contributed face-to-face through a workshop. A detailed review of published studies and reports was undertaken. In addition, information was collected through 33 semistructured interviews with key stakeholders. Results: NGS techniques consist of targeted gene sequencing, whole-exome sequencing (WES) and whole-genome sequencing (WGS). Targeted gene panels, which are the least complex, are in their infancy in clinical settings. Some interviewees thought that during the next 3-5 years targeted gene panels would be superseded by WES. If NGS technologies were to be fully introduced into clinical practice in the future a number of factors would need to be overcome. The main resource-related issues pertaining to service provision are the need for additional computing capacity, more bioinformaticians, more genetic counsellors and also genetics-related training for the public and a wide range of staff. It is also considered that, as the number of children undergoing genetic testing increases, there will be an increase in demand for information and support for families. The main issues relating to systems and safeguards are giving informed consent, sharing unanticipated findings, developing ethical and other frameworks, equity of access, data protection, data storage and data sharing. There is little published evidence on the cost-effectiveness of NGS technologies. The major barriers to determining cost-effectiveness are the uncertainty around diagnostic yield, the heterogeneity of diagnostic pathways and the lack of information on the impact of a diagnosis on health care, social care, educational support needs and the wider family. Furthermore, as NGS techniques are currently being used only in research, costs and benefits to the NHS are unclear. Conclusions: NGS technologies are at an early stage of development and it is too soon to say whether they can offer value for money to the NHS as part of the LD diagnostic process. Substantial organisational changes, as well as new systems and safeguards, would be required if NGS technologies were to be introduced into NHS clinical practice. Considerable further research is required to establish whether using NGS technologies to diagnose learning disabilities is clinically effective and cost-effective.

Beam, P. S., et al. (2006). "The changing library: What clinicians need to know." Mount Sinai Journal of Medicine 73(6): 857-863.
	Over the last two decades, changes in technology have allowed academic medical center libraries to bring the world of biomedical information to the physician's computer desktop. Because digital libraries have grown so rapidly and in so many ways, some clinicians may be uncertain about the services and resources that are available to them. This article explains how clinical faculty can best utilize their library to support their research and patient care. It addresses some of the most common myths about the "new" medical library, and it highlights innovations in library resources and services that can help physicians to better access, use and manage medical information.

Beaton, L. and R. Freeman (2016). "Oral health promotion and homelessness: A theory-based approach to understanding processes of implementation and adoption." Health Education Journal 75(2): 184-197.
	Objective: To use the Theory of Diffusion of Innovations as a framework to explore the qualitative data gleaned from a process evaluation of the Smile4life intervention across Scottish National Health Service (NHS) Boards and to inform future oral health promotion and homelessness. Design: A qualitative exploration. Setting: In 2012, the Smile4life programme to promote the oral health of homeless people was launched in Scotland. Practitioners received training to ensure its successful implementation and adoption. A process evaluation began in February 2013. Method: A total of 20 oral health officers from the 11 participating NHS Boards took part in the process evaluation. They were interviewed each month for a 17-month period. Boards were placed into adoption categories based on the time taken to adoption. The data were analysed using a framework approach. Results: The Theory of Diffusion of Innovations was used to define 'time to adoption' and to classify participating NHS Boards' adoption categories. It was also used to identify diffusion variables that underpinned Smile4life adoption. For Boards that more readily adopted Smile4life, the diffusion variables of familiarity and good social exchanges appeared to promote implementation. Numerous conflicts emerged, however, in late adoption Boards. These included a lack of resources and practitioner ambivalence, which slowed up implementation. Conclusion: The Theory of Diffusion of Innovations provided a useful theoretical framework for understanding the processes in the implementation and adoption of the Smile4life programme. It allowed specific training requirements for the practitioners to emerge to facilitate diffusion of the programme in their Boards. © Health Education Journal.

Beattie, B. L., et al. (2003). "A vision for older adults and health promotion." American Journal of Health Promotion 18(2): 200-204.
	Our rapidly aging population is expected to place heavy demands on all segments Of society, particularly the health care resources needed to attend to health concerns associated with aging. Is this a looming crisis, as some predict, or a challenge to use resources more wisely and to help older adults and their caregivers share in the responsibility for health promotion and chronic disease self-management activities? Community-based organizations serving older adults are uniquely positioned to augment health care providers' health promotion counseling activities and to bridge the gap between the research and practice of health promotion in older adults. They already play a crucial role by providing appropriate health promotion education, screening and referral, service planning, and reinforcement to facilitate self-care activities and behavior changes that promote healthy aging. By increasing teamwork across the network of services for the aging, the health sector, public and private organizations, and academe, there is a great opportunity to enhance the health and well-being of all older Americans.

Bebbington, P. E., et al. (2000). "Neurotic disorders and the receipt of psychiatric treatment." Psychological Medicine 30(6): 1369-1376.
	Background. Access to psychiatric treatment by people with neurotic disorders in the general population is likely to be affected both by the severity of disorder and by sociodemographic differences. Method. In the household component of the National Surveys of Psychiatric Morbidity > 10000 subjects in Great Britain with psychiatric symptoms were interviewed using the CIS-R. They were also asked about difficulties experienced in performing seven types of everyday activity. All subjects classed as having an ICD-10 disorder were questioned about their experience of treatment with antidepressants, hypnotics, and counselling or psychotherapy. Results. Less than 14 % of people with current neurotic disorders were receiving treatment for them. Within the previous year, only a third had made contact with their primary care physician for their mental problem: of these < 30 % were receiving treatment. Overall, 9 % of people with disorders were given medication and 8 % counselling or psychotherapy. A diagnosis of depressive episode was that most associated with antidepressant medication. Treatment access was affected by employment status, marital status, and age, but the major determinant was symptom severity. Neither sex nor social class influenced which people received treatment. Conclusions. People with psychiatric disorders seldom receive treatment, even when they have consulted their primary care physician about them. In many cases, this must represent unmet needs with a strong claim on health resources. There are also inequalities in the receipt of treatment, although the major influence is the severity of disorder.

Bech, M., et al. (2009). "The influence of economic incentives and regulatory factors on the adoption of treatment technologies: A case study of technologies used to treat heart attacks." Health Economics 18(10): 1114-1132.
	The Technological Change in Health Care Research Network collected unique patient-level data on three procedures for treatment of heart attack patients (catheterization, coronary artery bypass grafts and percutaneous transluminal coronary angioplasty) for 17 countries over a 15-year period to examine the impact of economic and institutional factors on technology adoption. Specific institutional factors are shown to be important to the uptake of these technologies. Health-care systems characterized as public contract systems and reimbursement systems have higher adoption rates than public-integrated health-care systems. Central control of funding of investments is negatively associated with adoption rates and the impact is of the same magnitude as the overall health-care system classification. GDP per capita also has a strong role in initial adoption. The impact of income and institutional characteristics on the utilization rates of the three procedures diminishes over time. Copyright © 2008 John Wiley & Sons, Ltd.

Beck, C., et al. (2011). "Filling the void in geriatric mental health: The Geropsychiatric Nursing Collaborative as a model for change." Nursing Outlook 59(4): 236-241.
	Mental health for older adults is a looming public health problem. Yet, geriatric mental health specialists are a scarce commodity, and few generalists have had formal education in either geriatrics or mental health. A multilevel collaboration using a diffusion of innovation model served to achieve change nationally in preparing entry-and advanced practice-level nurses to improve the mental health of older Americans. The John A. Hartford Foundation Geropsychiatric Nursing Collaborative at the American Academy of Nursing is the exemplar described here. The Geropsychiatric Nursing Collaborative developed and infused mental health competency enhancements for generalist and specialist nurses; identified and disseminated teaching-learning strategies to convey related key concepts using the POGOe (Portal of Geriatric Online Education) website; raised awareness through multiple presentations and publications; and notified deans of every school of nursing about these new resources. Fully embracing diffusion of innovation principles, the Geropsychiatric Nursing Collaborative is achieving change in this critical area of nursing practice. Cite this article: Beck, C., Buckwalter, K. C., Dudzik, P. M., & Evans, L. K. (2011, AUGUST). Filling the void in geriatric mental health: The Geropsychiatric Nursing Collaborative as a model for change. Nursing Outlook, 59(4), 236-242. doi:10.1016/j.outlook.2011.05.016.

Beck, J. B. and J. S. Tieder (2015). "Electronic resources preferred by pediatric hospitalists for clinical care." Journal of the Medical Library Association 103(4): 177-183.
	Objectives: There is little research on pediatric hospitalists' use of evidence-based resources. The aim of this study was to determine the electronic resources that pediatric hospitalists prefer. Methods: Using a web-based survey, the authors determined hospitalists' preferred electronic resources, as well as their attitudes toward lifelong learning, practice, and experience characteristics. Results: One hundred sixteen hospitalists completed the survey. The most preferred resource for general information, patient handouts, and treatment was UpToDate. Online search engines were ranked second for general information and patient handouts. Conclusions: Pediatric hospitalists tend to utilize less rigorous electronic resources such as UpToDate and Google. These results can set a platform for discussing the quality of resources that pediatric hospitalists use.

Becker, W. J., et al. (2007). "Moving forward to improve migraine management in Canada." Canadian Journal of Neurological Sciences 34(4): S20-S26.
	The goal of the Canadian Migraine Forum was to work towards improving the lives of Canadians with migraine by reducing their migraine-related disability. Migraine has been ranked 19th by the World Health Organization among causes of years of life lived with disability. To improve management of migraine in Canada, the participants in the forum identified several important needs and strategies. There is a need for more leaders in the field of migraine to work with other stakeholders to obtain funding and develop treatment programs across Canada. Leadership is also required to address the under use of both migraine specific symptomatic medications and prophylactic medications in Canada. More non-physician health professionals are required to work with physicians in migraine treatment teams. This could assist with a shortage of physician resources, and could also help to better meet the needs of the migraine patient. Individuals with migraine need to be identified who could work with health care professionals to help meet the needs of the migraine patients in our communities. Application of the chronic disease management model for migraine treatment was also seen as an important factor for the management of migraine. Programs are needed to promote earlier diagnosis, long term follow-up, comprehensive patient education, and the use of multidisciplinary treatment teams where appropriate. Also considered important was the need to increase knowledge about migraine through public awareness campaigns, websites, medical education, and appropriate reading material for patients. The public needs to be aware that migraine is a biological disorder that can cause significant disability and suffering. Lastly, there is a pressing need to promote more migraine research, including careful outcome assessments for treatment programs that involve non-pharmacological treatments and a team based approach to migraine management. There are many challenges that must be overcome if we are to be successful in reducing migraine related disability in Canada. Success will depend upon the joint efforts of physicians, other healthcare professionals, individuals with migraine, and the public at large.

Bediang, G., et al. (2013). "Computer literacy and E-learning perception in Cameroon: the case of Yaounde Faculty of Medicine and Biomedical Sciences." BMC Medical Education 13: 8.
	Background: Health science education faces numerous challenges: assimilation of knowledge, management of increasing numbers of learners or changes in educational models and methodologies. With the emergence of e-learning, the use of information and communication technologies (ICT) and Internet to improve teaching and learning in health science training institutions has become a crucial issue for low and middle income countries, including sub-Saharan Africa. In this perspective, the Faculty of Medicine and Biomedical Sciences (FMBS) of Yaounde has played a pioneering role in Cameroon in making significant efforts to improve students' and lecturers' access to computers and to Internet on its campus. The objective is to investigate how computer literacy and the perception towards e-learning and its potential could contribute to the learning and teaching process within the FMBS academic community. Method: A cross-sectional survey was carried out among students, residents and lecturers. The data was gathered through a written questionnaire distributed at FMBS campus and analysed with routine statistical software. Results: 307 participants answered the questionnaire: 218 students, 57 residents and 32 lecturers. Results show that most students, residents and lecturers have access to computers and Internet, although students' access is mainly at home for computers and at cyber cafes for Internet. Most of the participants have a fairly good mastery of ICT. However, some basic rules of good practices concerning the use of ICT in the health domain were still not well known. Google is the most frequently used engine to retrieve health literature for all participants; only 7% of students and 16% of residents have heard about Medical Subject Headings (MeSH). The potential of e-learning in the improvement of teaching and learning still remains insufficiently exploited. About two thirds of the students are not familiar with the concept of e-leaning. 84% of students and 58% of residents had never had access to e-learning resources. However, most of the participants perceive the potential of e-learning for learning and teaching, and are in favour of its development at the FMBS. Conclusion: The strong interest revealed by the study participants to adopt and follow-up the development of e-learning, opens new perspectives to a faculty like the FMBS, located in a country with limited resources. However, the success of its development will depend on different factors: the definition of an e-learning strategy, the implementation of concrete measures and the adoption of a more active and participative pedagogy.

Bednar, S., et al. (2011). "Simulation for physician extenders." Disease-a-Month 57(12): 802-806.
	
Beecham, J. (2014). "Annual Research Review: Child and adolescent mental health interventions: a review of progress in economic studies across different disorders." Journal of Child Psychology and Psychiatry 55(6): 714-732.
	BackgroundResources for supporting children and adolescents with psychiatric disorders continue to be scarce. Economics research can identify current patterns of expenditure, and help inform allocation of treatment and support resources between competing needs or uses. Scope and methodsThe aim was to identify the costs of supporting children and adolescents, the economic impacts of childhood psychiatric disorders in adulthood and any new evidence on the cost-effectiveness of interventions. An electronic search of databases (including PubMed, Medline and Psychinfo) identified peer-reviewed journal articles published between 2005 and 2012. FindingsSixty-seven papers provided data on support and treatment costs now or in the future, or cost-effectiveness analyses of services. Half the articles came from the United States. Most articles focussed on autism spectrum disorder (ASD; 23 articles), attention deficit hyperactivity disorder (ADHD; n=15), conduct disorder (CD; n=7), and anxiety or depression (n=8). ConclusionOnly 14 studies used a cost perspective wider than health care; most included education costs (n=11), but only five included costs to the justice system. The number of studies estimating costs to the family has increased, particularly for children with autism spectrum disorder (ASD). In the United Kingdom, support costs for children and adolescents with conduct disorder (CD) appear to be lower than for those with attention deficit hyperactivity disorder (ADHD), although for the United States, the opposite may be true. Support costs for children and adolescents with ASD may be higher than both CD and ADHD. However, there were many differences between the samples and the methods employed making comparisons between studies difficult. Outcomes in adulthood include negative impacts on (mental) health, quality of life, public sector services, employment status and income. The evidence base is improving for child and adolescent psychiatric disorders, although only one full cost-effectiveness analysis was identified since the previous review published in 2012. However, we still do not know enough about the economic implications of support and treatment for specific disorders.

Beemath, A. and R. J. Zalenski (2009). "Palliative Emergency Medicine: Resuscitating Comfort Care?" Annals of Emergency Medicine 54(1): 103-105.
	
Bekelis, K., et al. (2014). "Regional intensity of neurosurgical care and integration of aneurysm coiling in the United States." International Angiology 33(5): 446-454.
	Aim: There is wide regional variability in the volume of procedures performed for similar surgical patients throughout the United States. We investigated the association of the intensity of neurosurgical care with the diffusion of the novel technology of cerebral aneurysm coiling. Methods: We performed a retrospective cohort study involving patients who underwent any neurosurgical procedure from 2005-2010 and were registered in the National Inpatient Sample (NIS) database. A sub-cohort of patients undergoing aneurysm clipping or coiling was also created. Regression techniques were used to investigate the association of the average risk-adjusted intensity of neurosurgical care with the average rate of coiling. Results: There were significant disparities in the rate of coiling among several states (ANOVA, P<0.0001). It ranged from 0.24 in Maryland, where clipping was very predominant, to 0.82 in Minnesota, where coiling was the main treatment modality used. In multivariate analysis, higher coiling rate was associated with increased age, higher income, rural hospital location, and small institution size. The Midwest was association with higher rate in comparison to the Northeast, whereas the West and the South had even lower rates. Increasing rate of coiling was associated with increasing intensity of neurosurgical care. There was a positive correlation of the average risk-adjusted intensity of neurosurgical care with the average rate of coiling per state (Pearson's p=0.43, P<0.001). Conclusion: We observed significant disparities in the rate of coiling in the United States. Increased intensity of neurosurgical care was positively associated with the integration of coiling in treatment of cerebral aneurysms.

Bekes, C. (2007). "Active learning." Critical Care Medicine 35(7): 1785-1786.
	
Béland, F. and H. Bergman (2000). "Home care, continuing care and medicare: a Canadian model or innovative models for Canadians?" HealthcarePapers 1(4): 38-45, discussion 109-112.
	Why is home care excluded from the Canada Health Act? In the 1960s, the Hall Commission suggested that home care be covered through medicare. History decided otherwise--only "medically" necessary care was insured. Today, home-care services are provided in conjunction with episodes of hospital care, or are delivered to frail individuals as part of their social and healthcare needs. However, healthcare can no longer be defined simply as a state of absence of disease. Health also includes individuals' physical and mental functional abilities. Coverage for health services should include those services aimed at preserving and maintaining functional abilities. Moreover, access to home care is inequitable in Canada. Financing mechanisms should improve integration of care, not increase barriers between medical, hospital and social care. As home-care services are provided to persons with different needs, financing and organizational mechanisms have to guarantee that resources are distributed most effectively to meet these needs. Finally, home-care delivery should adapt to local, regional and provincial realities. There is no such thing as "one" Canadian home-care model. Already, a number of experiments with home care are being implemented in Canada. It is in the search for innovative service delivery modalities that Canadians will best be served.

Belkin, G. S., et al. (2011). "Scaling Up for the "Bottom Billion": "5x5" Implementation of Community Mental Health Care in Low-Income Regions." Psychiatric Services 62(12): 1494-1502.
	Common mental disorders pose tremendous health and social burdens in the poorest countries. This Open Forum describes a planning framework to advance effective, sustainable design and implementation of mental health services in these settings. It builds on research in treatment dissemination and on the authors' experience in several initiatives-including the Millennium Villages Project in sub-Saharan Africa and the Partners In Health system in Haiti (Zanmi Lasante). The authors describe a "pyramid of care" approach that specifies five key skill packages to address common mental disorders in low-resource settings and five implementation rules: assess context first; identify priority care pathways and map them across skill packages; specify decision supports, supervision, and triage rules; use quality improvement practices; and plan for sustainability and capacity building. The framework addresses the need for a shared vocabulary and a set of tools to coordinate and compare efforts to scale-up mental health treatment across diverse settings. (Psychiatric Services 62:1494-1502, 2011)

Bell, C., et al. (2006). "An evaluation of digital, split-site and traditional formats in conference poster sessions." Medical Teacher 28(2): 175-179.
	The paper reports an evaluation of digital, split-site and traditional poster presentations at the Association for Medical Education in Europe (AMEE) conference in September 2004. The programme included 300 posters in 19 sessions, viewed, potentially, by 1265 conference participants, in parallel with other events. The instrument was a questionnaire of 16 open- and closed-format questions applied opportunistically and gaining 250 complete responses. Qualitative and quantitative analysis suggested that no one format was preferred. Each had different strengths and weaknesses relating to seeing and hearing the presenter and viewing the poster. Opportunities for discussion were highly valued.

Bell, C. K., et al. (2010). "Curricular Adaptations in Inpatient Child Psychiatry for the 21st Century: The Flexner Model Revisited." Academic Psychiatry 34(3): 195-202.
	Objective: The authors describe curricular modifications created in response to the changing culture of medical education, health care systems, academic medicine, and generational differences. The authors propose a model child psychiatry inpatient curriculum that is sustainable within a community teaching hospital in the 21st century. Methods: The authors built upon the existing literature in health care financing, academic medicine, effective leadership, and the collective clinical, educational and administrative experience of its faculty to design a model inpatient curriculum that should be portable to other training programs. Results: An innovative training model was developed, implemented, and improved over a 5-year period without any additional fiscal resources. Conclusion: This training model has the potential to improve patient care, resident training, interdisciplinary functioning, and resident satisfaction.

Bell, E., et al. (2012). "Climate change: could it help develop 'adaptive expertise'?" Advances in Health Sciences Education 17(2): 211-224.
	Preparing health practitioners to respond to the rising burden of disease from climate change is emerging as a priority in health workforce policy and planning. However, this issue is hardly represented in the medical education research. The rapidly evolving wide range of direct and indirect consequences of climate change will require health professionals to have not only broad content knowledge but also flexibility and responsiveness to diverse regional conditions as part of complex health problem-solving and adaptation. It is known that adaptive experts may not necessarily be quick at solving familiar problems, but they do creatively seek to better solve novel problems. This may be the result of an acquired approach to practice or a pathway that can be fostered by learning environments. It is also known that building adaptive expertise in medical education involves putting students on a learning pathway that requires them to have, first, the motivation to innovatively problem-solve and, second, exposure to diverse content material, meaningfully presented. Including curriculum content on the health effects of climate change could help meet these two conditions for some students at least. A working definition and illustrative competencies for adaptive expertise for climate change, as well as examples of teaching and assessment approaches extrapolated from rural curricula, are provided.

Bell, S. E. and J. R. Hulbert (2008). "Translating social justice into clinical nurse specialist practice." Clinical nurse specialist CNS 22(6): 293-299; quiz 300-301.
	Translating social justice into clinical nurse specialist (CNS) practice involves not only facilitating equitable access to healthcare resources but also changing the definition of health from individual centric to population based. Clinical nurse specialists working within hospitals or healthcare systems generally have not explored the ethical conflicts between demand and available healthcare resources. Application of social justice to CNS practice requires microallocation decisions in direct patient care and macroallocation decisions in the distribution of all societal goods that alleviate health disparities. This article reviews the meaning, history, and current basis for the application of the principle of social justice to CNS practice.

Bellando, J., et al. (2016). "Autism Speaks Toolkits: Resources for Busy Physicians." Clinical Pediatrics 55(2): 171-175.
	Given the increased prevalence of autism spectrum disorders (ASD), it is likely that busy primary care providers (PCP) are providing care to individuals with ASD in their practice. Autism Speaks provides a wealth of educational, medical, and treatment/intervention information resources for PCPs and families, including at least 32 toolkits. This article serves to familiarize PCPs and families on the different toolkits that are available on the Autism Speaks website. This article is intended to increase physicians' knowledge on the issues that families with children with ASD frequently encounter, to increase their ability to share evidence-based information to guide treatment and care for affected families in their practice.

Bemelmans, M., et al. (2014). "Community-supported models of care for people on HIV treatment in sub-Saharan Africa." Tropical Medicine & International Health 19(8): 968-977.
	OBJECTIVES Further scale-up of antiretroviral therapy (ART) to those in need while supporting the growing patient cohort on ART requires continuous adaptation of healthcare delivery models. We describe several approaches to manage stable patients on ART developed by Medecins Sans Frontieres together with Ministries of Health in four countries in sub-Saharan Africa. METHODS Using routine programme data, four approaches to simplify ART delivery for stable patients on ART were assessed from a patient and health system perspective: appointment spacing for clinical and drug refill visits in Malawi, peer educator-led ART refill groups in South Africa, community ART distribution points in DRC and patient-led community ART groups in Mozambique. RESULTS All four approaches lightened the burden for both patients (reduced travel and lost income) and health system (reduced clinic attendance). Retention in care is high: 94% at 36 months in Malawi, 89% at 12 months in DRC, 97% at 40 months in South Africa and 92% at 48 months in Mozambique. Where evaluable, service provider costs are reported to be lower. CONCLUSION Separating ART delivery from clinical assessments was found to benefit patients and programmes in a range of settings. The success of community ART models depends on sufficient and reliable support and resources, including a flexible and reliable drug supply, access to quality clinical management, a reliable monitoring system and a supported lay workers cadre. Such models require ongoing evaluation and further adaptation to be able to reach out to more patients, including specific groups who may be challenged to meet the demands of frequent clinic visits and the integrated delivery of other essential chronic disease interventions.

Benahmed, N., et al. (2012). "Determinants of nonurgent use of the emergency department for pediatric patients in 12 hospitals in Belgium." European Journal of Pediatrics 171(12): 1829-1837.
	The nonurgent use of the emergency department (ED) for pediatric patients is an increasing problem facing healthcare systems worldwide. To evaluate the magnitude of the phenomenon and to identify associated factors, an observational prospective survey was performed including all patients (< 15 years) attending the ED in 12 Belgian hospitals during 2 weeks in autumn 2010. Use of ED was considered appropriate if at least one of the following criteria was met: child referred by doctor or police, brought by ambulance, in need for short stay, technical examination or orthopedic treatment, in-patient admission, or death. Among the 3,117 children, attending ED, 39.9 % (1,244) of visits were considered inappropriate. Five factors were significantly associated with inappropriate use: age of child, distance to ED, having a registered family doctor, out-of-hours visit, and geographic region. The adjusted odds ratio and 95 % confidence intervals are respectively-1.7 (1.3-2.0), 1.7 (1.3-2.2), 1.5 (1.1-2.2), 1.5 (1.2-1.9), and 0.6 (0.5-0.8). Almost 40 % of all paediatric ED attendances did not require hospital expertise. The risk of an inappropriate use of ED by pediatrician patients is predominantly associated with organizational and cultural factors. Access, equity, quality of care, and medical human resources availability have to be taken into account to design financially sustainable model of care for those patients. Furthermore, future research is needed to explain reasons why parents visit ED rather than using of primary-care services.

Benatar, S. R. and T. E. Fleischer (2007). "Ethical issues in research in low-income countries." International Journal of Tuberculosis and Lung Disease 11(6): 617-623.
	During the twentieth century, spectacular developments in science, technology and medical practice coupled with economic growth have transformed health care and improved the lives of many people. Despite such progress, the world today is more inequitable than it was 50 years ago: disparities in wealth and health are widening inexorably, and infectious diseases are again becoming a major scourge and pose a threat to the lives of all. Hundreds of millions of people live in degrading poverty, with little, if any, access to health care. Recognition of this context in which much research takes place should sharpen our focus on the ethical requirements for research that could improve the health of a greater proportion of the world's population - one of the most pressing moral problems of our time. The intense debate on ethical dilemmas associated with an expanding programme of clinical research in developing countries has revealed much common ground, but has also left a residuum of controversy. We suggest that contested issues could be resolved by paying greater attention to different world views on the relationship between research and clinical care and by defining policies that both progressively improve the standard of care in research and link research to improved delivery of health care in developing countries. © 2007 The Union.

Ben-David, M. F. (2000). "The role of assessment in expanding professional horizons." Medical Teacher 22(5): 472-477.
	This paper explores assessment innovations which have a system-wide effect on medical education and the medical profession. Important assessment approaches such as the objective structured clinical examination (OSCE), the portfolio, and hi-tech simulations are examples of reform-driven developments. A detailed account is provided on assessment areas that require further developments. The identified areas reflect current thinking in the Centre for Medical Education, University of Dundee Medical School.The assessment innovations are being developed alongside the implementation of the outcome-based curriculum. Areas that require extensive work are: assessment of progression towards defined outcomes, assessment of integrated abilities, assessment of different forms of medical knowledge, assessment of on-the-job learning, learning through assessment, assessment of error management and assessment of portfolio evidence. The identified areas for further assessment development are discussed and where appropriate a theoretical framework is provided.

Bendzsak, A., et al. (2011). "Overview of Lung Cancer Surgery in Ontario." Annals of Thoracic Surgery 91(2): 361-366.
	Background. Surgery is the primary curative treatment for lung cancer and thus appropriate surgical resource allocation is critical. This study describes the distribution of lung cancer incidence and surgical care in Ontario, a Canadian province with universal health care, for the fiscal year of 2004. Methods. All new lung cancer cases in Ontario between April 1, 2003 and March 31, 2004 were identified in the Ontario Cancer Registry. Incidence rates and surgical procedures were compared by age, health region, neighborhood income, and community size. Results. Lung cancer incidence was highest in lower income neighborhoods (90.2 cases of 100,000 vs 55.6 in the highest quintile, p < 0.001) and smaller communities (87.1 of 100,000 in communities less than 100,000 vs 56.3 of 100,000 in cities greater than 1.25 million, p < 0.001). Surgical interventions were most common in younger patients (47.4% aged 20 to 54 years versus 30.5% greater than 75 years, p < 0.001), and those in wealthier neighborhoods (43.4% in highest quintile versus 35.8% in the lowest, p < 0.001). Surgical procedures overall and specifically formal resections (20% in cities >1.25 million versus 18% in communities < 100,000, p < 0.03) were more common in larger communities (43.4% versus 37.7%, p < 0.001). Pneumonectomy was more common in smaller communities (14.5% vs 9.9%, p = 0.048, whereas more lobar (53.8 vs 45.2%, p = 0.01) and sublobar resections (44.9% vs 31.7%, p < 0.0001) were more common in larger communities. Thoracic surgeons provided the majority of formal resections (51% to 57%) compared with general surgeons (17% to 21%). Conclusions. Lung cancer incidence and surgical care vary significantly by health region, income level, and community size. These disparities require further evaluation to meet the needs of patients with lung cancer. (Ann Thorac Surg 2011; 91: 361-6) (C) 2011 by The Society of Thoracic Surgeons

Benjamin, S. (2013). "Educating psychiatry residents in neuropsychiatry and neuroscience." International Review of Psychiatry 25(3): 265-275.
	Neuropsychiatry and psychiatric neuroscience should be part of the general psychiatry curriculum so that graduate psychiatrists will be able to allow their patients the benefit of neuroscientifically informed diagnosis and treatment. Current neurology and neuroscience educational requirements for US psychiatry training are reviewed. The draft milestone requirements for clinical neuroscience training as part of the US Accreditation Council for Graduate Medical Education's Next Accreditation System are also provided. Suggestions for the neuropsychiatric and neuroscience content of psychiatry residency training are made, along with a description of pedagogic methods and resources. Survey data are reviewed indicating agreement by programme directors with the importance of neuroscience training and an increase in the amount of time devoted to this area. Faculty staff development in neuropsychiatry and neuroscience literacy will be needed to provide high quality training in these areas.

Bennett, E. E. and T. L. Higgens (2016). "Systems that Teach: Medical Education and the Future Healthcare Workforce." New Horizons in Adult Education and Human Resource Development 28(2): 40-49.
	Physician education has followed relatively rigid guidelines since the Flexner report of 1910. Medical education has been largely didactic with time-based progression and certifying exams, and with variable degrees of autonomy and supervision in graduate (post MD/DO degree) medical education programs. Innovative educational approaches now incorporate adult learning theories, encompass broader skill-sets, and utilize competency-based milestones rather than temporal based objectives to gauge progress. Human resource development (HRD) is more synergistic with evolving innovative medical education approaches than traditional approaches, and it can foster a healthy teaching system. In this article, we explore HRD strategies for medical education, including clinical simulation, workflow and educational redesign, and ongoing competency evaluation.

Benor, D. E. (2000). "Faculty development, teacher training and teacher accreditation in medical education: twenty years from now." Medical Teacher 22(5): 503-512.
	To address the issue of faculty development in the year 2020, an attempt is made to predict the structure of the future medical school and the profile of a future medical teacher. By projecting from the technological, sociological and structural processes that affect medical education, it can be envisaged that there will be several types of medical teachers, namely specialists, who will be resource people for the students, evaluators of student performance, and a minority of 'process teachers'. The role of the process teachers will be to tutor, facilitate learning, coach and guide the students in the only domain which cannot be self-learned by technological devices, namely: moral issues, interpersonal communication and crisis management. Each type of teacher requires a different training programme. All programmes, however, should be comprehensive, longitudinal or multiphasic, and lead the faculty member from orientation in both the institution and the educational field to a leadership position by successive approximations. It is further expected that societal demands will impose teacher accreditation and, perhaps, licensing. This, however, will remain in the medical profession's hands, and may bring about a resolution of the 'role-profession conflict', and a more favourable self-perception of faculty members as teachers. Finally, an optimistic conclusion is drawn for the future of medical education.

Bensend, T., et al. (2014). "What's the Harm? Genetic Counselor Perceptions of Adverse Effects of Genetics Service Provision by Non-Genetics Professionals." Journal of Genetic Counseling 23(1): 48-63.
	Anecdotal accounts suggest some patients have experienced negative outcomes as a result of receiving genetics services from non-genetics providers, but empirical evidence of these incidents and their outcomes is limited. This study examined genetic counselors' perceptions of the occurrence of such incidents in the state of Minnesota. Twenty-five genetic counselors completed an on-line survey and 20 also participated in a semi-structured telephone interview. The interviewees recalled and described 37 specific incidents they perceived as having negative outcomes for patients and/or their families. Inductive and cross-case analysis revealed common themes including: adverse psychosocial effects, inadequate genetic counseling, genetic testing and screening errors, medical mismanagement, negative shifts in attitudes toward medical providers, and unnecessary use of health care resources. Commonly mentioned strategies for preventing/mitigating negative outcomes included: educational outreach and awareness programs for medical providers and the general public, standardized testing and screening processes, and implementing mechanisms for reporting and addressing adverse events. Additional findings, practice and policy implications, and research recommendations are discussed.

Bentaleb, E., et al. (2016). "Development and evaluation of an in-house single step loop-mediated isothermal amplification (SS-LAMP) assay for the detection of Mycobacterium tuberculosis complex in sputum samples from Moroccan patients." Bmc Infectious Diseases 16: 10.
	Background: Tuberculosis (TB) is a major global health problem and remains the leading cause of morbidity and mortality in developing countries. Routinely used TB diagnostic methods, in most endemic areas, are time-consuming, often less-sensitive, expensive and inaccessible to most patients. Therefore, there is an urgent need for the development of early, easy to use and effective diagnosis tools of TB, which can be effectively integrated into resource limited settings, to anticipate the early treatment and limit further spread of the disease. Over the last decade, Loop-mediated isothermal amplification (LAMP) assays have become a powerful tool for rapid diagnosis of infectious diseases because of the simplicity of device requirements. Indeed, LAMP is a simple, quick and cost effective Isothermal Nucleic Acid Amplification diagnostic test (INAAT) that has the potential to be used in TB endemic settings of resource-poor countries. Methods: In the present study, we have developed a simple and rapid TB molecular diagnostic test using a Single-Step Loop-mediated isothermal DNA amplification (SS-LAMP) method for the detection of Mycobacterium tuberculosis complex (MTBC) strains, with a simplified sample preparation procedure, eliminating DNA extraction prior to LAMP amplification, DNA initial denaturation and enzymatic inactivation steps during the amplification process. To perform our in-house SS-LAMP assay, a set of six specific primers was specifically designed to recognize eight distinct regions on the MTBC species-specific repetitive insertion sequence 6110 (IS6110). The amplification of the targeted DNA was carried out under isothermal conditions at 65 degrees C within 1 h. Our protocol was firstly optimized using 60 of confirmed MTBC isolates and a recombinant pGEMeasy-IS6110 vector for sensitivity testing. Thereafter, the assay was evaluated on liquefied sputum specimens collected from 157 Moroccan patients suspected of having TB. Results: Our SS-LAMP developed assay was able to detect MTBC DNA directly from liquefied sputum samples without any prior DNA extraction, denaturation nor the final enzymatic inactivation step. When compared to routinely used Lowenstein Jensen (LJ) Culture method, our SS-LAMP assay is rapid and showed specificity and sensitivity of 99.14 % and 82.93 % respectively which are within the international standards. In addition, the limit of detection of our assay was found to be as little as 10 copies of bacterial DNA. Conclusion: To our knowledge, this is the first study using a single step LAMP (SS-LAMP) procedure as a rapid, easy to perform and cost effective testing for TB early detection. This innovative assay could be suitable for low-income countries with restricted health equipment facilities.

Beran, D. (2015). "The Impact of Health Systems on Diabetes Care in Low and Lower Middle Income Countries." Current Diabetes Reports 15(4): 13.
	This review will highlight the current challenges and barriers to diabetes management in low and lower middle income countries using the World Health Organization's 6 Building Blocks for Health Systems (service delivery; healthcare workforce; information; medical products, vaccines and technologies; financing; and leadership and governance). Low and lower middle income countries are characterized by low levels of income and insufficient health expenditure. These countries face a shift in disease burden from communicable to noncommunicable diseases including diabetes. Many argue that health systems in these countries do not have the capacity to meet the needs of people with chronic conditions such as diabetes. A variety of barriers exist in terms of organization of health systems and care, human resources, sufficient information for decision-making, availability and affordability of medicines, policies, and alleviating the financial burden of care. These health system barriers need to be addressed, taking into account the need to have diabetes included in the global development agenda and also tailoring the response to local contexts including the needs of people with diabetes.

Beran, D., et al. (2015). "Burden of asthma and chronic obstructive pulmonary disease and access to essential medicines in low-income and middle-income countries." Lancet Respiratory Medicine 3(2): 159-170.
	Demographic and epidemiological transitions are changing the age structure of the population and the most common diseases. Non-communicable respiratory diseases are an increasing problem at both ends of the age range in low-income and middle-income countries. In children, who represent a large proportion of the total population, the increasing problem of asthma is a strain on health services. Improved survival of the older population is increasing the proportion of morbidity and mortality attributable to chronic lung diseases. Health services in low-resource countries are poorly adapted to treating chronic diseases. Designed to respond episodically to acute disease, almost all historical investment has focused on infectious diseases. Crucial to the successful management of chronic diseases is an infrastructure designed to support pro-active management, providing not only an accurate diagnosis, but also a secure supply of cost effective drugs at an affordable price. The absence of such an infrastructure in many countries and the market failure that makes drugs generally more expensive in low-resource regions means that many people with chronic non-communicable lung diseases are not given effective treatment. This has damaging economic consequences. The common causes of poor lung health in low-income countries are not the same as those in richer countries, and there is a need to study why they are so common and how best to manage them.

Berges, R. R. and L. Pientka (1999). "Management of the BPH syndrome in Germany: Who is treated and how?" European Urology 36: 21-27.
	Objectives: To review the available data on contemporary management of symptomatic benign prostatic hyperplasia (BPH) within the German healthcare system. Methods: Information was obtained from articles published in scientific journals retrieved through searches in Medline and Embase. In addition, preliminary data from the first representative German survey on lower urinary tract symptoms (LUTS) were obtained ('Herner LUTS-Study', a community-based survey in Herne, a city within the industrial complex called the Ruhr Area). Finally, the recently established German guidelines for the diagnosis and treatment of the BPH-Syndrom (BPS) were reviewed. Results: Only few studies are published in the literature analysing the current concepts of management of BPH in Germany. These studies show that there is variation in the concepts of conservatory and surgical management of BPH. The German BPH guidelines suggest watchful waiting for patients with mild LUTS (total I-PSS less than or equal to 7) and medical therapy or surgery for those with moderate to severe LUTS (I-PSS > 7). There was no final consensus on the role of phytotherapy in the German treatment guidelines, due to the lack of clinical data. alpha(1)-Blockers and finasteride (for prostates >40 mi) are recommended medical treatment approaches. Transurethral resection of the prostate (TUR-P) is considered to be the standard surgical procedure. Preliminary data from the Herner LUTS-Study show, that approximately 30% of men aged 50-80 years have moderate to severe LUTS (i.e. total I-PSS score >7). About a third of these men currently seek healthcare. Conclusions: LUTS and BPS are a highly prevalent condition in Germany. With the estimate that the number of men over the age of 65 will almost double in Germany within the next 30 years, it will be a challenge in the next millennium to find the healthcare resources for the management of BPS. Copyright (C) 1999 S. Karger AG, Basel.

Bergman, E. M., et al. (2008). "How much anatomy is enough?" Anatomical Sciences Education 1(4): 184-188.
	Innovations in undergraduate medical education, such as integration of disciplines and problem based learning, have given rise to concerns about students' knowledge of anatomy. This article originated from several studies investigating the knowledge of anatomy of students at the eight Dutch medical schools. The studies showed that undergraduate students uniformly perceived deficiencies in their anatomical knowledge when they started clinical training regardless of their school's didactic approach. A study assessing students' actual knowledge of clinical anatomy revealed no relationship between students' knowledge and the school's didactic approach. Test failure rates based on absolute standards set by different groups of experts were indicative of unsatisfactory levels of anatomical knowledge, although standards differed markedly between the groups of experts. Good test performance by students seems to be related to total teaching time for anatomy, teaching in clinical context, and revisiting anatomy topics in the course of the curriculum. These factors appeared to outweigh the effects of disciplinary integration or whether the curriculum was problem-based or traditional. [References: 41]

Bergman, J., et al. (2016). "Engaging Physician Learners Through a Web-Based Platform: Individualized End-of-Life Education." American Journal of Hospice & Palliative Medicine 33(8): 748-754.
	Background: Web-based modules provide a convenient and low-cost education platform, yet should be carefully designed to ensure that learners are actively engaged. In order to improve attitudes and knowledge in end-of-life (EOL) care, we developed a web-based educational module that employed hyperlinks to allow users access to auxiliary resources: clinical guidelines and seminal research papers. Methods: Participants took pre-test evaluations of attitudes and knowledge regarding EOL care prior to accessing the educational module, and a post-test evaluation following the module intervention. We recorded the type of hyperlinks (guideline or paper) accessed by learners, and stratified participants into groups based on link type accessed (none, either, or both). We used demographic and educational data to develop a multivariate mixed-effects regression analysis to develop adjusted predictions of attitudes and knowledge. Results: 114 individuals participated. The majority had some professional exposure to EOL care (prior instruction 62%; EOL referral 53%; EOL discussion 56%), though most had no family (68%) or personal experience (51%). On bivariate analysis, non-partnered (p = .04), medical student training level (p = .03), prior palliative care referral (p = .02), having a family member (p = .02) and personal experience of EOL care (p < .01) were all associated with linking to auxiliary resources via hyperlinks. When adjusting for confounders, coefficient estimates and least squares estimation demonstrated that participants clicking on both hyperlink types were more likely to score higher on all knowledge and attitude items, and demonstrate increased score improvements. Conclusion: Auxiliary resources accessible by hyperlink are an effective adjunct to web-based learning in end-of-life care.

Berman, B. (2000). "The academic children's hospital primary care clinic: Responding to the challenges of a changing health care environment." Clinical Pediatrics 39(8): 473-478.
	Academic medical centers have encountered increasing fiscal challenges as the paradigm in health care has shifted from traditional fee-for-service reimbursement to systems of managed care. Most academic centers have maintained primary care clinics, which have served as "educational laboratories" for students and trainees, Largely providing care to underserved patients, academic primary care clinics have been heavily dependent on Medicaid reimbursement for support, Given the realities of a rapidly changing health care environment, academic primary care clinics have been challenged to respond with innovation and creativity in order to remain viable. The pediatric primary care clinic at Rainbow Babies & Children's Hospital of University Hospitals of Cleveland initiated a reorganization program with the goal of ensuring that patients receive quality, cost efficient care and that students and pediatric residents receive first-rate ambulatory education in a fiscally responsible setting, Fundamental was the setting of priorities for patient care and service while promoting an environment conducive to medical education. Educational programs were segregated into a well-defined educational "module," and various initiatives were advanced emphasizing patient access, consistency of care, efficient use of space and personnel resources, limitation of inappropriate use of costly after-hours resources, and identification and coordination of care for patients with chronic illness and/or at high risk for medical complications. Three years after the instituting of fundamental organizational change, objective measures of cost efficiency and selected quality measures compare quite favorably with a broad range of primary care providers throughout the region. If academic medical centers are to remain leaders in ambulatory pediatric education, energetic, proactive, and thoughtful responses to the rapidly changing global health care environment will be necessary.

Berman, N. B., et al. (2011). "A collaborative model for developing and maintaining virtual patients for medical education." Medical Teacher 33(4): 319-324.
	There is great interest in using computer-assisted instruction in medical education, but getting computer-assisted instruction materials used broadly is difficult to achieve. We describe a successful model for the development and maintenance of a specific type of computer-assisted instruction - virtual patients - in medical education. The collaborative model's seven key components are described and compared to other models of diffusion of innovation and curriculum development. The collaborative development model that began in one medical discipline is now extended to two additional disciplines, through partnerships with their respective clerkship director organizations. We believe that the ability to achieve broad use of virtual patients, and to transition the programs from successfully relying on grant funding to financially self-sustaining, resulted directly from the collaborative development and maintenance process. This process can be used in other learning environments and for the development of other types of computer-assisted instruction programs.

Berman, N. B., et al. (2008). "Computer-assisted instruction in clinical education: a roadmap to increasing CAI implementation." Advances in Health Sciences Education 13(3): 373-383.
	This reflection is based on the premise that clinical education can be improved by more widespread use of computer-assisted instruction (CAI) and that a roadmap will enable more medical educators to begin using CAI. The rationale for CAI use includes many of its inherent features such as incorporation of multimedia and interactivity yet the use of CAI remains limited, apparently because educators are not convinced about the role for CAI. Barriers to CAI use are discussed including misinterpretation of the literature for CAI effectiveness; a disconnect between CAI developers and the educators who make decisions about CAI use; and the paucity of knowledge regarding how to integrate CAI effectively into clinical education. Specific roles for CAI in undergraduate and graduate medical education can include improving uniformity of instruction, providing documentation of exposure or competence, improving the learners' educational experience or outcomes, and assessment that is matched to learning. Funding for CAI remains an important barrier but the authors believe that this will be overcome when use of CAI becomes more widespread.

Bermedo-Carrasco, S. and C. L. Waldner (2016). "The role of socio-demographic factors in premature cervical cancer mortality in Colombia." BMC Public Health 16: 13.
	Background: While cervical cancer (CC) is an important cause of premature mortality in Colombia, the impact of socio-demographic factors on CC mortality in young women is not well understood. The primary objective of this study was to identify differences in CC mortality among Colombian women aged 20-49 years associated with education, type of health insurance, urban or rural and region of residence, and to determine whether differences in mortality associated with education or insurance varied by age. Methods: Cervical cancer deaths for 2005-2013 and risk factors were obtained from the National Administrative Department of Statistics. Populations at risk were calculated from age-stratified population projections and the 2010 National and Demographic Health Survey. Negative binomial regression models, stratified by age, were used to examine associations between socio-demographic factors and mortality rates and whether the effects of education and health insurance varied by age. Multiple imputation was used to examine the importance of missing data. Results: Differences of CC mortality were identified among women with limited to no education compared to highly educated women, with the largest disparity in the youngest age group (IRR 26.8, 95 % CI 6.65-108). Differences in mortality associated with health insurance also varied based on age group. Women with contributory and special health insurance had lower mortality rates than women with subsidised or no health insurance, except in the youngest age group. No differences were observed between women with subsidised and those with no insurance in any age group. Mortality rates were high among women who resided in urban areas and in the Atlantic, Central, Pacific, and Amazon-Orinoquia regions of Colombia. Missing values in the mortality database did not impact the findings from this study. Conclusions: Limited education was most strongly associated with premature CC mortality in the youngest women. Subsidised insurance did not appear to provide significant protection against CC mortality when compared to not having insurance, suggesting the need to examine diagnostic and treatment services available under the subsidised insurance plan. Our results could be used to target interventions to optimise the impact of resources to prevent premature mortality due to CC in Colombia.

Bernard, D. B., et al. (1998). "Health and disease management: What is it and where is it going? What is the role of health and disease management in hypertension?" American Journal of Hypertension 11(8): 103S-108S.
	Health and disease management, a clinical improvement process that integrates best practice principles in a comprehensive manner throughout the entire continuum of care, is likely to be the dominant style of health care delivery in the future. The goal of these programs is to eliminate or reduce unacceptable variations in cost and quality between various providers by developing guidelines that will achieve measurable outcomes for specific diseases. These protocols also emphasize wellness and disease prevention, coordinate resources across the entire continuum of care, and define interventions for the entire duration of the disease. Conditions most suited to this management strategy include diseases that are of high volume and cost, complex to manage, and present chronically over a long period of the patient's life. Such programs are developed by a multidisciplinary team that is also charged with obtaining buy-in and championing the program to their peers. Among the many components of a comprehensive health and disease management program, intensive education for patients and families and altering physician behavior to obtain compliance are key areas on which to focus. Hypertension is an ideal condition to manage in this way. It is frequently the most common reason for patients to be seen by a primary care provider, is an expensive disease to treat, and is an important cause of major organ damage from inadequate treatment. Successfully adopting a disease management model for hypertension treatment that will integrate all health care providers and offer intensive education of patients and providers to encourage adherence to the highly effective therapies currently available should afford a major opportunity for a dramatic reduction in complications and costs, with enhanced clinical outcomes and quality of life for these patients. Am J Hypertens 1998;11:103S-108S (C) 1998 American Journal of Hypertension, Ltd.

Bernard, R. W. (2013). "Why read journals, anyway." Aesthetic Surgery Journal 33(8): 1206-1207.
	
Bernatchez, A. C., et al. (2015). "Knowing about a public bicycle share program in Montreal, Canada: Are diffusion of innovation and proximity enough for equitable awareness?" Journal of Transport & Health 2(3): 360-368.
	Researchers and practitioners are increasingly interested in public bicycle share programs (PBSP). Greater PBSP use promotes health benefits through increased physical activity yet financial costs and distant location of docking stations are barriers to PBSP uptake and reach of health promoting amenities is poorer among lesser educated individuals. However, lack of awareness of PBSP is the first barrier to overcome. This study examined 2-year changes in lack of awareness of a transport-related innovation implemented in Spring 2009 in Montreal, Canada, namely a PBSP called BIXI (c) as a function of proximity to bicycle docking stations and educational attainment As part of a larger investigation, a repeated cross-sectional design was used. A sample of 7011 adults was recruited through random-digit dialling to landline telephones in three population surveys: prior to implementation (n=2000), after season 1 (n=2502), and after season 2 (n=2509). Multivariable logistic regression analyses examined associations of survey periods, proximity to docking stations, and education with lack of awareness while controlling for socio-demographic and health characteristics. At baseline, lower education and absence of docking stations within walking distance were associated with lower likelihood of awareness of the PBSP. There was a greater likelihood of being PBSP-unaware among those with lower education after season 1 implementation in comparison to those with higher education (OR=1.60, 95%CI: 1.18, 2.19). Those with lower education after season 2 implementation in neighbourhoods where PBSP was available were more likely to be PBSP-unaware in comparison to those with higher education in neighbourhoods without PBSP docking stations (OR=1.63, 95%CI: 1.01, 2.64). Although lack of awareness decreased over time, greater percentages of being PBSP-unaware were observed among those with lower education and living in neighbourhoods both with and without PBSP docking stations. Despite accessibility of the PBS!' docking stations in neighbourhoods, inequalities in awareness persist. (C) 2015 Elsevier Ltd. All rights reserved.

Bernstein, S. L., et al. (2007). "Public Health Considerations in Knowledge Translation in the Emergency Department." Academic Emergency Medicine 14(11): 1036-1041.
	Effective preventive and screening interventions have not been widely adopted in emergency departments (EDs). Barriers to knowledge translation of these initiatives include lack of knowledge of current evidence, perceived lack of efficacy, and resource availability. To address this challenge, the Academic Emergency Medicine 2007 Consensus Conference, "Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake," convened a public health focus group. The question this group addressed was "What are the unique contextual elements that need to be addressed to bring proven preventive and other public health initiatives into the ED setting?" Public health experts communicated via the Internet beforehand and at a breakout session during the conference to reach consensus on this topic, using published evidence and expert opinion. Recommendations include 1) to integrate proven public health interventions into the emergency medicine core curriculum, 2) to configure clinical information systems to facilitate public health interventions, and 3) to use ancillary ED personnel to enhance delivery of public health interventions and to obtain successful funding for these initiatives. Because additional research in this area is needed, a research agenda for this important topic was also developed. The ED provides medical care to a unique population, many with increased needs for preventive care. Because these individuals may have limited access to screening and preventive interventions, wider adoption of these initiatives may improve the health of this vulnerable population. © 2007 Society for Academic Emergency Medicine.

Bernstein, S. L., et al. (2015). "Dissemination and implementation research in emergency medicine." Academic Emergency Medicine 22(2): 229-236.
	Published medical research takes years to change clinical practice. The reasons for this evidence-to-practice gap are many. To address this gap, in recent years the field of dissemination and implementation (D&I) science has grown dramatically. D&I studies design and test strategies to accelerate the movement of new evidence-based diagnostic and therapeutic maneuvers into real-world clinical practice. This article summarizes the proceedings of sessions at the 2011 and 2012 annual meetings of the Society for Academic Emergency Medicine that discussed D&I studies in emergency medicine. Examples of current studies are provided, along with a review of D&I methods, funding opportunities, and suggestions for future research. © 2015 by the Society for Academic Emergency Medicine.

Bert, F., et al. (2014). "Next generation of public health professionals: Networks and the EUPHAnxtintegration approach." European Journal of Public Health 24(6): 876.
	
Bertagnolio, S., et al. (2012). "Determinants of HIV drug resistance and public health implications in low- and middle-income countries." Antiviral Therapy 17(6): 941-953.
	Global scale-up of antiretroviral therapy (ART) in low-and middle-income countries (LMICs) is an unprecedented public health achievement. With planned efforts of expanded ART access including earlier treatment initiation and the use of antiretroviral (ARV) drugs for prophylaxis, increasing levels of HIV drug resistance (HIVDR) are expected. Several factors may lead to selection and transmission of significant HIVDR in LMICs, which will lead to decreased population-level efficacy of standard first-and second-line ART regimens. These factors include low genetic barrier of some ARVs to resistance development, drug-drug interactions, inappropriate prescribing practices, interruption of drug supply, poor retention in care and lack of routine viral load monitoring. To maximize long-term effectiveness of available ARVs, policy makers and programme managers in LMICs should routinely monitor programme factors associated with emergence and transmission of HIVDR and implement routine HIVDR surveillance following standardized methods. When surveillance results suggest the need for action, specific public health interventions must be taken to adjust ART programme functioning to minimize further emergence and transmission of HIVDR. In this paper, we review ARV drug, HIV, patient and programme-related determinants of HIVDR. Additionally, we summarize the World Health Orgnization's global HIVDR surveillance and prevention strategy and describe resulting public health and policy implications.

Bertakis, K. D. and R. Azari (2010). "Patient Gender Differences in the Prediction of Medical Expenditures." Journal of Womens Health 19(10): 1925-1932.
	Aims: The prediction of individuals' use of medical services and associated costs is crucial for medical systems. We modeled a risk assessment equation that included patient sociodemographic characteristics and health risk behaviors (obesity, smoking, and alcohol abuse) to strengthen the power of self-reported health status to predict healthcare resource use. We also sought to uncover gender-specific differences in the predictive value of the models. Methods: Before their first primary care visit, 509 new patients were interviewed. Data collected included sociodemographics, self-reported health status Medical Outcomes Study Short-Form (MOS SF-36), body mass index (BMI), and screening for alcoholism and smoking. Subsequent use of healthcare services for 1 year was determined by reviewing medical and billing records. Results: Generalized linear models and two-part regressions were estimated relating the five types of charges (plus total charges) to self-reported physical health status, controlling for gender, age, education, income, obesity, smoking, alcohol abuse, and mental health status. Lower physical health status was associated with higher charges for primary care (p 0.0022), specialty care (p = 0.0141), diagnostic services (p < 0.0001), hospitalizations (p = 0.0069), and total charges (p < 0.0001). For female patients, the regression equation predicted 14% of the variation in total medical charges compared with 28% for males. Female patients had higher charges for primary care (p = 0.0019), diagnostic services (p = 0.0005), and total charges (p = 0.0180). Conclusions: Health status and patient gender were significant predictors of healthcare use and charges. The R(2) of total charges was two times higher for men vs. women. This research has policy implications for healthcare organizations in predicting the usage patterns.

Bertakis, K. D. and R. Azari (2011). "Determinants and outcomes of patient-centered care." Patient Education and Counseling 85(1): 46-52.
	Objective: This paper defines an interactional analysis instrument to characterize patient-centered care and identify associated variables. Methods: In this study, 509 new adult patients were randomized to care by family physicians and general internists. An adaption of the Davis Observation Code was used to measure a patient-centered practice style. The main outcome measures were visit-specific satisfaction and healthcare resource utilization. Results: In initial primary care visits, patient-centered practice style was positively associated with higher patient self-reported physical health status (p = 0.0328), higher educational level (p = 0.0050), and non-smoking status (p = 0.0108); it was also observed more often in the interactions of family physicians compared to internists (p = 0.0003). Controlling for patient sociodemographic variables, self-reported health status, pain, health risk behaviors (obesity, alcohol abuse, and smoking), and clinic assignment, patient satisfaction was not related to the provision of patient-centered care. Moreover, a higher average amount of patient-centered care recorded in visits throughout the one-year study period was significantly related to lower annual medical charges (p = 0.0003). Conclusions: Patient-centered care was observed more often with family physician caring for healthier, more educated patients, and was associated with lower charges. Practice implications: Reduced annual medical care charges are an important outcome of patient-centered medical visits. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Berthiaume, L. R., et al. (2009). "Time series analysis of use patterns for common invasive technologies in critically ill patients." Journal of Critical Care 24(3): 6.
	Purpose: Critically ill patients are frequently managed with invasive technologies as part of their medical care. Little is known about use patterns. We examined use trends for invasive technologies used in critically ill patients. Materials and Methods: Using time series analysis and data on 26 989 patients from 3 medical-surgical intensive care units (ICUs) (n = 18 224) and 1 surgical ICU (n = 8765) between January 1, 1999, and January 1, 2007, we measured changes in the proportion of patients receiving the 4 most frequently used invasive technologies used in critically ill patients. Results: The 4 most common invasive technologies used in critically ill patients during the study period were arterial lines (71%), endotracheal intubations (61%), central venous catheters (51%), and pulmonary artery catheters (18%). The proportion of ICU patients who received pulmonary artery catheters decreased from 25% in 1999 to 8% in 2006 (P < .001). Use of central venous catheters increased from 39% to 46% (P < .001). After adjusting for baseline characteristics, patients admitted in 2006 were 4 times less likely to receive a pulmonary artery catheter (odds ratio, 0.28; 95% confidence interval, 0.24-0.33), but 42% (odds ratio, 1.42; 95% confidence interval, 1.27-1.58) more likely to receive a central venous catheter than patients admitted in 1999. No significant changes were observed for intubations and arterial lines. Conclusions: The use of invasive technologies in critically ill patients is changing and may have important implications for resource use, clinician education, and patient care. Initiatives should be considered for ensuring clinician competency during technology transitions. (C) 2009 Elsevier Inc. All rights reserved.

Best, A., et al. (2003). "Health Promotion Dissemination and Systems Thinking: Towards an Integrative Model." American Journal of Health Behavior 27(SUPPL. 3): S206-S216.
	Objective: To help close the gap between health promotion research and practice by using systems thinking. Methods: We reviewed 3 national US tobacco control initiatives and a project (ISIS) that had introduced systems thinking to tobacco control, speculating on ways in which systems thinking may add value to health promotion dissemination and implementation in general. Results: The diversity of disciplines involved in tobacco control have created disconnection in the field; systems thinking is necessary to increase the impact of strategies. Conclusion: Systems thinking has potential to improve synthesis, translation, and dissemination of research findings in other health promotion initiatives.

Betz, M. E., et al. (2011). "Public Health Education for Emergency Medicine Residents." American Journal of Preventive Medicine 41(4): S242-S250.
	Emergency medicine (EM) has an important role in public health, but the ideal approach for teaching public health to EM residents is unclear. As part of the national Regional Public Health-Medicine Education Centers-Graduate Medical Education initiative from the CDC and the American Association of Medical Colleges, three EM programs received funding to create public health curricula for EM residents. Curricula approaches varied by residency. One program used a modular, integrative approach to combine public health and EM clinical topics during usual residency didactics, one partnered with local public health organizations to provide real-world experiences for residents, and one drew on existing national as well as departmental resources to seamlessly integrate more public health-oriented educational activities within the existing residency curriculum. The modular and integrative approaches appeared to have a positive impact on resident attitudes toward public health, and a majority of EMresidents at that program believed public health training is important. Reliance on pre-existing community partnerships facilitated development of public health rotations for residents. External funding for these efforts was critical to their success, given the time and financial restraints on residency programs. The optimal approach for public health education for EM residents has not been defined. (Am J Prev Med 2011;41(4S3):S242-S250) (C) 2011 American Journal of Preventive Medicine

Beverly, C. J., et al. (2007). "The Arkansas aging initiative: An innovative approach for addressing the health of older rural Arkansans." Gerontologist 47(2): 235-243.
	The Donald W. Reynolds Institute on Aging at the University of Arkansas for Medical Sciences in Little Rock is addressing one of the most pressing policy issues facing the United States: how to care for the burgeoning number of older adults. In 2001, the Institute created the Arkansas Aging Initiative, which established seven satellite centers on aging across the state using $1.3 to $2 million dollars annually from the state's portion of the Master Tobacco Settlement. These centers on aging assist the state's population of older adults, many of whom reside in rural areas, live in poverty, and suffer from pc.or health. The centers provide multiple avenues of education for the community, health care providers, families, and caregivers. The Arkansas Aging Initiative, in partnership with local hospitals, also makes geriatric primary and specialty care more accessible through senior health clinics established across rural Arkansas. In 2005, older adults made more than 36,000 visits to these clinics. All sites have attracted at least one physician who holds a Certificate of Added Qualifications in geriatrics and one advanced practice nurse. Other team members include geriatric medical social workers, pharmacists, nutritionists, and neuropsychologists. This initiative also addresses other policy issues, including engaging communities in building partnerships and programs crucial to maximizing their limited resources and identifying opportunities to change reimbursement mechanisms for care provided to the growing number of older adults. We believe this type of program has the potential to create a novel paradigm for nationwide implementation.

Beyrer, C., et al. (2013). "The increase in global HIV epidemics in MSM." Aids 27(17): 2665-2678.
	Epidemics of HIV in MSM continue to expand in most low, middle, and upper income countries in 2013 and rates of new infection have been consistently high among young MSM. Current prevention and treatment strategies are insufficient for this next wave of HIV spread. We conducted a series of comprehensive reviews of HIV prevalence and incidence, risks for HIV, prevention and care, stigma and discrimination, and policy and advocacy options. The high per act transmission probability of receptive anal intercourse, sex role versatility among MSM, network level effects, and social and structural determinants play central roles in disproportionate disease burdens. HIV can be transmitted through large MSM networks at great speed. Molecular epidemiologic data show marked clustering of HIV in MSM networks, and high proportions of infections due to transmission from recent infections. Prevention strategies that lower biological risks, including those using antiretrovirals, offer promise for epidemic control, but are limited by structural factors including, discrimination, criminalization, and barriers to healthcare. Subepidemics, including among racial and ethnic minority MSM in the United States and UK, are particularly severe and will require culturally tailored efforts. For the promise of new and combined bio-behavioral interventions to be realized, clinically competent healthcare is necessary and community leadership, engagement, and empowerment are likely to be key. Addressing the expanding epidemics of HIV in MSM will require continued research, increased resources, political will, policy change, structural reform, community engagement, and strategic planning and programming, but it can and must be done.

Bezold, C. (2005). "The future of patient-centered care: Scenarios, visions, and audacious goals." Journal of Alternative and Complementary Medicine 11(SUPPL. 1): S-77-S-84.
	The U.S. health care system is transforming. It must. Patient-centered care (PCC) is a core quality that the system should include. This article presents the highlights of a project on the future of PCC created for the Picker Institute. As an example of futures work, this project developed four images or stories of what might happen, as well as a vision and audacious goals for what should happen to PCC. The first and most likely scenario is an increase in patient-centeredness as a function of current trends. However, in the second scenario, health care could become even more stressed and leave PCC behind as it seeks to lower cost without focusing on quality. The third scenario envisions more excellent systems that integrate PCC seamlessly into their work. The fourth scenario sees collaboration and shared responsibility, in association with advanced information tools, thereby enabling PCC to contribute to preventing illness and lowering health care costs. The scenarios indicate that the patient-centeredness of health care could improve slightly, stall, or advance significantly. The PCC Vision calls for each of us to be in charge of our health, and to get the care we need (not less and not more) in timely, effective, and personal ways consistent with our values. The audacious goals set an agenda with priorities from the PCC community. These include shared decision making by consumers, ensuring health care professionals are trained in supporting active patients, anticipating health and long-term care needs for individuals, adopting the Institute of Medicine's (IOM) simple rules for health care, and making the patient perspective a priority in policy and planning. Each of us and our organizations are confronted with the challenge of this vision and audacious goals. Health care professionals and provider systems, whether conventional or alternative in nature, face these issues. While complementary and alternative medicine (CAM) providers often get higher marks from consumers for their attention, many CAM modalities are largely provider-determined. Patient-centered care will require more empowerment and activation of patients and consumers. © Mary Ann Liebert, Inc.

Bhanji, F., et al. (2014). "Education scholarship in emergency medicine part 3: a "how-to" guide." Canadian Journal of Emergency Medicine 16: S13-S18.
	Successful emergency medicine (EM) education scholarship requires a systematic approach that includes searching the (grey) literature, mobilizing resources, adopting frameworks to focus the innovation, integrating a component of program evaluation, and disseminating the innovation via traditional and emerging avenues. This paper provides direction for EM teachers and educators looking to transform their education innovation into scholarship. Recommendations on producing EM education scholarship from the 2013 consensus conference of the Academic Section of the Canadian Association of Emergency Physicians are presented.

Bhaskaranarayana, A., et al. (2009). "Indian space research organization and telemedicine in India." Telemedicine and e-Health 15(6): 586-591.
	Telemedicine in India is spearheaded by the Indian Space Research Organization (ISRO) and has matured beyond technology demonstration to enter an operational phase in its history. This article attempts to bring out the evolution and development of telemedicine in India: the genesis, the approach followed, the stakeholders involved, and the results so far, with an outline for the future. ISRO has coupled its prowess in satellite communication technology with medical science and information technology to project specialty healthcare to the doorsteps of the rural, remote, and distant populace across the country. Having set the telemedicine program as a model for benefiting society with advances in modern technology, India is advancing to international dimensions the proven domestic program to people in other parts of the globe. More specifically, the article attempts to bring out the role played by ISRO, its vision, goals, and partners in the program along with the technology and observed impact. © 2009, Mary Ann Liebert, Inc.

Bhaskaranarayana, A., et al. (2009). "Space-based societal applications-Relevance in developing countries." Acta Astronautica 65(9-10): 1479-1486.
	Space technology has the vast potential for addressing a variety of societal problems of the developing countries, particularly in the areas of communication, education and health sectors. land and water resources management, disaster management and weather forecasting. Both remote sensing and Communication technologies can be used to achieve this goal. With its primary emphasis on application of space technology, on an end-to-end basis, towards national development. the Indian Space Programme has distinguished itself as one of the most cost-effective and development-oriented space programmes in the world. Developing nations are faced with the enormous task of carrying development-oriented education to the masses at the lower strata of their societies. One important Feature of these Populations is their large number and the spread over vast and remote areas of these nations, making the reaching out to them a difficult task. Satellite communication (Satcom) technology offers the unique capability of simultaneously reaching Out to very large numbers, spread over vast areas, including the remote corners of the country. It is a strong tool to support development education. India has been amongst the first few nations to explore and put to use the Satcom technology for education and development-oriented services to the rural masses. Most of the developing countries have inadequate infrastructure to provide proper medical care to the rural population. Availability of specialist doctors in rural areas is a major bottleneck. Use of Satcom and information technology to connect rural clinics to urban hospitals through telemedicine systems is one of the solutions; and India has embarked upon an effective satellite-based telemedicine programme. Space technology is also useful in disaster warning and management related applications. Use of satellite systems and beacons for locating the distressed units on land, sea or air is well known to us. Indian Space Research Organisation (ISRO) is already a part of the International initiative called Satellite Aided Search and Rescue System. The programme to set up satellite-based Village Resource Centres (VRCs) across India, for providing a variety of services relevant to the rural communities, is also a unique societal application of space technology. The VRCs are envisaged as single window delivery mechanism for a variety of space-based products and services, such as tele-education; telemedicine; information on natural resources for planning and development at local level; interactive advisories on agriculture, fisheries, land and water resources management, livestock management, etc.; interactive vocational training towards alternative livelihood; e-governance weather information; etc. This paper describes the various possibilities and potentials of Satcom and Remote Sensing technologies for societal applications. The initiatives taken by Indian Space Research Organisation in this direction are highlighted. (C) 2009 Published by Elsevier Ltd.

Bhatia, K., et al. (2015). "An Innovative Educational and Mentorship Program for Emergency Medicine Women Residents to Enhance Academic Development and Retention." Canadian Journal of Emergency Medicine 17(6): 685-688.
	Given the discrepancy between men and women's equal rates of medical school matriculation and their rates of academic promotion and leadership role acquisition, the need to provide mentorship and education to women in academic medicine is becoming increasingly recognized. Numerous large-scale programs have been developed to provide support and resources for women's enrichment and retention in academic medicine. Analyses of contributory factors to the aforementioned discrepancy commonly cite insufficient mentoring and role modeling as well as challenges with organizational navigation. Since residency training has been shown to be a critical juncture for making the decision to pursue an academic career, there is a need for innovative and tailored educational and mentorship programs targeting residents. Acknowledging residents' competing demands, we designed a program to provide easily accessible mentorship and contact with role models for our trainees at the departmental and institutional levels. We believe that this is an important step towards encouraging women's pursuit of academic careers. Our model may be useful to other emergency medicine residencies looking to provide such opportunities for their women residents.

Bhattacharyya, O., et al. (2015). "Assessing health program performance in low- and middle-income countries: building a feasible, credible, and comprehensive framework." Globalization and Health 11: 16.
	Background: Many health service delivery models are adapting health services to meet rising demand and evolving health burdens in low-and middle-income countries. While innovative private sector models provide potential benefits to health care delivery, the evidence base on the characteristics and impact of such approaches is limited. We have developed a performance measurement framework that provides credible (relevant aspects of performance), feasible (available data), and comparable (across different organizations) metrics that can be obtained for private health services organizations that operate in resource-constrained settings. Methods: We synthesized existing frameworks to define credible measures. We then examined a purposive sample of 80 health organizations from the Center for Health Market Innovations (CHMI) database (healthmarketinnovations.org) to identify what the organizations reported about their programs (to determine feasibility of measurement) and what elements could be compared across the sample. Results: The resulting measurement framework includes fourteen subgroups within three categories of health status, health access, and operations/delivery. Conclusions: The emphasis on credible, feasible, and comparable measures in the framework can assist funders, program managers, and researchers to support, manage, and evaluate the most promising strategies to improve access to effective health services. Although some of the criteria that the literature views as important - particularly population coverage, pro-poor targeting, and health outcomes - are less frequently reported, the overall comparison provides useful insights.

Bhojani, U., et al. (2015). "Intervening in the local health system to improve diabetes care: lessons from a health service experiment in a poor urban neighborhood in India." Global Health Action 8: 12.
	Background: Many efficacious health service interventions to improve diabetes care are known. However, there is little evidence on whether such interventions are effective while delivered in real-world resource-constrained settings. Objective: To evaluate an intervention aimed at improving diabetes care using the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework. Design: A quasi-experimental study was conducted in a poor urban neighborhood in South India. Four health facilities delivered the intervention (n = 163 diabetes patients) and the four matched facilities served as control (n = 154). The intervention included provision of culturally appropriate education to diabetes patients, use of generic medications, and standard treatment guidelines for diabetes management. Patients were surveyed before and after the 6-month intervention period. We did field observations and interviews with the doctors at the intervention facilities. Quantitative data were used to assess the reach of the intervention and its effectiveness on patients' knowledge, practice, healthcare expenditure, and glycemic control through a difference-in-differences analysis. Qualitative data were analyzed thematically to understand adoption, implementation, and maintenance of the intervention. Results: Reach: Of those who visited intervention facilities, 52.3% were exposed to the education component and only 7.2% were prescribed generic medications. The doctors rarely used the standard treatment guidelines for diabetes management. Effectiveness: The intervention did not have a statistically and clinically significant impact on the knowledge, healthcare expenditure, or glycemic control of the patients, with marginal reduction in their practice score. Adoption: All the facilities adopted the education component, while all but one facility adopted the prescription of generic medications. Implementation: There was poor implementation of the intervention, particularly with regard to the use of generic medications and the standard treatment guidelines. Doctors' concerns about the efficacy, quality, availability, and acceptability by patients of generic medications explained limited prescriptions of generic medications. The patients' perception that ailments should be treated through medications limited the use of non-medical management by the doctors in early stages of diabetes. The other reason for the limited use of the standard treatment guidelines was that these doctors mainly provided follow-up care to patients who were previously put on a given treatment plan by specialists. Maintenance: The intervention facilities continued using posters and television monitors for health education after the intervention period. The use of generic medications and standard treatment guidelines for diabetes management remained very limited. Conclusions: Implementing efficacious health service intervention in a real-world resource-constrained setting is challenging and may not prove effective in improving patient outcomes. Interventions need to consider patients' and healthcare providers' experiences and perceptions and how macro-level policies translate into practice within local health systems.

Bhuiya, A., et al. (2008). "Action monitoring for equity and gender in health." Journal of Health, Population & Nutrition 26(3): 378-383.
	Equity and gender, despite being universal concerns for all health programmes in Bangladesh, are often missing in many of the health agenda. The health programmes fail to address these important dimensions unless these are specifically included in the planning stage of a programme and are continually monitored for progress. This paper presents the situation of equity in health in Bangladesh, innovations in monitoring equity in the use of health services in general and by the poor in particular, and impact of targeted non-health interventions on health outcomes of the poor. It was argued that an equitable use of health services might also result in enhanced overall coverage of the services. The findings show that government services at the upazila level are used by the poor proportionately more than they are in the community, while at the private facilities, the situation is reverse. Commonly-used monitoring tools, at times, are not very useful for the programme managers to know how well they are doing in reaching the poor. Use of benefit-incidence ratio may provide a quick feedback to the health facility managers about their extent of serving the poor. Similarly, Lot Quality Assurance Sampling can be an easy-to-use tool for monitoring coverage at the community level requiring a very small sample size. Although health problems are biomedical phenomena, their solutions may include actions beyond the biomedical framework. Studies have shown that non-health interventions targeted towards the poor improve the use of health services and reduce mortality among children in poor households. The study on equity and health deals with various interlocking issues, and the examples and views presented in this paper intend to introduce their importance in designing and managing health and development programmes.

Bhurgri, Y., et al. (2007). "Patho-epidemiology of cancer cervix in Karachi South." Asian Pacific Journal of Cancer Prevention 8(3): 357-362.
	Introduction: The present study was conducted with the objective of examining descriptive epidemiological and pathological characteristics of cancer cervix in Karachi South, an all urban district population of Karachi, Pakistan. Methodology: A total of 74 cases of cancer cervix, ICD-10 (International Classification of Diseases 10th Revision) category C53 were registered at the Karachi Cancer Registry, for Karachi South, during a 3 year period, 1st January, 1995 to 31st December 1997. Results: The age standardized incidence rate (ASR) world and crude incidence rate (CIR) per 100,000 were 6.81 (5.2, 8.43) and 3.22 (2.49 to 3.96). Cancer cervix accounted for approximately 3.6% of all cancers in females and was the sixth malignancy in hierarchy. The mean age of the cancer cases was 53.27 years [standard deviation (SD) 11.6; 95% confidence interval (CI) 50.58, 55.96; range (R) 32-85 years)]. The distribution by religion was Muslims (90.5%), Christians (8.1%) and Hindus (1.4%). There were no cases reported in Parsees. The frequency distribution by ethnicity was Urdu speaking Mohajirs (20.3%), Punjabis (17.6%), Gujrati speaking Mohajirs (4.1%), memon Mohajirs (8.1%), Sindhis (10.8%), Baluchs (8.1%), Pathans (5.4%) and Afghan migrants (2.7%). The ethnicity was not known in approximately a fourth (23.0%) of the cases. The socio-economic distribution was 27.0% financially deprived class, 24.4% lower middle class and 48.7% upper middle and affluent classes. The majority of the women were married (86.5%); a smaller number were unmarried (2.7%) or widows (10.8%). The age-specific curves showed a gradual increase in risk from the fourth up till the seventh decade, followed by an actual apparent decrease in risk after 64 years of age. The peak incidence was observed in the 60-64 year age group. The morphological categorization was squamous cell carcinoma (86.5%), adenocarcinoma (10.9%) and adenosquamous carcinoma (2.6%). The majority of cases presented with moderately differentiated or grade 2 lesions (45.9%). There were no in-situ cases. Approximately half the cancers (58.1%) had spread regionally and 8.1% to a distant site at the time of diagnosis. Odds ratios (OR) were calculated for socioeconomic residential categories, religion, ethnicity, age groups and education. The OR, for socioeconomic residential categories ranged between 0.69 and 2.9 with a marginally higher risk in the lower [OR 2.09 (95% CI .97; 4.49)] and lower middle class [OR 2.08 (95% CI 0.95; 4.58)]. Hindus [OR 1.2 (95% CI 0.18; 2.2)] had a slightly higher risk then the Muslims [OR 0.14 (95% CI 0.17; 1.2)]. A higher risk was also observed for Christians [OR 7.76 (95% CI 1.74; 34.5)]. Conclusion: The incidence of cervical cancer in Karachi South (1995-97) reflects a low risk population with a late presentation and a high stage disease at presentation. It is suggested that cervical screening if implemented should focus on once a life time methodology involving 36-45 year old women. This should be combined with HPV vaccination for the young and public health education for all. A regular cervical screening program would require mobilization of considerable financial, structural and human resources along with training for personnel. This may burden the already stretched health resources of a developing country.

Bhutta, Z. A., et al. (2009). "Delivering interventions to reduce the global burden of stillbirths: improving service supply and community demand." Bmc Pregnancy and Childbirth 9: 37.
	Background: Although a number of antenatal and intrapartum interventions have shown some evidence of impact on stillbirth incidence, much confusion surrounds ideal strategies for delivering these interventions within health systems, particularly in low-/middle-income countries where 98% of the world's stillbirths occur. Improving the uptake of quality antenatal and intrapartum care is critical for evidence-based interventions to generate an impact at the population level. This concluding paper of a series of papers reviewing the evidence for stillbirth interventions examines the evidence for community and health systems approaches to improve uptake and quality of antenatal and intrapartum care, and synthesises programme and policy recommendations for how best to deliver evidence-based interventions at community and facility levels, across the continuum of care, to reduce stillbirths. Methods: We systematically searched PubMed and the Cochrane Library for abstracts pertaining to community-based and health-systems strategies to increase uptake and quality of antenatal and intrapartum care services. We also sought abstracts which reported impact on stillbirths or perinatal mortality. Searches used multiple combinations of broad and specific search terms and prioritised rigorous randomised controlled trials and meta-analyses where available. Wherever eligible randomised controlled trials were identified after a Cochrane review had been published, we conducted new meta-analyses based on the original Cochrane criteria. Results: In low-resource settings, cost, distance and the time needed to access care are major barriers for effective uptake of antenatal and particularly intrapartum services. A number of innovative strategies to surmount cost, distance, and time barriers to accessing care were identified and evaluated; of these, community financial incentives, loan/insurance schemes, and maternity waiting homes seem promising, but few studies have reported or evaluated the impact of the wide-scale implementation of these strategies on stillbirth rates. Strategies to improve quality of care by upgrading the skills of community cadres have shown demonstrable impact on perinatal mortality, particularly in conjunction with health systems strengthening and facilitation of referrals. Neonatal resuscitation training for physicians and other health workers shows potential to prevent many neonatal deaths currently misclassified as stillbirths. Perinatal audit systems, which aim to improve quality of care by identifying deficiencies in care, are a quality improvement measure that shows some evidence of benefit for changes in clinical practice that prevent stillbirths, and are strongly recommended wherever practical, whether as hospital case review or as confidential enquiry at district or national level. Conclusion: Delivering interventions to reduce the global burden of stillbirths requires action at all levels of the health system. Packages of interventions should be tailored to local conditions, including local levels and causes of stillbirth, accessibility of care and health system resources and provider skill. Antenatal care can potentially serve as a platform to deliver interventions to improve maternal nutrition, promote behaviour change to reduce harmful exposures and risk of infections, screen for and treat risk factors, and encourage skilled attendance at birth. Following the example of high-income countries, improving intrapartum monitoring for fetal distress and access to Caesarean section in low-/middle-income countries appears to be key to reducing intrapartum stillbirth. In remote or low-resource settings, families and communities can be galvanised to demand and seek quality care through financial incentives and health promotion efforts of local cadres of health workers, though these interventions often require simultaneous health systems strengthening. Perinatal audit can aid in the development of better standards of care, improving quality in health systems. Effective strategies to prevent stillbirth are known; gaps remain in the data, the evidence and perhaps most significantly, the political will to implement these strategies at scale.

Bickford, J. J. and A. R. Kothari (2008). "Research and knowledge in Ontario Tobacco control networks." Canadian Journal of Public Health 99(4): 297-300.
	Objectives: This study sought to better understand the role of research knowledge in Ontario tobacco control networks by asking: 1) How is research managed; 2) How is research evaluated; and 3) How is research utilized? Methods: This is a secondary analysis of a qualitative study based on individual semi-structured interviews with 29 participants between January and May 2006. These participants were purposefully sampled from across four Ministries in the provincial government (n=7), non-government (n=15), and public health organizations (n=7). Interviews were transcribed verbatim and coded and analyzed using QSR N7 qualitative software. This study received ethics approval from The University of Western Ontario Health Research Ethics Board. Results: There exists a dissonance between the preference for peer-reviewed, unbiased, non-partisan knowledge to support claims and the need for fast, "real-time" information on which to base tobacco-related policy decisions. Second, there is a great deal of tacit knowledge held by experts within the Ontario tobacco control community. The networks among government, non-government, and public health organizations are the structures through which tacit knowledge is exchanged. These networks are dynamic, fluid and shifting. Conclusion: There exists a gap in the production and utilization of research knowledge for tobacco control policy. Tacit knowledge held by experts in Ontario tobacco control networks is an integral means of managing and evaluating research knowledge. Finally, this study builds on Weiss's concept of tactical model of evidence use by highlighting the utilization of research to enhance one's credibility.

Biehl, J. and A. Moran-Thomas (2009). "Symptom: Subjectivities, Social Ills, Technologies." Annual Review of Anthropology 38: 267-288.
	In the domain of health, not only are the raw effects of economic, social, and medical inequalities continually devastating, but novel processes of reconfiguring illness experience, subjectivity, and control are also underway. Human relationships to medical technology are increasingly constituted outside the clinical encounter. In this article we explore how the domestic encroachment of medical commodities affects social bonds in both affluent and resource-poor contexts, as well as how these commodities become interwoven in the very fabric of symptoms and identities. Symptoms are more than contingent matters; they are, at times, a necessary condition for the afflicted to articulate a new relationship to the world and to others. In exploring how people conceptualize technological self-care, we are specifically concerned with disciplinary modes of evidence-making and ask the following: what are the possibilities and limitations of theoretical frameworks (such as structural violence, biopower, social suffering, and psychoanalysis) through which these conceptions are being analyzed in contemporary anthropological scholarship? What can the unique capacities of ethnography add to the task of capturing the active embroilment of reason, life, and ethics as human conditions are shaped and lost? The intellectual survival of anthropological theory, we argue, might well be connected to people's own resilience and bodily struggles for realities to come.

Bielaszka-DuVernay, C. (2011). "Innovation profile: The 'GRACE' model: In-home assessments lead to better care for dual eligibles." Health Affairs 30(3): 431-434.
	Systems: Wishard Health Services, based in Indianapolis, Indiana, the third-largest safety-net health organization in the United States; HealthCare Partners Medical Group (Los Angeles); the Indianapolis Veterans Affairs (VA) Medical Center (part of the Veterans Health Administration Office of Geriatrics and Extended Care); and the Aging and Disability Resource Center Evidence-Based Care Transition Programs, funded by the US Administration on Aging and the Centers for Medicare and Medicaid Services. Key Innovation: Geriatric Resources for Assessment and Care of Elders (GRACE), an integrated care model targeting low-income seniors, many dually eligible and most with multiple chronic conditions. The model uses in-home assessments by a team consisting of a nurse practitioner and a social worker to develop an individualized plan of care. Cost Savings: In a randomized controlled trial of 951 adults age sixty-five and older, with incomes below 200 percent of the federal poverty level, high-risk patients enrolled in GRACE had fewer visits to emergency departments, hospitalizations, and readmissions and reduced hospital costs compared to the control group. The two-year GRACE intervention saved $1,500 per enrolled high-risk patient by the second year. Quality Improvement Results: In the same randomized controlled trial, GRACE received high ratings by physicians. Grace patients also reported higher quality of life compared with the control group. Challenges: The GRACE model improves health and reduces costs in a capitated system, but only 10 percent of its costs are covered by fee-forservice Medicare. © 2011 by Project HOPE - The People-to-People Health Foundation, Inc.

Bigal, M. E., et al. (2006). "Patterns of medical diagnosis and treatment of migraine and probable migraine in a health plan." Cephalalgia 26(1): 43-49.
	The objectives of this study were to assess the proportion of subjects with strict migraine (SM, migraine with and without aura), probable migraine (PM), and all migraine (AM, SM and PM pooled together), who receive a medical diagnosis or a specific treatment within a health plan. Eligible participants were 18-55-year participants of a non-profit health maintenance organization (HMO) who had received out-patient, emergency department, or in-patient care from a physician within the past year. We used a validated computer-assisted telephone interview (CATI) survey to identify SM, PM and controls (received out-patient, emergency department, or in-patient care from a physician for any reason within the past year, but did not have SM or PM). Medical and prescription drug claims for the 24-month period were linked to participant files. Among 8579 respondents, we identified 1265 SM sufferers and 1252 PM sufferers, which were compared with 960 randomly selected controls. Just 194 (15.3%) SM, 21 (1.7%) PM, and 215 (8.5%) AM sufferers received an in-patient or out-patient primary migraine claim in the previous 24 months, compared with six (0.5%) controls; 240 (18.9%) SM, 39 (3.1%) PM, 279 (11.1%) AM sufferers, and eight controls (0.6%) received any migraine claim. There were claims for migraine drugs (ICD-9 code for triptans or ergot compounds) for just 140 (11.1%) SM and 34 (2.7%) PM sufferers, and migraine analgesics (butalbital and isomethepthene compounds), for 6.3% SM and 2.2% PM sufferers (0.7% of the controls). Migraine preventives were used for a larger number of SM and PM sufferers (19.6% and 13.1%), but also for controls (10.5%), indicating that they were probably used for other medical reasons. Both SM and PM are underdiagnosed and undertreated within a health plan. Educational strategies should focus on physician education addressing diagnosing the full spectrum of migraine and physician management of migraine with specific migraine therapy in appropriate patients.

Bigbee, J. L., et al. (2009). "Community Health Nursing and Cooperative Extension: A Natural Partnership." Journal of Community Health Nursing 26(4): 192-197.
	Community health nursing and cooperative extension represent two influential and respected disciplines in rural and frontier communities. The history and philosophy of the two disciplines reveal commonalities related to community-based health promotion and dissemination of research. A review of the extension and health sciences literature revealed some evidence of collaboration between extension and health science professionals, however very little documentation specifically of nurses' involvement with extension professionals. An exemplar of a highly effective ongoing cooperation between rural public health nurses and extension educators in one Idaho county is provided. This local interdisciplinary effort has resulted in enhanced community health promotion services, positive interprofessional relationships, and maximization of scarce resources. Nursing-extension collaboration presents creative opportunities for interdisciplinary practice, research, and educational innovations to enhance the health of rural and frontier communities.

Bigdeli, M., et al. (2013). "Health policy and systems research in access to medicines: a prioritized agenda for low- and middle-income countries." Health Research Policy & Systems 11: 37.
	OBJECTIVES: To identify priority policy issues in access to medicines (ATM) relevant for low- and middle-income countries, to identify research questions that would help address these policy issues, and to prioritize these research questions in a health policy and systems research (HPSR) agenda.
METHODS: The study involved i) country- and regional-level priority-setting exercises performed in 17 countries across five regions, with a desk review of relevant grey and published literature combined with mapping and interviews of national and regional stakeholders; ii) interviews with global-level stakeholders; iii) a scoping of published literature; and iv) a consensus building exercise with global stakeholders which resulted in the formulation and ranking of HPSR questions in the field of ATM.
RESULTS: A list of 18 priority policy issues was established following analysis of country-, regional-, and global-level exercises. Eighteen research questions were formulated during the global stakeholders' meeting and ranked according to four ranking criteria (innovation, impact on health and health systems, equity, and lack of research). The top three research questions were: i) In risk protection schemes, which innovations and policies improve equitable access to and appropriate use of medicines, sustainability of the insurance system, and financial impact on the insured? ii) How can stakeholders use the information available in the system, e.g., price, availability, quality, utilization, registration, procurement, in a transparent way towards improving access and use of medicines? and iii) How do policies and other interventions into private markets, such as information, subsidies, price controls, donation, regulatory mechanisms, promotion practices, etc., impact on access to and appropriate use of medicines?
CONCLUSIONS: Our HPSR agenda adopts a health systems perspective and will guide relevant, innovative research, likely to bear an impact on health, health systems and equity.

Bilodeau, A., et al. (2010). "Interprofessional education at Laval University: Building an integrated curriculum for patient-centred practice." Journal of Interprofessional Care 24(5): 524-535.
	The Laval University Faculty of Medicine, Faculty of Nursing, and School of Social Work, in partnership with the Vieille-Capitale Health and Social Services Centre in Quebec City, obtained funding from Health Canada to design, implement, and evaluate an integrated interprofessional education (IPE) program for family medicine, nursing, and social work students and for professionals from those professions working in primary care. The program was developed around four components and produced the following outcomes: a 45-hour undergraduate curriculum; IPE practical training for professionals, supervisors, residents and trainees in primary care teaching settings; a continuing education model for professionals based on a coaching approach, and; information and communication technology resources. After briefly describing the implementation process, educational content, and evaluation highlights of each component, the integrated program is discussed with respect to the inter-area complementarities and coherence with the conceptual dimensions that have guided the development of the program: IPE, collaboration, and collaborative patient-centered practice. The positive evaluation outcomes, the sustainability of the educational activities, and the enthusiasm of the different partners led to the creation of the Collaborative Network on Interprofessional Practices at Laval University and its affiliated health and social services clinical network.

Bin Abdulrahman, K., et al. (2013). "The medical education journey continues." Medical Teacher 35 Suppl 1: S5-7.
	
Bin Naeem, S. and R. Bhatti (2015). "Clinical information needs and access in primary health care: a comparative cross-sectional study of rural and non-rural primary care physicians." Health Information and Libraries Journal 32(4): 287-299.
	Background: Primary care physicians (PCPs) need a wide range of clinical information (CI) resources to manage their patients. Continued access to these resources in their practice settings provides self-reliance and a better approach towards clinical decision making. Objective: To compare the PCPs CI needs and access to CI in rural versus non-rural practice setting. Methods: A comparative cross-sectional survey was conducted in the Government health centres of the District of Multan, Pakistan. PCPs were classified into rural and non-rural according to their practice setting using the State Office of Rural Health definition. Rural means 'more than 10 miles from a population centre of 30 000 or more'. Results: The CI needs of rural and non-rural PCPs were the same, but rural PCPs had significantly less access to nearly all CI resources when compared to non-rural PCPs. Age was a major determining factor of perceived information needs for continuing medical education but not for accessing CI. Discussion: Primary care physicians in rural settings face innumerable difficulties in accessing the required CI due to non-existence of libraries and poor information infrastructure. Conclusion: Despite no difference in information needs, rural PCPs have significantly less access to CI resources. The study suggests ways to address the inequality in provision of CI resources.

Binagwaho, A., et al. (2013). "Shared learning in an interconnected world: innovations to advance global health equity." Globalization and Health 9: 5.
	The notion of "reverse innovation" that some insights from low-income countries might offer transferable lessons for wealthier contexts-is increasingly common in the global health and business strategy literature. Yet the perspectives of researchers and policymakers in settings where these innovations are developed have been largely absent from the discussion to date. In this Commentary, we present examples of programmatic, technological, and research-based innovations from Rwanda, and offer reflections on how the global health community might leverage innovative partnerships for shared learning and improved health outcomes in all countries.

Binder-Finnema, P., et al. (2015). "Determinants of marginalization and inequitable maternal health care in North-Central Vietnam: a framework analysis." Global Health Action 8: 12.
	Background: Vietnam has achieved great improvements in maternal healthcare outcomes, but there is evidence of increasing inequity. Disadvantaged groups, predominantly ethnic minorities and people living in remote mountainous areas, do not gain access to maternal health improvements despite targeted efforts from policymakers. Objective: This study identifies underlying structural barriers to equitable maternal health care in Nghe An province, Vietnam. Experiences of social inequity and limited access among child-bearing ethnic and minority women are explored in relation to barriers of care provision experienced by maternal health professionals to gain deeper understanding on health outcomes. Design: In 2012, 11 focus group discussions with women and medical care professionals at local community health centers and district hospitals were conducted using a hermeneutic-dialectic method and analyzed for interpretation using framework analysis. Results: The social determinants 'limited negotiation power' and 'limited autonomy' orchestrate cyclical effects of shared marginalization for both women and care professionals within the provincial health system's infrastructure. Under-staffed and poorly equipped community health facilities referwomen and create overload at receiving health centers. Limited resources appear diverted away from local community centers as compensation to the district for overloaded facilities. Poor reputation for low care quality exists, and professionals are held in low repute for causing overload and resulting adverse outcomes. Country-wide reforms force women to bear responsibility for limited treatment adherence and health insight, but overlook providers' limited professional development. Ethnic minority women are hindered by relatives from accessing care choices and costs, despite having advanced insight about government reforms to alleviate poverty. Communication challenges are worsened by non-existent interpretation systems. Conclusions: For maternal health policy outcomes to become effective, it is important to understand that limited negotiation power and limited autonomy simultaneously confront childbearing women and health professionals. These two determinants underlie the inequitable economic, social, and political forces in Vietnam's disadvantaged communities, and result in marginalized status shared by both in the poorest sectors.

Bird, R. and E. R. Rodriguez (1999). "Decentralization and poverty alleviation. International experience and the case of the Philippines." Public Administration and Development 19(3): 299-319.
	In recent years, decentralization has become quite common in developing countries. The essence of decentralization is that it does not occur in general but rather in a particular context, so that decentralization takes many different forms in different countries at different times. Comparative analysis is often illuminating and the article uses it to cast some light on the current moves towards decentralization in the Philippines. Section 2 provides a quantitative overview of the relationship between decentralization and poverty across a number of Asian and Latin American countries. Section 3 discusses key aspects of the relationship between decentralization and poverty alleviation in the Philippines, drawing on a number of decentralization experiences in countries such as Argentina, Chile, Colombia, Indonesia and Vietnam. Section 3.1 focuses on local capacity and Section 3.2 on local financial resources, in particular the role of fiscal transfers. Section 3.3 examines the effects of different approaches to decentralization on the targeting and delivery of poverty-related services-health, primary education, housing and infrastructure. Section 4 concludes by noting the importance of migration in any treatment of decentralization and poverty. Copyright (C) 1999 John Wiley & Sons, Ltd.

Birken, S. A., et al. (2013). "Improving the effectiveness of health care innovation implementation: middle managers as change agents." Medical Care Research & Review 70(1): 29-45.
	The rate of successful health care innovation implementation is dismal. Middle managers have a potentially important yet poorly understood role in health care innovation implementation. This study used self-administered surveys and interviews of middle managers in health centers that implemented an innovation to reduce health disparities to address the questions: Does middle managers' commitment to health care innovation implementation influence implementation effectiveness? If so, in what ways does their commitment influence implementation effectiveness? Although quantitative survey data analysis results suggest a weak relationship, qualitative interview data analysis results indicate that middle managers' commitment influences implementation effectiveness when middle managers are proactive. Scholars should account for middle managers' influence in implementation research, and health care executives may promote implementation effectiveness by hiring proactive middle managers and creating climates in which proactivity is rewarded, supported, and expected.

Birken, S. A., et al. (2015). "From strategy to action: How top managers' support increases middle managers' commitment to innovation implementation in health care organizations." Health Care Management Review 40(2): 159-168.
	Background: Evidence suggests that top managers' support influences middle managers' commitment to innovation implementation. What remains unclear is how top managers' support influences middle managers' commitment. Results may be used to improve dismal rates of innovation implementation. Methods: We used a mixed-method sequential design. We surveyed (n = 120) and interviewed (n = 16) middle managers implementing an innovation intended to reduce health disparities in 120 U. S. health centers to assess whether top managers' support directly influences middle managers' commitment; by allocating implementation policies and practices; or by moderating the influence of implementation policies and practices on middle managers' commitment. For quantitative analyses, multivariable regression assessed direct and moderated effects; a mediation model assessed mediating effects. We used template analysis to assess qualitative data. Findings: We found support for each hypothesized relationship: Results suggest that top managers increase middle managers' commitment by directly conveying to middle managers that innovation implementation is an organizational priority (beta = 0.37, p = .09); allocating implementation policies and practices including performance reviews, human resources, training, and funding (bootstrapped estimate for performance reviews = 0.09; 95% confidence interval [0.03, 0.17]); and encouraging middle managers to leverage performance reviews and human resources to achieve innovation implementation. Practice Implications: Top managers can demonstrate their support directly by conveying to middle managers that an initiative is an organizational priority, allocating implementation policies and practices such as human resources and funding to facilitate innovation implementation, and convincing middle managers that innovation implementation is possible using available implementation policies and practices. Middle managers may maximize the influence of top managers' support on their commitment by communicating with top managers about what kind of support would be most effective in increasing their commitment to innovation implementation.

Biswas, R., et al. (2009). "Revitalizing primary health care and family medicine/primary care in India - Disruptive innovation?" Journal of Evaluation in Clinical Practice 15(5): 873-880.
	Context India has rudimentary and fragmented primary health care (PHC) and family medicine systems, yet it also has the policy expectation that PHC should meet the needs of extremely large populations with slums and difficult to reach groups, rapid social and epidemiological transition from developing to developed nation profiles. Historically, the system has lacked impetus to achieve PHC. Objective To provide an overview of PHC approaches and the current state of PHC and family medicine in India in order to assess the opportunities for their revitalization. Methods A narrative review of the published and grey literature on PHC, family medicine, Web2.0 and health informatics key papers and policy documents, pertinent to India. Outcomes A conceptual framework and recommendations for policy makers and practitioner audiences. Findings PHC is constructed through systems of local providers who address individual, family and local community basic health needs with strong community participation. Successful PHC is a pre-eminent strategy for India to address the determinants of health and the almost chaotic of massive social transition in its institutions and health care sector. There is a lack of an articulated comprehensive framework for the publicly stated goals of improving health and implementing PHC. Also, there exists a very limited education and organization of a medical and PHC workforce who are trained and resourced to address individual, family and local community health and who have become increasingly specialized. However, emerging technology, Health2.0 and user generated health care informatics, which are largely conducted through mobile phones, are co-evolving patient-driven health systems, and potentially enhance PHC and family medicine workforce development. Conclusions In order to improve health outcomes in an equitable manner in India, there is a pressing need for a framework for implementing PHC. The co-emergence of information technologies accessible to the mass population and user-driven health care provide a potential catalyst or innovation for this transition. © 2009 Blackwell Publishing Ltd.

Bittencourt, S. D. D., et al. (2016). "Adequacy of public maternal care services in Brazil." Reproductive Health 13: 9.
	Background: In Brazil, hospital childbirth care is available to all, but differences in access and quality of care result in inequalities of maternal health. The objective of this study is to assess the infrastructure and staffing of publicly financed labor and birth care in Brazil and its adequacy according to clinical and obstetric conditions potentially associated with obstetric emergencies. Methods: Nationwide cross-sectional hospital-based study "Birth in Brazil: national survey into labor and birth" conducted in 2011-2012. Data from 209 hospitals classified as public (public funding and management) or mixed (public or private funding and private management) that generate estimates for 1148 Brazilian hospitals. Interview with hospital managers provided data for the structure adequacy assessment covering four domains: human resources, medications, equipment for women emergency care and support services. We conducted analysis of the structure adequacy rate according to type of hospital (public or mixed), availability of ICU and the woman obstetric risk using the chi(2) test to detect differences in categorical variables with the level of statistical significance set at p < 0.05. Results: Global rate of adequacy of 34.8 %: 42.2 % in public hospitals and 29.0 % in mixed hospitals (p < 0.001). Public and mixed hospitals with ICU had higher scores of adequacy than hospitals without ICU (73.3 % x 24.4 % public hospitals; 40.3 % x 10.6 % mixed hospitals). At a national level, 32.8 % of women with obstetric risk were cared for in hospitals without ICU and 29.5 % of women without risk were cared for in hospitals with ICU. Inequalities were observed with the North, Northeast and non-capital regions having the lower rates of hospitals with ICU. Conclusions: The majority of maternity wards across the country have a low rate of adequacy that can affect the quality of labor and birth care. This holds true for women at high obstetric risk, who suffer the possibility of having their care compromised by failures of hospital infrastructure, and for women at low obstetric risk, who may not receive the appropriate care to support the natural evolution of their labor when in a technological hospital environment.

Bjerke, N. B. (2006). "Leveraging your culture for change." Critical Care Nursing Quarterly 29(2): 132-136.
	The focus of this article is on understanding how to assess the impact that culture has on the acceptance and implementation of new ideas. Some guidance is offered on how to develop a strategy for addressing a unit's local culture to minimize barriers to change and maximize the potential for successful implementation of best practices. © 2006 Lippincott Williams & Wilkins, Inc.

Blackford, S., et al. (1996). "Basal cell carcinomas cause little handicap." Quality of Life Research 5(2): 191-194.
	Basal cell carcinoma (BCC) is the most common type of skin cancer and the incidence of BCC is expected to rise, with increased demand on dermatology resources. Little is known of the effect on people's lives of having skin cancer. The aim of this study was to quantify the handicap caused by basal cell carcinomas before and after therapy. Forty-four patients (22 males, mean age = 65 yrs, range = 35-81 yrs) with 48 BCCs were recruited and 37 patients completed the study. Each patient completed the UK Sickness Impact Profile (UKSIP) and the Dermatology Life Quality Index (DLQI) at the initial visit to the dermatology clinic, 1 week after treatment and 3 months after treatment. Lesions had been present for a mean of 25 months (range = 1-240 months), their mean diameter was 9.6mm (range = 3-35mm) and the sites were head and neck (79%), trunk (17%) and limbs (4%). There was no relationship between the quality of life score and size of lesion. Overall the scores at presentation were very low, rising 1 week after treatment and falling to below the initial scores at 3 months (mean UKSIP 0.4%, 0.7%, 0.13%; mean DLQI 5.3% 8.7%, 1.2%). BCCs cause little handicap. This may explain the delay in seeking medical attention and should be considered in planning public health education about BCCs.

Blackie, M. (2014). "The role of agriculture in the nutrition of children." Paediatrics and International Child Health 34(4): 289-294.
	Data from across the developing world show consistently that a fundamental cause of poor nutrition is low agricultural productivity and consequent low incomes, especially amongst poor rural households. Conventionally, technical solutions have been sought to contribute to greater household food security, and thus better childhood nutrition. A more holistic approach is required. This paper draws from field examples, mainly in southern and east Africa, to illustrate the implementation and effectiveness of what is termed a 'green evolution' approach which emphasizes the efficient use of available resources of land, labour and inputs, thus allowing food to be sold profitably at low prices. With low food prices, the poor can use their limited funds to invest in better housing, education and health care. This is achieved through building thoughtful, farmer demand-led initiatives, backed by high quality science to deliver widespread improvements in nutrition for the poor.

Blackman, D. J. and C. M. Masi (2006). "Racial and ethnic disparities in breast cancer mortality: Are we doing enough to address the root causes?" Journal of Clinical Oncology 24(14): 2170-2178.
	Breast cancer is the most common noncutaneous malignancy and the second most lethal form of cancer among women in the United States. Mortality from breast cancer has declined since the late 1980s, but this decline has been steeper among white women compared with black women. As a result, the black:white mortality rate ratio has increased over-the last two decades. Other ethnic minorities also suffer from disproportionately high breast cancer mortality rates. This review discusses the causes of racial and ethnic disparities in breast cancer mortality and describes the most common approaches to reducing these disparities. The literature suggests that outcome disparities are related to patient-, provider-, and health system-level factors. Lack of insurance, fear of testing, delay in seeking care, and unfavorable tumor characteristics all contribute to disparities at the patient level. At the provider level, insufficient screening, poor follow-up of abnormal screening tests, and nonadherence to guideline-based treatments add to outcome disparities. High copayment requirements, lack of a usual source of care, fragmentation of care, and uneven distribution of screening and treatment resources exacerbate disparities at the health system level. Although pilot programs have increased breast cancer screening among select populations, persistent disparities in mortality suggest that changes are needed at the policy level to address the root causes of these disparities.

Blair, B., et al. (2013). "Improving women's sexual health: a quantitative evaluation of an educational intervention for healthcare professionals." Sex Education-Sexuality Society and Learning 13(5): 535-547.
	Forty-three per cent of women in the USA report some type of sexual complaint and these complaints have been shown to negatively impact quality of life and overall wellbeing. With proper training and experience, healthcare professionals are in a unique position to help their patients improve their sexual health. The present study was designed to increase knowledge about female sexual dysfunction by offering a continuing education workshop combining didactic and experiential learning. Healthcare professionals representing the specialties of obstetrics, gynaecology, primary care, psychiatry and psychology attended the conference. Participants completed a pre- and post-test questionnaire assessing levels of comfort, competence, attitudes toward female sexual health and readiness for change. Using the pre- and post-test questionnaire, participants reported a significant increase in awareness about the importance of discussing issues of sexual health with their patients. Participants also reported motivation ( or intent) to ask their patients about their sexual health. Providing information about female sexual dysfunction and its impact on patients' quality of life, effective treatments and referral resources as well as giving healthcare professionals an opportunity to practise asking about sexual health with facilitated feedback may significantly improve their motivation to respond to female sexual complaints.

Blake, S. M., et al. (2005). "Local school district adoption of state-recommended policies on HIV prevention education." Preventive Medicine 40(2): 239-248.
	Background. This study evaluated the extent to which school districts in Massachusetts adopted HIV education policies consistent with state education agency recommendations, and whether adoption of state-recommended policy language was associated with other core components of school-based HIV prevention programs such as staff development, curriculum, and implementation characteristics. Methods. A census of health coordinators (n = 251) and high school HIV teachers (n = 174) in randomly selected schools in Massachusetts were surveyed. Chi-squares and analysis of variance (ANOVAs) were used to analyze data. Results. Most districts' policies fully incorporated state-recommended language for training HIV teachers (62%), providing HIV education within comprehensive sexuality education (62%), and providing skills-based instruction (57%). Districts adopting state-recommended policies were significantly more likely to have trained more HIV teachers (82% vs. 59% of teachers trained; P < 0.001), provided HIV education to a greater percentage of students (90% vs. 50% of students educated; P < 0.001), and adopted research-based curricula (44% vs. 27%; P < 0.01). High school teachers who received training and those using research-based curricula covered more HIV prevention topics and used more skills-based instructional methods than those who did not receive training or did not use research-based curricula (P < 0.01). Conclusions. Results suggest that strong, state-level HIV prevention education policy recommendations can help shape local school health policy and, when adopted locally, can positively influence the reach and quality of HIV education. © 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved.

Blalock, S. J., et al. (2002). "Effects of an osteoporosis prevention program incorporating tailored educational materials." American Journal of Health Promotion 16(3): 146-156.
	Purpose. To evaluate the effects of two interventions on calcium intake and exercise and assess whether intervention effects varied as a function of participants' stage of change. Design. The study used a 2 by 2 factorial research design. Baseline, 3-, 6-, and 72-month follow-up data were collected. Setting. Twelve counties in western North Carolina. Subjects. Of 714 women recruited, 547 (76.6%) completed all data collection procedures, Intervention. One intervention, conducted at the individual level, compared thee effects of tailored vs. nontailored educational materials. The tailored educational intervention was delivered via two packets of written materials and one telephone counseling session. The written materials: and counseling session were tailored according to participants' current calcium intake and exercise level, perceived adequacy of these behaviors, stage of change, behavioral goals, and perceived barriers to change, A community-based intervention was also evaluated, This intervention, implemented in 6 of the 12 counties, included establishing an Osteoporosis Resource Center, conducting a workshop on osteoporosis, prevention, and offering free bone density screening. Measures. Outcome measures were calcium intake and exercise level. Stage of change was assessed as a moderating variable. Results. Irrespective of intervention group, among women not consuming adequate calcium at baseline, intake increased an average of about 500 mg/d over the course of the study. Changes involving exercise were more modest. Repeated measures regression analyses were used to evaluate intervention effects. The effect of the tailored educational intervention varied, in appropriate, ways, among women in different stages of change at baseline (F-2,F-527 = 6.37, p <.002). Among women in the Engaged stage, the tailored intervention was associated with a greater increase in calcium intake. In contrast among women who were obtaining adequate calcium at baseline (i.e., Action stage), the tailored intervention appeared to forestall inappropriate increases in calcium intake, The community-based intervention had no consistent effects oil calcium intake, either alone, or in combination with the tailored intervention. Finally, neither intervention had an effect on exercise, either alone or in combination. Conclusions. Limited support for the superiority of tailored vs. nontailored educational interventions was found, The differential effects observed could be due to the telephone counseling received by women in the Tailored Education Group, however.

Blanchard, R. D., et al. (2015). "Harvest the Low-Hanging Fruit: Strategies for Submitting Educational Innovations for Publication." Journal of Graduate Medical Education 7(3): 318-322.
	
Blanchard, R. D., et al. (2015). "Cultivating Medical Education Research Mentorship as a Pathway Towards High Quality Medical Education Research." Journal of General Internal Medicine 30(9): 1359-1362.
	The lack of effective and consistent research mentorship and research mentor training in both undergraduate medical education (UME) and graduate medical education (GME) is a critical constraint on the development of innovative and high quality medical education research. Clinical research mentors are often not familiar with the nuances and context of conducting education research. Clinician-educators, meanwhile, often lack the skills in developing and conducting rigorous research. Mentors who are not prepared to articulate potential scholarship pathways for their mentees risk limiting the mentee's progress in early stages of their career. In fact, the relative paucity of experienced medical education research mentors arguably contributes to the perpetuation of a cycle leading to fewer well-trained researchers in medical education, a lack of high quality medical education research, and relative stagnation in medical education innovation. There is a path forward, however. Integration of doctoral-level educators, structured inter-departmental efforts, and external mentorship provide opportunities for faculty to gain traction in their medical education research efforts. An investment in medical education research mentors will ensure rigorous research for high quality innovation in medical education and patient care.

Blanchet, K. D. (2008). "Innovative programs in telemedicine northwest telehealth." Telemedicine and e-Health 14(4): 318-322.
	
Blanco, P. (2015). "A traditional paradigm vs. an ultrasound-supported paradigm in emergency and critical care medicine: A crisis of the mind is needed." Journal of Emergency Medicine 49(2): e63-e63.
	
Bland, A. J., et al. (2014). "Time to unravel the conceptual confusion of authenticity and fidelity and their contribution to learning within simulation-based nurse education. A discussion paper." Nurse Education Today 34(7): 1112-1118.
	High-fidelity patient simulation is a method of education increasingly utilised by educators of nursing to provide authentic learning experiences. Fidelity and authenticity, however, are not conceptually equivalent. Whilst fidelity is important when striving to replicate a life experience such as clinical practice, authenticity can be produced with low fidelity. A challenge for educators of undergraduate nursing is to ensure authentic representation of the clinical situation which is a core component for potential success. What is less clear is the relationship between fidelity and authenticity in the context of simulation based learning. Authenticity does not automatically follow fidelity and as a result, educators of nursing cannot assume that embracing the latest technology-based educational tools will in isolation provide a learning environment perceived authentic by the learner. As nursing education programmes increasingly adopt simulators that offer the possibility of representing authentic real world situations, there is an urgency to better articulate and understand the terms fidelity and authenticity. Without such understanding there is a real danger that simulation as a teaching and learning resource in nurse education will never reach its potential and be misunderstood, creating a potential barrier to learning. This paper examines current literature to promote discussion within nurse education, concluding that authenticity in the context of simulation-based learning is complex, relying on far more than engineered fidelity. (C) 2014 Elsevier Ltd. All rights reserved.

Bland, C. J., et al. (2000). "Curricular change in medical schools: How to succeed." Academic Medicine 75(6): 575-594.
	Society's changing needs, advancing knowledge, and innovations in education require constant changes of medical school curricula. But successful curricular change occurs only through the dedicated efforts of effective change agents. This study systematically searched and synthesized the literature on educational curricular change (at all levels of instruction), as well as organizational change, to provide guidance for those who direct curricular change initiatives in medical schools. The focus was on the process of planning, implementing, and institutionalizing curricular change efforts; thus, only those articles that dealt with examining the change process and articulating the factors that promote or inhibit change efforts were included, In spite of the highly diverse literature reviewed, a consistent set of characteristics emerged as being associated with successful curricular change. The frequent reappearance of the same characteristics in the varied fields and settings suggests they are robust contributors to successful change. Specifically, the characteristics are in the areas of the organization's mission and goals, history of change in the organization, politics (internal networking, resource allocation, relationship with the external environment), organizational structure, need for change, scope and complexity of the innovation, cooperative climate, participation by the organization's members, communication, human resource development (training, incorporating new members, reward structure), evaluation, performance dip (i.e,, the temporary decrease in an organization's performance as a new program is implemented), and leadership. These characteristics are discussed in detail and related specifically to curricular change in medical school settings.

Blank, A., et al. (2013). ""Quality of prenatal and maternal care: bridging the know-do gap" (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa." Bmc Medical Informatics and Decision Making 13: 16.
	Background: Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels. Methods: A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline "Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice". Results: The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri-and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved. Conclusion: The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings.

Blankenship, J. C. (2015). "Glance backward before forging ahead: Strategically mapping SCAI's future." Catheterization & Cardiovascular Interventions 85(7): 1109-1111.
	
Blashki, G. A., et al. (2008). "Impact of an educational intervention on general practitioners' skills in cognitive behavioural strategies: a randomised controlled trial." Medical Journal of Australia 188(12): S129-S132.
	Objective: To evaluate the impact of an educational intervention on general practitioners' skills in cognitive behavioural strategies (CBS). Design: Randomised controlled trial, with baseline and post-training measurement of GP competency in CBS using standardised simulated patient consultations, conducted between January 2005 and December 2006. Participants and setting: 55 GPs in Victoria with a special interest in mental health issues. Intervention: A 20-hour multifaceted educational program facilitated by mental health experts, incorporating rehearsal of CBS and provision of resources such as patient education material and worksheets. Main outcome measures Objective ratings of videotaped consultations of a standardised simulated patient using the Cognitive Therapy Scale. Results: 32 doctors completed all phases of the intervention and the evaluation protocol. The intervention group showed greater improvements than the control group in both general therapeutic and specific CBS skills after the training. Conclusion: Competency in CBS in highly motivated GPs can be improved by a brief training intervention. Trial registration: International Standard Randomised Controlled Trial Number ISRCTN62481969.

Blayney, D. W. (2010). "Enhancing quality through innovation: American Society of Clinical Oncology presidential address 2010." Journal of Clinical Oncology 28(28): 4283-4288.
	
Bleakley, A. and J. Bligh (2008). "Students learning from patients: Let's get real in medical education." Advances in Health Sciences Education 13(1): 89-107.
	Medical students must be prepared for working in inter-professional and multi-disciplinary clinical teams centred on a patient's care pathway. While there has been a good deal of rhetoric surrounding patient-centred medical education, there has been little attempt to conceptualise such a practice beyond the level of describing education of communication skills and empathy within a broad 'professionalism' framework. Paradoxically, while aiming to strengthen patient-student interactions, this approach tends to refocus on the role modelling of the physician, and opportunities for potentially deep collaborative working relationships between students and patients are missed. A radical overhaul of conventional doctor-led medical education may be necessary, that also challenges the orthodoxies of individualistic student-centred approaches, leading to an authentic patient-centred model that shifts the locus of learning from the relationship between doctor as educator and student to the relationship between patient and student, with expert doctor as resource. Drawing on contemporary poststructuralist theory of text and identity construction, and on innovative models of work-based learning, the potential quality of relationship between student and patient is articulated in terms of collaborative knowledge production, involving close reading with the patient as text, through dialogue. Here, a medical 'education' displaces traditional forms of medical 'training' that typically involve individual information reproduction. Students may, paradoxically, improve clinical acumen through consideration of silences, gaps, and contradictions in patients as texts, rather than treating communication as transparent. Such paradoxical effects have been systematically occluded or denied in traditional medical education.

Bligh, J. and A. Bleakley (2006). "Distributing menus to hungry learners: can learning by simulation become simulation of learning?" Medical Teacher 28(7): 606-613.
	Simulation offers an important context for clinical education, providing a structured, safe and supportive environment bridging the classroom and the clinic. Two trends in the simulation community appear to be developing uncritically and without adequate evaluation. First, there is a fascination with seductive high-fidelity simulation realized through sophisticated technology. Second, simulation has increasingly appropriated learning in the psychological domain, such as communication skills, under the rationale of 'integration'. Developments in simulation activities have largely been made in a theoretical vacuum and where theory is invoked it is learning theory rather than theory of simulation. This paper introduces theories of simulation from cultural studies as a critical balance to the claims of the simulation community. Work-based and simulation-based learning could engage in a new dialogue for an effective clinical education.

Block, S. M., et al. (2015). "Defining "faculty" in academic medicine: responding to the challenges of a changing environment." Academic Medicine 90(3): 279-282.
	Academic medicine in the United States is at a crossroads. There are many drivers behind this, including health care reform, decreased federal research funding, a refined understanding of adult learning, and the emergence of disruptive innovations in medicine, science, and education. As faculty members are at the core of all academic activities, the definition of "faculty" in academic medicine must align with the expectations of institutions engaged in patient care, research, and education. Faculty members' activities have changed and continue to evolve. Academic health centers must therefore define new rules of engagement that reflect the interplay of institutional priorities with the need to attract, retain, and reward faculty members. In this Commentary, the authors describe and explore the potential effects of the changing landscape for institutions and their clinical faculty members. The authors make a case for institutions to adapt faculty appointment, evaluation, and promotion processes, and they propose a framework for a standardized definition of "faculty" that allows for individual variability. This framework also provides a means to evaluate and reward faculty members' contributions in education, research, and clinical care. The authors propose a deliberate national conversation to ensure that careers in academic medicine remain attractive and sustainable and that the future of academic medicine is secure.

Bloom, B. S. (1999). "Benefits foregone: Too much of the wrong and too little of the right." American Journal of Managed Care 5(6): S355-S360.
	Physicians, patients, and payers use some interventions that do not work, while they ignore others that have a scientific basis for efficacy. As a society, Americans are unwilling to address collectively healthcare issues, as witnessed by legislative inaction on reform. They have chosen instead to leave such matters up to the impersonal economic market. In doing so, the basic laws of economics must be taken into account: Healthcare resources are limited and conscious societal trade-offs must be made about who gets which services, how much, and who pays. Healthcare resources tend to be rationed according to income, even with Medicaid and other programs available to those with low incomes. The economic market lacks perfect or almost perfect information to enable rational choices to be made among alternatives. Even when the value of an intervention is known, physicians may over- or underuse it. Much of the literature focuses on overuse, but underuse is finally being recognized as a severe problem. For example, effective prevention and treatment measures for breast cancer exist and should be promoted for appropriate candidates, despite the low relative risk of adverse effects like other neoplasms.

Bloomgarden, Z. T. (2009). "Summary of the ACRE inaugural meeting." Endocrine Practice 15(7): 672-681.
	The charter meeting of the Association of Clinical Researchers and Educators (ACRE) provided a powerful set of arguments against assertions that physician-industry collaboration is harmful and represents a "conflict of interest." Such collaboration has, in fact, improved medical care for patients, a case made overwhelmingly by patients and patient advocacy groups at the meeting. The contentions that physician-industry collaboration is problematic are not based on evidence. They depend on unjustified generalization from inevitable, sometimes egregious, but vanishingly uncommon adverse outcomes of industry-physician interaction without reference to how so much more commonly these interactions add value. Furthermore, the claim that physician-industry collaboration is unprofessional is refuted by rational scrutiny. Indeed, the term "conflict of interest" itself is vague, inviting subjectivity and deserving to be rejected. The unwarranted success of conflict of interest regulation has prevailed because of the failure of physicians, educators, and innovators, through apathy and intimidation, to pay attention to its fallacies and resist its dangers. It has arisen from activist ambitions and from misalignment between the purposes of medical practitioners, educators, and innovators and those of administrators in medical journals and in academic medical centers. The media and politicians have not appreciated these misalignments and have accepted conflict of interest arguments at face value. Regulation emanating from conflict of interest criticism is confusing, onerous, expensive, disrespectful, and damaging. Prohibitions against speaking about medical products inhibit physician and patient education concerning rapidly emerging and complex therapies. Input by physicians cognizant of compliance requirements into such presentations should be encouraged. Restrictions to the free flow of corporate support of academic health centers, professional societies, and patient organizations threaten to delay medical innovation and education.

Bluml, B. M., et al. (2013). "Consortium recommendations for advancing pharmacists' patient care services and collaborative practice agreements." Journal of the American Pharmacists Association 53(2): E132-+.
	Objective: To develop consensus recommendations that provide principles and strategies for effectively implementing health care system changes, including an optimized role for pharmacists to engage in team-based, patient-centered care. Data sources: An interdisciplinary group of stakeholders representing 12 states and 10 pharmacy practice settings. Consortium participants represented many areas of pharmacy, medicine, and nursing. Summary: The health care environment in the United States is undergoing unprecedented change, with myriad health care reform initiatives, mounting evidence for the positive contributions of pharmacists, and federal government interest in pharmacist-provided services from the Centers for Medicare & Medicaid Services, Centers for Disease Control and Prevention, and Surgeon General. Many individuals and groups have asserted that pharmacists are a dramatically underused resource that could help improve outcomes within our health care delivery system, if properly engaged as essential members of the health care team. In January 2012, the American Pharmacists Association Foundation convened a roundtable consortium in Washington, DC, for dialogue on the role of pharmacists in patient care. The consortium participants' seven recommendations for advancing pharmacists' patient care services and collaborative practice agreements included (1) use of consistent terminology; (2) provider control over collaborative practice details; (3) infrastructure that embeds pharmacists' patient care services and collaborative practice agreements into care; (4) use of electronic health records and technology in patient care services; (5) relationships among the health care team that are strong, trusting, and mutually beneficial; (6) incentive alignments based on meaningful process and outcome measures; and (7) redesign of health professionals' practice acts, education curriculums, and operational policies. Conclusion: Pharmacists deliver many patient care services to sustain and improve health. In an era of health care reform, advancing the level and scope of pharmacy practice holds promise to improve health and reduce costs for care. Published evidence supports the role of pharmacists as essential members of the interdisciplinary health care team and emphasizes that pharmacists are well positioned to perform medication-and wellness-related interventions that improve patient outcomes. The consortium participants' seven recommendations provide methods and infrastructure for empowering collaborative, interdisciplinary care.

Bobo, W. V. and B. P. Yawn (2014). "Concise Review for Physicians and Other Clinicians: Postpartum Depression." Mayo Clinic Proceedings 89(6): 835-844.
	Postpartum depression (PPD) is a common, potentially disabling, and, in some cases, life-threatening condition. Fortunately, PPD is also readily detectable in routine practice and is amenable to treatment by a wide variety of modalities that are effective for treating nonpuerperal major depression. Postpartum depression screening can improve case identification (an Edinburgh Postnatal Depression Scale score of >= 13 indicates a high risk of PPD) and, when associated with a diagnostic and follow-up program, leads to improved clinical outcomes. Symptom severity, patient preference, past response to treatment, availability of local mental health care resources, and patient decisions about breast-feeding will drive management decisions. In general, cognitive-behavioral therapy and interpersonal therapy are preferred psychotherapies for women with mild to moderate PPD, whereas antidepressants are appropriate in more severe cases. Many patients will require other types of assistance, such as parenting support, case management, or care coordination because many barriers to receiving adequate PPD treatment must still be overcome. (C) 2014 Mayo Foundation for Medical Education and Research

Bobrow, K., et al. (2014). "Efficacy of a text messaging (SMS) based intervention for adults with hypertension: protocol for the StAR (SMS Text-message Adherence suppoRt trial) randomised controlled trial." BMC Public Health 14: 9.
	Background: Interventions to support people with hypertension in attending clinics and taking their medication have potential to improve outcomes, but delivery on a wide scale and at low cost is challenging. Some trials evaluating clinical interventions using short message service (SMS) text-messaging systems have shown important outcomes, although evidence is limited. We have developed a novel SMS system integrated with clinical care for use by people with hypertension in a low-resource setting. We aim to test the efficacy of the system in improving blood pressure control and treatment adherence compared to usual care. Methods/design: The SMS Text-message Adherence suppoRt trial (StAR) is a pragmatic individually randomised three-arm parallel group trial in adults treated for hypertension at a single primary care centre in Cape Town, South Africa. The intervention is a structured programme of clinic appointment, medication pick-up reminders, medication adherence support and hypertension-related education delivered remotely using an automated system with either informational or interactive SMS text-messages. Usual care is supplemented by infrequent non-hypertension related SMS text-messages. Participants are 1: 1: 1 individually randomised, to usual care or to one of the two active interventions using minimisation to dynamically adjust for gender, age, baseline systolic blood pressure, years with hypertension, and previous clinic attendance. The primary outcome is the change in mean systolic blood pressure at 12-month follow-up from baseline measured with research staff blinded to trial allocation. Secondary outcomes include the proportion of patients with 80% or more of days medication available, proportion of participants achieving a systolic blood pressure less than 140 mmHg and a diastolic blood pressure less than 90 mmHg, hospital admissions, health status, retention in clinical care, satisfaction with treatment and care, and patient related quality of life. Anonymised demographic data are collected on non-participants. Discussion: The StAR trial uses a novel, low cost system based on widely available mobile phone technology to deliver the SMS-based intervention, manage communication with patients, and measure clinically relevant outcomes. The results will inform implementation and wider use of mobile phone based interventions for health care delivery in a low-resource setting.

Bocker, E., et al. (2012). "Rural older adults' mental health: status and challenges in care delivery." Rural and Remote Health 12(4): 13.
	Introduction: Health disparities remain a challenge in rural populations, with mental health care especially challenging as the proportion of older adults continues to increase worldwide. This study examined the mental health service needs of, and use by, independently living rural older adults, with a focus on depression. Methods: Older adults (>= 50 years) were asked to complete a survey. Results: There were 150 respondents: 29% were between the ages of 50 and 64 years and 71% were 65 years and older. On a composite variable, 23.3% were at-risk for depression. One-half to two-thirds reported awareness of local mental health services, but nearly three-quarters never used these. Barriers to effective treatment of depression included stress, healthcare costs, and denial/fear of depression. There was an 'avoidance' factor in depression diagnosis and management. Conclusion: Older adults in rural communities experiencing depression pose a problem. Strategies are needed to overcome multiple barriers to effective diagnosis and treatment. There is a need to better understand the role of stress in older adults' lives. It is especially important for primary care providers and the local community to organize resources to allow for more time to be spent with older adults with mental health problems.

Boden-Albala, B., et al. (2010). "A stroke preparedness RCT in a multi-ethnic cohort: Design and methods." Contemporary Clinical Trials 31(3): 235-241.
	Background: Tissue plasminogen activator (EPA), the only approved treatment for acute ischemic stroke (IS), is significantly underutilized likely due to poor lay information about stroke as an emergency. In order to improve outcomes in acute IS, it is critical to raise awareness and recognition of stroke symptoms particularly among minority populations. This manuscript describes the application of a stroke preparedness behavioral intervention and includes baseline information in a multi-ethnic population of stroke and transient ischemic attack (TIA) survivors. Methods: In the Stroke Warning Information and Faster Treatment Study (SWIFT), we prospectively identified, and randomized IS and TIA patients to determine efficacy of a culturally tailored interactive stroke preparedness strategy. Data collected at baseline included acute stroke parameters, stroke knowledge, severity, social resources and vascular risk assessment. Results: Of the 736 enrolled to date, 76% were IS and 24% TIA events. The cohort was 51% female: 45% Hispanic, 26% White and 25% Black. Over 75% reported hypertension, 36% diabetes, and 16% cardiac disease. Mean time from onset to emergency department (ED) arrival was 46 h (median 13 h) differing significantly between Whites (mean 52 h, median 11 h) and Blacks (mean 52 h, median 17 h) versus Hispanics (mean 39 h, median 11 h). Knowledge that a stroke occurs in the brain differed significantly by between Whites (85%), Blacks (64%), Hispanics (66%, p < 0.000). Conclusions: Disparities remain in both action and knowledge surrounding acute stroke. Use of written information has not proven an effective means of changing health behaviors. We propose an interactive culturally tailored intervention to address behavioral change in acute stroke. (C) 2010 Elsevier Inc. All rights reserved.

Bodicoat, D. H., et al. (2014). "Identifying effective pathways in a successful continuous quality improvement programme: the GEDAPS study." Journal of Evaluation in Clinical Practice 20(6): 1137-1143.
	Rationale, aims and objectives Continuous quality improvement programmes often target several aspects of care, some of which may be more effective meaning that resources could be focussed on these. The objective was to identify the effective and ineffective aspects of a successful continuous quality improvement programme for individuals with type 2 diabetes in primary care. Methods Data were from a series of cross-sectional studies (GEDAPS) in primary care, Catalonia, Spain, in 55 centres (2239 participants) in 1993, and 92 centres (5819 participants) in 2002. A structural equation modelling approach was used. Results The intervention was associated with improved microvascular outcomes through microalbuminuria and funduscopy screening, which had a direct effect on microvascular outcomes, and through attending 2-4 nurse visits and having >= 1 blood pressure measurement, which acted through reducing systolic blood pressure. The intervention was associated with improved macrovascular outcomes through blood pressure measurement and attending 2-4 nurse visits (through systolic blood pressure) and having >= 3 education topics, >= 1 HbA1c measurement and adequate medication (through HbA1c). Cholesterol measurement, weight measurement and foot examination did not contribute towards the effectiveness of the intervention. Conclusions The pathways through which a continuous quality improvement programme appeared to act to reduce microvascular and macrovascular complications were driven by reductions in systolic blood pressure and HbA1c, which were attained through changes in nurse and education visits, measurement and medication. This suggests that these factors are potential areas on which future quality improvement programmes should focus.

Bodurow, C. C., et al. (2009). "Multivariable Value Densification Modeling Using GIS." Transactions in Gis 13: 147-175.
	A team of researchers comprised of architects, urbanists, planners and civil engineers from Lawrence Technological University and the University of Detroit Mercy developed a value densification tool used primarily to evaluate density of resources and physical features within Southwest Detroit, Michigan. This community is a diverse and vibrant neighborhood that is currently transforming socially, physically and economically. This project - the Value Densification Community Mapping Project (VDCmp) - was developed to explore how aspects of the post-industrial city can be understood, communicated and leveraged in service of equity and sustainability and to use technology to reveal data about the city in order to convince community, political and economic leadership to embrace a broader interpretation of value. Building on an asset-based, community empowerment planning model, the research team is collaborating to create a unique "free-ware" GIS incorporating and merging components of Google Earth, Sketch Up and ERSI ArcGIS to model physical and social density and value in three dimensions. The resultant digital interface empowers the community through asset identification and creation of an accessible tool to assist in envisioning its environmental, social and economic future. The VDCmp digital interface is unique in that it models "social exchanges" in three dimensions and allows the user to overlay social and infrastructure layers with physical density. With funding from the American Institute of Architects (AIA) and the Local Initiatives Support Corporation (LISC), the VDCmp and research team is engaging nonprofit groups in Southwest Detroit to determine how they can best utilize data and mapping in planning, design, development and evaluative tools. The focus of this work has been on creating a comprehensive tool that can support community design and development policy decisions. Community members have become active partners in evolving the digital interface as a tool for strategic planning at the agency/organization, coalition, city and regional levels. The active community members have either provided to the research team the self-generated data found to be significant to them (the stakeholders) or requested certain publicly available data sets to be incorporated in the interface. Significant geoprocessing using ArcGIS was used on these data sets (of various formats) in order to pre-process and evaluate the data for accuracy and quality assurance. These data were then exported to keyhole markup language (kml) or keyhole markup zip (kmz) files and the visualization of these data were developed in Google Earth, which included significant polygon and polyline extrusion (used to display multivariable attributes for single features). Sketch Up models were also used to display density of historic sites, green infrastructure, parking and other features. The team will also incorporate three dimensional network diagrams in GIS to display the interactions and relationships that residential households have with religious, cultural and commercial assets, among others. These techniques have allowed the community groups to visually identify over-or under-served resources, conflicting planning objectives, environmental health impacts, or areas of social inequality, with an end-goal of developing a dynamic, unified development and preservation strategy for the community. The VDCmp has evolved from a pilot project to an ever expanding collaborative initiative featuring multiple institutions, clients, stakeholders and geographies. The VDCmp has a triprtite nature. It is at once a Research Initiative; a Tool; and a Community Process, each requiring very different approaches to collaboration, deliverables and dissemination. Now developed, this framework may be replicated in other Detroit neighborhoods or across the region or country to further advance the concepts of Value Densification mapping.

Bolin, J., et al. (2005). "Chronic disease management in rural and underserved populations: Innovation and system improvement help lead to success." Managed Care Interface 18(3): 37-41+55.
	Successful implementation of disease management (DM) is based on the ability of an organization to overcome a variety of barriers to deliver timely, appropriate care of chronic illnesses. Such programs initiate DM services to patient populations while initiating self-management education among medication-resistant patients who are chronically ill. Despite formidable challenges, rural health care providers have been successful in initiating DM programs and have discovered several ways in which these programs benefit their organizations. This research reports on six DM programs that serve large rural and underserved populations and have demonstrated that DM can be successfully implemented in such areas. Copyright 2005 by Medicom International. All rights reserved.

Bolin, J. N., et al. (2013). "Diabetes Education Kiosks in a Latino Community." The Diabetes Educator 39(2): 204-212.
	Purpose The purpose of this study was to examine the implementation, use, and sustainability of a computerized touch-screen diabetes education kiosk (Diosk) designed to provide “on-demand” education in a predominantly Latino community in South Texas. A pilot study was conducted to examine the implementation, use, and sustainability of the Diosk in 5 settings (eg, clinics, community centers, and pharmacies) serving low-income, low-literacy populations. Both quantitative and qualitative data from embedded computerized usage tracking, user surveys, and key stakeholder interviews were collected and analyzed using descriptive statistics. There were more than 5300 uses of the Diosk in the different sites during the 11-month study. The majority of users were female, between the ages of 36 and 64 years, and Latino, and they identified themselves as having or being at risk for type 2 diabetes. Several challenges were faced in maintaining the Diosk during the study, such as organizational capacity to host wireless Internet and establishing “office champions” responsible for overseeing the Diosk. At the end of the study, 3 of the 5 sites committed to sustaining the Diosk on their own. This pilot study testing the feasibility and acceptability of the Diosk demonstrated that a Diosk can be implemented, used, and sustained in a population with high rates of diabetes and limited prior use of disease management programs. Computerized technology offers one solution to expanding the reach of diabetes education through easily accessible community and clinical settings. © 2013, SAGE Publications. All rights reserved.

Bolliger, C. T., et al. (2008). "Promoting hospital-based smoking cessation services at major Swiss hospitals: A before and after study." Swiss Medical Weekly 138(29-30): 427-431.
	Questions under study: Whether a 1-year nationwide, government supported programme is effective in significantly increasing the number of smoking cessation clinics at major Swiss hospitals as well as providing basic training for the staff running them. Methods: We conducted a baseline evaluation of hospital services for smoking cessation, hypertension, and obesity by web search and telephone contact followed by personal visits between October 2005 and January 2006 of 44 major public hospitals in the 26 cantons of Switzerland; we compared the number of active smoking cessation services and trained personnel between baseline to 1 year after starting the programme including a training workshop for doctors and nurses from all hospitals as well as two further follow-up visits. Results: At base line 9 (21%) hospitals had active smoking cessation services, whereas 43 (98%) and 42 (96%) offered medical services for hypertension and obesity respectively. Hospital directors and heads of Internal Medicine of 43 hospitals were interested in offering some form of help to smokers provided they received outside support, primarily funding to get started or to continue. At two identical workshops, 100 health professionals (27 in Lausanne, 73 in Zurich) were trained for one day. After the programme, 22 (50%) hospitals had an active smoking cessation service staffed with at least 1 trained doctor and 1 nurse. Conclusion: A one-year, government-supported national intervention resulted in a substantial increase in the number of hospitals allocating trained staff and offering smoking cessation services to smokers. Compared to the offer for hypertension and obesity this offer is still insufficient.

Bolsin, S., et al. (2005). "Practical virtue ethics: healthcare whistleblowing and portable digital technology." Journal of Medical Ethics 31(10): 612-618.
	Medical school curricula and postgraduate education programmes expend considerable resources teaching medical ethics. Simultaneously, whistleblowers' agitation continues, at great personal cost, to prompt major intrainstitutional and public inquiries that reveal problems with the application of medical ethics at particular clinical "coalfaces''. Virtue ethics, emphasising techniques promoting an agent's character and instructing their conscience, has become a significant mode of discourse in modern medical ethics. Healthcare whistleblowers, whose complaints are reasonable, made in good faith, in the public interest, and not vexatious, we argue, are practising those obligations of professional conscience foundational to virtue based medical ethics. Yet, little extant virtue ethics scholarship seriously considers the theoretical foundations of healthcare whistleblowing. The authors examine whether healthcare whistleblowing should be considered central to any medical ethics emphasising professional virtues and conscience. They consider possible causes for the paucity of professional or academic interest in this area and examine the counterinfluence of a continuing historical tradition of guild mentality professionalism that routinely places relationships with colleagues ahead of patient safety. Finally, it is proposed that a virtue based ethos of medical professionalism, exhibiting transparency and sincerity with regard to achieving uniform quality and safety of health care, may be facilitated by introducing a technological imperative using portable computing devices. Their use by trainees, focused on ethical competence, provides the practical face of virtue ethics in medical education and practice. Indeed, it assists in transforming the professional conscience of whistleblowing into a practical, virtue based culture of self reporting and personal development.

Bonastre, J., et al. (2014). "Access to innovation: Is there a difference in the use of expensive anticancer drugs between French hospitals?" Health Policy 116(2-3): 162-169.
	In DRG-based hospital payment systems, expensive drugs are often funded separately. In France, specific expensive drugs (including a large proportion of anticancer drugs) are fully reimbursed up to national reimbursement tariffs to ensure equity of access. Our objective was to analyse the use of expensive anticancer drugs in public and private hospitals, and between regions. We had access to sales per anticancer drug and per hospital in the year 2008. We used a multilevel model to study the variation in the mean expenditure of expensive anticancer drugs per course of chemotherapy and per hospital. The mean expenditure per course of chemotherapy was €. 922 [95% CI: 890-954]. At the hospital level, specialisation in chemotherapies for breast cancers was associated with a higher expenditure of anticancer drugs per course for those hospitals with the highest proportion of cancers at this site. There were no differences in the use of expensive drugs between the private and the public hospital sector after controlling for case mix. There were no differences between the mean expenditures per region. The absence of disparities in the use of expensive anticancer drugs between hospitals and regions may indicate that exempting chemotherapies from DRG-based payments and providing additional reimbursement for these drugs has been successful at ensuring equal access to care. © 2013 Elsevier Ireland Ltd.

Bonci, C. M., et al. (2008). "National athletic trainers' association position statement: Preventing, detecting, and managing disordered eating in athletes." Journal of Athletic Training 43(1): 80-108.
	Objective: To present recommendations for the prevention, detection, and comprehensive management of disordered eating (DE) in athletes. Background: Athletes with DE rarely self-report their symptoms. They tend to deny the condition and are often resistant to referral and treatment. Thus, screenings and interventions must be handled skillfully by knowledgeable professionals to obtain desired outcomes. Certified athletic trainers have the capacity and responsibility to play active roles as integral members of the health care team. Their frequent daily interactions with athletes help to facilitate the level of medical surveillance necessary for early detection, timely referrals, treatment follow-through, and compliance. Recommendations: These recommendations are intended to provide certified athletic trainers and others participating in the health maintenance and performance enhancement of athletes with specific knowledge and problem-solving skills to better prevent, detect, and manage DE. The individual biological, psychological, sociocultural, and familial factors for each athlete with DE result in widely different responses to intervention strategies, challenging the best that athletics programs have to offer in terms of resources and expertise. The complexity, time intensiveness, and expense of managing DE necessitate an interdisciplinary approach representing medicine, nutrition, mental health, athletic training, and athletics administration in order to facilitate early detection and treatment, make it easier for symptomatic athletes to ask for help, enhance the potential for full recovery, and satisfy medicolegal requirements. Of equal importance is establishing educational initiatives for preventing DE.

Bond, M. F., et al. (2002). "The use of simulation for emergency medicine resident assessment." Academic Emergency Medicine 9(11): 1295-1299.
	Simulations are exercises designed to mimic real-life situations in which learners are given the opportunity to reason through a clinical problem and make critical decisions without the potential of harming actual patients. Simulation, using a variety of formats, is useful for assessing the core competencies-particularly patient care (decision making, prioritizing, procedural skills), interpersonal skills (team leadership, communication), and systems-based practice (team structure and utilization, resource use). High-fidelity computerized human simulators are a relatively new tool for use in medical simulation. These realistic mannequins mimic physical findings including respiratory rate, breath sounds, central and peripheral pulses, murmurs, and pupil reactivity. They generate an electrocardiographic (ECG) waveform, cardiac indices, and oxygen saturation that can be viewed on standard cardiac monitoring equipment and can be programmed to respond physiologically to medications and invasive procedures. The use of human simulators to reproduce life-threatening situations will be especially useful in assessing the clinical competence of emergency medicine physicians. Operational definitions of competence and tools with which to evaluate performance must first be developed. Standardization of scenarios and evaluation tools will permit assessment of the reproducibility of scenarios and the reliability and validity of the tools used to measure competence.

Bond, W. F., et al. (2007). "The use of simulation in emergency medicine: A research agenda." Academic Emergency Medicine 14(4): 353-363.
	Medical simulation is a rapidly expanding area within medical education. In 2005, the Society for Academic Emergency Medicine Simulation Task Force was created to ensure that the Society and its members had adequate access to information and resources regarding this new and important topic. One of the objectives of the task force was to create a research agenda for the use of simulation in emergency medical education. The authors present here the consensus document from the task force regarding suggested areas for research. These include opportunities to study reflective experiential learning, behavioral and team training, procedural simulation, computer screen-based simulation, the use of simulation for evaluation and testing, and special topics in emergency medicine. The challenges of research in the field of simulation are discussed, including the impact of simulation on patient safety. Outcomes-based research and multicenter efforts will serve to advance simulation techniques and encourage their adoption.

Bonetti, D. and J. E. Clarkson (2016). "Fluoride Varnish for Caries Prevention: Efficacy and Implementation." Caries Research 50: 45-49.
	Many reviews support fluoride varnish (FV) as a caries-inhibitory agent. Evidence from 6 Cochrane systematic reviews involving 200 trials and more than 80,000 participants further confirms the effectiveness of FV, applied professionally 2-4 times a year, for preventing dental caries in both primary and permanent teeth. The relative benefit of FV application seems to occur irrespective of baseline caries risk, baseline caries severity, background exposure to fluorides, use of fluoride toothpaste and application features such as prior prophylaxis, concentration of fluoride or frequency of application. While the efficacy of FV is acknowledged in clinical practice guidelines globally, the implementation of this recommendation may still be an issue. Factors that may facilitate FV application in the USA include Medicaid eligibility, relationships with dentists/community centers and strong cooperation and communication between physicians and support staff. Barriers include insufficient time to integrate oral health services into well-child visits, difficulty in applying FV (lack of skills/training) and resistance among colleagues and staff. Research in the UK/Scotland also suggests encouraging clinicians in their motivation to perform this treatment and addressing professional and parental concerns relating to possible negative consequences may be influential. Further research targeting cost-effectiveness and how FV in routine care may fit in with political agendas relating to, for example, inequalities in health care provision and access will also play a key part in stakeholder decisions to put resources into this issue. (C) 2016 The Author(s) Published by S. Karger AG, Basel

Bonetti, D., et al. (2005). "Guiding the design and selection of interventions to influence the implementation of evidence-based practice: An experimental simulation of a complex intervention trial." Social Science and Medicine 60(9): 2135-2147.
	A consistent finding in health services research is the report of uneven uptake of research findings. Implementation trials have a variable record of success in effectively influencing clinicians' behaviour. A more systematic approach may be to conduct Intervention Modelling Experiments before service-level trials, examining intervention effects on 'interim endpoints' representing clinical behaviour, derived from empirically supported psychological theories. The objectives were to: (1) Design Intervention Modelling Experiments by backward engineering a 'real-world' randomised controlled trial (NEXUS); (2) examine the applicability of psychological theories to clinical decision-making; (3) explore whether psychological theories can illuminate how interventions achieve their effects. A 2×2 factorial randomised controlled trial was designed with pre- and post-intervention data collection by postal questionnaire surveys. The first survey was used to generate feedback data and the interventions were delivered in the second survey. General medical practitioners (GPs) in England and Scotland participated. First survey respondents were randomised twice to receive or not audit and feedback and educational reminder messages. The main outcome measures included behavioural intention (general plan to refer for lumbar X-rays) and simulated behaviour (specific, scenario-based, decisions to refer for lumbar X-ray). Predictors were attitude, subjective norm, perceived behavioural control (theory of planned behaviour), self-efficacy (social cognitive theory) and decision difficulty. Both interventions significantly influenced simulated behaviour, but neither influenced behavioural intention. There were no interaction effects. All theoretically derived cognitions significantly predicted simulated behaviour. Only subjective norm was not predictive of behavioural intention. The effect of audit and feedback on simulated behaviour was mediated through perceived behavioural control. The results of this study suggest that Intervention Modelling Experiments, using psychological models to help isolate mediators of clinical decision-making, may be a means of developing more potent interventions, and selecting implementation interventions with a greater likelihood of success in a service-level randomised controlled trial. © 2004 Elsevier Ltd. All rights reserved.

Bonventre, J. V., et al. (2014). "The kidney research national dialogue: Gearing up to move forward." Clinical Journal of the American Society of Nephrology 9(10): 1806-1811.
	The National Institute of Diabetes and Digestive and Kidney Diseases–supported Kidney Research National Dialogue asked the scientific community to formulate and prioritize research objectives that would improve our understanding of kidney function and disease; >1600 participants from >30 countries posted >300 ideas and >500 comments covering all areas of kidney research. Smaller groups of investigators interrogated the postings and published a series of commentaries in CJASN. Additional review of the entire series identified six cross-cutting themes: (1) increase training and team science opportunities to maintain/expand the nephrology workforce, (2) develop novel technologies to assess kidney function, (3) promote human discovery research to better understand normal and diseased kidney function, (4) establish integrative models of kidney function to inform diagnostic and treatment strategies, (5) promote interventional studies that incorporate more responsive outcomes and improved trial designs, and (6) foster translation from clinical investigation to community implementation. Together, these cross-cutting themes provide a research plan to better understand normal kidney biology and improve the prevention, diagnosis, and treatment of kidney disease, and as such, they will inform future research efforts supported by the National Institute of Diabetes and Digestive and Kidney Diseases through workshops and initiatives. © 2014 by the American Society of Nephrology.

Boore, J. and S. Porter (2011). "Education for entrepreneurship in nursing." Nurse Education Today 31(2): 184-191.
	The different types of entrepreneurship, including social entrepreneurship and intrapreneurship, and the importance of social entrepreneurship skills in the changing world of health care are discussed. The term social intrapreneurship is introduced to characterise the many nurses introducing change and enhancing care working within the NHS. The strategy for development of entrepreneurship education within one region of the UK is presented and its integration into a pre-registration nursing programme is the main focus of this paper. The process of integration of skills in the changing world of health care is discussed. The strategy for development of entrepreneurship is presented under the headings of the NICENT (Northern Ireland Centre for Entrepreneurship) @ Ulster Integration Model: Awareness and Understanding; Interpretation; Contextualisation; Integration (Theoretical Content); Integration (Assessment); Validation/Revalidation; Implementation; and Review and Reflection. The most important stages were the first two in which nursing academic staff came to realise the relevance of the topic to nursing and the interpretation and translation into 'nurse-speak' of the business terminology to alleviate the initial rejection of entrepreneurship as of no relevance to nursing. © 2010 Elsevier Ltd.

Bordage, G. and I. Harris (2011). "Making a difference in curriculum reform and decision-making processes." Medical Education 45(1): 87-94.
	Context Although firmly grounded in Flexner's legacy of ideas, today's medical curriculum, as both an entity and a process, has become more and more complex. The curriculum as an entity is portrayed according to five key elements: the expected competencies and roles; the learners at the centre of the enterprise; assessment linking competencies and learners; the conditions and resources for learning; and a multifaceted socio-politico-cultural context in which the learning occurs. Significant developments have also occurred in the disciplines of curriculum studies, cognitive psychology and organisational change over the past century, as well as in institutional best practices, that help us to better understand and plan curricular innovations. Discussion Practical advice is offered to help curriculum developers in designing or reforming the medical curriculum. The key points of this are: (i) while focusing reform and innovation on specific elements of the curriculum, consider how those elements affect other elements and vice versa, in positive and negative ways; (ii) while grounding the reform or innovation in sound conceptual frameworks, seize any opportunities to formulate a research agenda that can build upon and advance our understanding of curricular innovations, and, (iii) moving beyond considering the curriculum as an entity, use deliberative and leadership processes that can lead to enduring curriculum reform.

Borders, S., et al. (2011). "Devolution's policy impact on non-emergency medical transportation in state children's health insurance programs." Social Work in Public Health 26(2): 137-157.
	Proponents of devolution often maintain that the transfer of power and authority of programs enables local officials to craft policy solutions that better align with the needs of their constituents. This article provides one of the first empirical evaluations of this assumption as it relates to non-emergency medical transportation (NEMT) in the State Children's Health Insurance Program (SCHIP). NEMT programs meet a critical need in the areas in which they serve, directly targeting this single key access barrier to care. Yet states have great latitude in making such services available. The authors utilize data from 32 states to provide a preliminary assessment of devolution's consequences and policy impact on transportation-related access to care. Their findings provide mixed evidence on devolution's impact on policy outcomes. Proponents of devolution can find solace in the fact that several states have gone beyond federally mandated minimum requirements to offer innovative programs to remove transportation barriers to care. Detractors of devolution will find continued pause on several key issues, as a number of states do not offer NEMT to their SCHIP populations while cutting services and leaving over $7 billion in federal matching funding unspent. © Taylor & Francis Group, LLC.

Borenstein, J., et al. (2003). "Physician attitudes toward strategies to promote the adoption of medical evidence into clinical practice." American Journal of Managed Care 9(3): 225-234.
	Background: Promoting the adoption of medical evidence into clinical practice has been advocated as one approach to improving healthcare quality and reducing medical errors. Data describing the effectiveness of different strategies to achieve this goal in real-world settings are limited. Objective: To determine the effectiveness of selected interventions on the adoption of medical evidence into clinical practice. Study design: A cross-sectional survey of a random sample of physicians selected from the American Medical Association's Physician Master File. Patients and methods: We examined the perceived effectiveness of 7 strategies (represented by 27 individual interventions) and 5 general approaches for promoting the adoption of medical evidence into clinical practice in 1100 practicing physicians. Respondent exposure to interventions was also determined. Regression analyses were performed to identify factors that affected effectiveness ratings. Analysis of variance was used to test the hypothesis of equal mean scores across different comparison groups. Results: Of 1100 surveys mailed, 63 (5.7%) were excluded and 431 were completed (response rate = 41.6%). Mean ± SD effectiveness scores for the 27 individual interventions on a 5-point Likert scale ranged from 2.0 ± 0.9 (literature received from insurance companies and managed care organizations) to 4.2 ± 0.8 (one-on-one communication with respected colleagues). Ranges for the 7 strategies were 2.6 ± 1.0 (patient-mediated interventions) to 3.6 ± 0.9 (educational meetings) and for the 5 general approaches were 1.98 ± 0.9 (administrative interventions) to 3.3 ± 0.8 (provider education). The hypothesis of equal mean effectiveness scores was rejected for all comparisons (P < .001). Frequency of exposure was the only variable to predict effectiveness (P < .001 for all regression models). Conclusion: From the perspective of practicing physicians, the frequency of exposure to strategies for promoting the adoption of medical evidence into clinical practice strongly affects their perceived effectiveness.

Borrego, M., et al. (2014). "Systematic Literature Reviews in Engineering Education and Other Developing Interdisciplinary Fields." Journal of Engineering Education 103(1): 45-76.
	Background In fields such as medicine, psychology, and education, systematic reviews of the literature critically appraise and summarize research to inform policy and practice. We argue that now is an appropriate time in the development of the field of engineering education to both support systematic reviews and benefit from them. More reviews of prior work conducted more systematically would help advance the field by lowering the barrier for both researchers and practitioners to access the literature, enabling more objective critique of past efforts, identifying gaps, and proposing new directions for research. Purpose The purpose of this article is to introduce the methodology of systematic reviews to the field of engineering education and to adapt existing resources on systematic reviews to engineering education and other developing interdisciplinary fields. Scope/Method This article is primarily a narrative review of the literature on conducting systematic reviews. Methods are adapted to engineering education and similar developing interdisciplinary fields. To offer concrete, pertinent examples, we also conducted a systematic review of systematic review articles published on engineering education topics since 1990. Fourteen exemplars are presented in this article and used to illustrate systematic review procedures. Conclusions Systematic reviews can benefit the field of engineering education by synthesizing prior work, by better informing practice, and by identifying important new directions for research. Engineering education researchers should consider including systematic reviews in their repertoire of methodologies.

Borycki, E. M., et al. (2009). The University of Victoria Interdisciplinary Electronic Health Record Educational Portal. 2009 Conference on Advances in Information Technology and Communication in Health: Revolutionizing Health Care with Informatics - From Research to Practice, ITCH 2009, Victoria, BC.
	Use of Electronic Health Record (EHR) systems is increasing globally. However, adoption rates of Health Information Systems (HISs) continue to remain poor. To improve adoption rates, there is need to provide greater HIS experience to health professionals and informaticians in health and biomedicine during their undergraduate and graduate education. A recent review of the health professional educational curricula (i.e., medicine, nursing, allied health and health/biomedical informatics) revealed that they provide only limited exposure to EHRs. In response to this educational need, the authors have developed the University of Victoria Interdisciplinary Electronic Health Record Educational Portal (UVicIED-EHR Portal). This unique, web-based portal allows students of the health professions and practicing professionals to access and interact with a set of representative EHR HIS solutions using the web. The portal, which links to several EMRs, EPRs and PHRs, has been used by several health professional educational programs in medicine, nursing and health informatics. It provides practicing health and health/biomedical informatics professionals, for example, managers and directors, with opportunities to access and review EHR systems. The portal has been used successfully in the classroom, laboratory and with distance education to give hands-on experience with a variety of HISs and their components. © 2009 ITCH 2009 Steering Committee and IOS Press. All rights reserved.

Bosch-Capblanch, X., et al. (2011). "Managerial supervision to improve primary health care in low- and middle-income countries." Cochrane Database of Systematic Reviews(9): 61.
	Background Primary healthcare (PHC) workers often work alone or in isolation. Healthcare managerial supervision is recommended to help assure quality; but this requires skilled supervisors and takes time and resources. It is therefore important to assess to what extent supervision is beneficial and the ways in which it can be implemented. Objectives To review the effects of managerial supervision of health workers to improve the quality of PHC (such as adherence to guidance or coverage of services) in low-and middle-income countries. Search strategy We searched The Cochrane Central Register of Controlled Trials (CENTRAL) 2011, Issue 1, part of The Cochrane Library. www.thecochranelibrary.com, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (searched 10 March 2011); MEDLINE, Ovid 1950 to March Week 1 2011 (searched 08 March 2011); EMBASE, Ovid 1980 to 2011 Week 12 (searched 08 March 2011); CINAHL, Ebsco 1981 -present (searched 10 March 2011); LILACS, VHL (searched 10 March 2011). Selection criteria Randomised controlled trials, controlled before-and-after studies, and interrupted time series studies, conducted in PHC in low-and middle-income countries. Supervision includes site visits from a central level of the health system, plus at least one supervisory activity. We excluded studies aimed solely at improving the clinical skills of PHC workers. Data collection and analysis We extracted data using a predefined form and assessed for risk of bias using the EPOC risk of bias criteria. Data are presented in a narrative way without pooling the effects on the outcomes as studies and outcomes were diverse. Main results Nine studies met the inclusion criteria: three compared supervision with no supervision, five compared enhanced supervision with routine supervision, and one study compared less intensive supervision with routine supervision. Most outcomes were scores relating to providers' practice, knowledge and provider or user satisfaction. The majority of the outcomes were measured within nine months after the interventions were introduced. In two studies comparing supervision with no supervision, small benefits on provider practice and knowledge were found. For methods of enhancing supervision, we identified five studies, and two studies of frequent supportive supervision demonstrated small benefits on workers performance. The one study examining the impact of less intensive supervision found no evidence that reducing the frequency of visits had any effect on the utilisation of services. The GRADE evidence quality for all comparisons and outcomes was "low" or "very low". Authors' conclusions It is uncertain whether supervision has a substantive, positive effect on the quality of primary health care in low- and middle-income countries. The long term effectiveness of supervision is unknown.

Bosnic-Anticevich, S. Z., et al. (2014). "Development and evaluation of an innovative model of inter-professional education focused on asthma medication use." BMC Medical Education 14: 10.
	Background: Inter-professional learning has been promoted as the solution to many clinical management issues. One such issue is the correct use of asthma inhaler devices. Up to 80% of people with asthma use their inhaler device incorrectly. The implications of this are poor asthma control and quality of life. Correct inhaler technique can be taught, however these educational instructions need to be repeated if correct technique is to be maintained. It is important to maximise the opportunities to deliver this education in primary care. In light of this, it is important to explore how health care providers, in particular pharmacists and general medical practitioners, can work together in delivering inhaler technique education to patients, over time. Therefore, there is a need to develop and evaluate effective inter-professional education, which will address the need to educate patients in the correct use of their inhalers as well as equip health care professionals with skills to engage in collaborative relationships with each other. Methods: This mixed methods study involves the development and evaluation of three modules of continuing education, Model 1, Model 2 and Model 3. A fourth group, Model 4, acting as a control. Model 1 consists of face-to-face continuing professional education on asthma inhaler technique, aimed at pharmacists, general medical practitioners and their practice nurses. Model 2 is an electronic online continuing education module based on Model 1 principles. Model 3 is also based on asthma inhaler technique education but employs a learning intervention targeting health care professional relationships and is based on sociocultural theory. This study took the form of a parallel group, repeated measure design. Following the completion of continuing professional education, health care professionals recruited people with asthma and followed them up for 6 months. During this period, inhaler device technique training was delivered and data on patient inhaler technique, clinical and humanistic outcomes were collected. Outcomes related to professional collaborative relationships were also measured. Discussion: Challenges presented included the requirement of significant financial resources for development of study materials and limited availability of validated tools to measure health care professional collaboration over time.

Bostrom, A. C., et al. (2006). "Electronic health record: Implementation across the Michigan Academic Consortium." CIN - Computers Informatics Nursing 24(1): 44-52.
	The Michigan Academic Consortium of academic nurse-managed primary care centers supported member sites to venture into computer-based advances with the potential to improve quality of health services and students' educational experiences. The experiences of this consortium as it incorporated electronic health records in tandem with an electronic patient management system at several of its member sites reveal the benefits and challenges of such an endeavor. The processes of selection, adoption, and implementation of the electronic health record are discussed in this article. Many lessons learned in the process are discussed. © 2006 Lippincott Williams & Wilkins, Inc.

Bosworth, H. B., et al. (2000). "Racial variation in wanting and obtaining mental health services among women veterans in a primary care clinic." Journal of the National Medical Association 92(5): 231-236.
	Epidemiologic studies suggest that African-American women may be less likely to obtain mental health services. Racial differences were explored in wanting and obtaining mental health services among women in an equal access primary care clinic setting after adjusting for demographics, mental disorder symptoms, and a history of sexual trauma. Participating in the study were women veterans at a primary care clinic at the Durham Veterans Affairs Medical Center. Consecutive women patients (n = 526) between the ages of 20 and 49 years were screened for a desire to obtain mental health services. Patients were given the Primary Care Evaluation of Menial Disorders questionnaire (PRIME-MD) and a sexual trauma questionnaire. Mental health service utilization was monitored for 12 months. The median age of the women was 35.8 years; 54.4% of them were African-American. African-American women expressed a greater desire for menial health services than whites, yet mental health resources at the clinic were similarly used by both racial groups. African-American women may want more mental health services; however, given an equal access system, there were no racial differences in mental health use.

Bouchard, R. A. (2007). "KSR v. Teleflex. Part 2: Impact of U.S Supreme Court Patent Law on Canadian and global systems-based innovation ecologies." Health law journal 15: 247-294.
	Decisions such as KSR illustrate that Canadian firms and inventors do not operate within a purely local sphere, but rather are embedded within a complex domestic network of scientific, legal, regulatory, economic and political actors enfolded within a still larger global innovation ecology. It was reasoned that a system of this nature has many of the hallmark characteristics of an open and continually evolving complex adaptive system. A complex systems approach to innovation privileges the interrelationships among actors and institutions and their interdependence in maximizing system fitness--in this case innovation in the medical sciences and enhancing national productivity and prosperity. Of importance from a health law and policy perspective, a systems approach is conducive to accomplishing these goals in a manner that respects many of the fundamental distributive and egalitarian considerations embedded within the democratic state, common law, Rule of Law and entrenched human rights. That the goal of a robust complex adaptive system is not optimization but operational efficiency from the perspective of the whole, underscores the importance of maximizing social efficiencies and minimizing social inefficiencies. When drafting law and policy with the goal of respecting the characteristics of a complex system, it is therefore important to balance accommodation and cooperation with competition among system elements so as to maximize the flexibility and responsiveness of the system to changing conditions. As discussed in the context of pharmaceutical innovation, placing too much emphasis on controlling or regulating an inherently indeterminate and emergent system without paying sufficient attention to states of criticality and phase transitions can lead to inefficient behaviors of a system that contradict its stated policy objective. Over-regulation of innovation by excessive or narrowly circumscribed IPR rights may allow for escape of creative energy away from the desired policy goal towards less innovative, less resource heavy yet more constrained pathways that benefit discrete actors and institutions rather than the system. A highly constraining IPR rights regime not only has the potential to skew the benefits of innovation towards discrete modules (corporations, individuals), but also to skew function of the system more broadly by influencing the general pattern and scope of innovative activity by persons skilled in the art as well as the manner in which newly synthesized scientific knowledge is used by legal, regulatory, economic and political actors. The ironic result of this is that innovation can be stifled by the very policies meant to stimulate it. Indeed, in its leading patent jurisprudence, SCOTUS, from Hotchkiss through Graham and KSR, has maintained the position that the grant of patents for non-inventive products and processes inhibits rather than stimulates innovation and competition. There is some evidence to suggest that a conceptual model of innovation as a global systems ecology may have particular resonance for Canada, as well as other nations seeking to leverage their national S&T base in the medical sciences, in light of several signs signifying Canada is nearing a major phase transition in its system of public health. These include: (a) the CIHR moving from a system of medical research focused on accrual of new knowledge by university-based researchers to one which underscores the importance of translating knowledge into marketable products through public-private partnerships; (b) attempts by the CIHR and other national and provincial funding agencies to emulate the successes of the United States in commercializing university-based medical research through accumulation of IPR rights; (c) the TPD positioning Canada as one of the first jurisdictions in the world to transition from a regime of drug approval and regulation based on the precautionary principle to a corporate-based risk management style regime; (d) the move by Health Canada generally away from a traditional political "gatekeeper" rol in protecting public health to a hybrid position where government is equally responsible for public health and ensuring a high return on investment on medical research; (e) the move by the Government of Canada towards both deregulation and regulatory harmony with other federal agencies funding medical research and regulating the products of that research; (f) the possibility of a two-tiered medical system following Chaoulli; and (g) the Government of Canada's avowed purpose in engaging in many of these activities to succeed not only domestically, but globally, in order to enhance national productivity and prosperity on the back of "leading edge" medical research. The observation in an array of natural, biological and technological complex adaptive systems that newer systems are more labile and uncertain than older established systems suggests a certain degree of prudence in ilishilig for such a large scale transition. Several considerations support a tote of caution, including the possibility that a large Iraction of the physical mci economic risks ol a new public health system wood be shifted away [mm govemnutent and corporatiorts and onto the pnhlic. and the willingness shown by the government to enter into public-private partnerships with increasing trequency over the development of policy, legislation and regulations pertaining to a variety ol public healilt issues. This is not to say the government should rely ott older back-loaded models ol policy development and regrmlation instead of newer organizational models. Rather, in order to grapple with partictmlarly "sticky' or wicked" policy problems. such considerations tmnderscore the neeti for just such novel models and therefore the need to thoroughly explore evolving conceptual and technological models of complex adaptive systems. By taking an approach that respects rather than avoids the complex nattire and inherent uncertainties of global innovation and product development, nations entering large-scale phase transitions related to medical research can avoid both the Ilaws inherent to organizational strategies based on deterministic, linear and ctinnstrained cnncepttmal models and the moral and physical dangers of their improper application in a ptmblic health context. One of the major leverage poimtts of complex adaptive systems. and other systems-based approaches, is the acceptance of tomtcertainty as an inherent. unavoidable and positive force, rather than something to be restrained and constrained at all costs. This has some fairly straight forward implications for innovation, in the medical sciences or otherwise. This is because the sine qua non of innovatmon is tnventitmrm, which is at heart a highly serendipitous process rather than one that can be qtmantified by narrowly circumscribed or measurable IPR rights-intensive S&T policies. This is particularly true where, as in the present imistance, the concepttmal models for obtaining, synthesizing and exulicatine new forms ot knowledge are themselves new and evolving.

Bouchonville, M. F., et al. (2016). "Taking Telemedicine to the Next Level in Diabetes Population Management: a Review of the Endo ECHO Model." Current Diabetes Reports 16(10): 7.
	Worldwide increases in diabetes prevalence in the face of limited medical resources have prompted international interest in innovative healthcare delivery models. Project ECHO (Extension for Community Healthcare Outcomes) is a "telementoring" program which has been shown to increase capacity for complex disease management in medically underserved regions. In contrast to a traditional telemedicine model which might connect a specialist with one patient, the ECHO model allows for multiple patients to benefit simultaneously by building new expertise. We recently applied the ECHO model to improve health outcomes of patients with complex diabetes (Endo ECHO) living in rural New Mexico. We describe the design of the Endo ECHO intervention and a 4-year, prospective program evaluation assessing health outcomes, utilization patterns, and cost-effectiveness. The Endo ECHO evaluation will demonstrate whether and to what extent this intervention improves outcomes for patients with complex diabetes living in rural New Mexico, and will serve as proof-of-concept for academic medical centers wishing to replicate the model in underserved regions around the world.

Boulet, J. R. and D. J. Murray (2010). "Simulation-based Assessment in Anesthesiology Requirements for Practical Implementation." Anesthesiology 112(4): 1041-1052.
	Simulations have taken a central role in the education and assessment of medical students, residents, and practicing physicians. The introduction of simulation-based assessments in anesthesiology, especially those used to establish various competencies, has demanded fairly rigorous studies concerning the psychometric properties of the scores. Most important, major efforts have been directed at identifying, and addressing, potential threats to the validity of simulation-based assessment scores. As a result, organizations that wish to incorporate simulation-based assessments into their evaluation practices can access information regarding effective test development practices, the selection of appropriate metrics, the minimization of measurement errors, and test score validation processes. The purpose of this article is to provide a broad overview of the use of simulation for measuring physician skills and competencies. For simulations used in anesthesiology, studies that describe advances in scenario development, the development of scoring rubrics, and the validation of assessment results are synthesized. Based on the summary of relevant research, psychometric requirements for practical implementation of simulation-based assessments in anesthesiology are forwarded. As technology expands, and simulation-based education and evaluation takes on a larger role in patient safety initiatives, the groundbreaking work conducted to date can serve as a model for those individuals and organizations that are responsible for developing, scoring, or validating simulation-based education and assessment programs in anesthesiology.

Boulet, L. P. (2001). "How can we translate advances in respiratory diseases into improved care?" Canadian Respiratory Journal 8(2): 69-70, 73-64.
	
Boulet, L. P. (2008). "IMPROVING KNOWLEDGE TRANSFER ON CHRONIC RESPIRATORY DISEASES: A CANADIAN PERSPECTIVE. HOW TO TRANSLATE RECENT ADVANCES IN RESPIRATORY DISEASES INTO DAY-TO-DAY CARE." Journal of Nutrition Health & Aging 12(10): 758S-763S.
	Background: Chronic diseases represent an increasing burden for health care systems. Ongoing research efforts provide regularly new scientific evidence on how optimize current medical care. In regard to respiratory diseases, as for other health problems, optimal management of these conditions has been summarized in recent consensus guidelines but implementation of these recommendations is still poor. Not only are the keymessages of such guidelines often unknown to the practitioner and the patient but even when it is, they are often insufficiently integrated into Current care, often related to behavioral, organizational and communication barriers. Methods: Literature review oil the topic of Clinical Practice Guidelines implementation and reference to recent projects aimed at improving management of asthma in the province of Quebec and elsewhere, as models for such implementation process. Results: The basic principles of an effective translation Of Current knowledge into day-to-day care are known, but healthcare delivery structures, practice tools and resources, and regional/local leadership should be available to make it happen. Ideally, implementation requires a multidisciplinary effort of care providers, specialists, general practitioners, allied health professionals, patients and their family. The general public, health administrators and policy makers should also be aware of the consequences of poor management of these diseases and be supportive of the proposed initiatives. Finally, these last should be adequately evaluated to ensure their effectiveness and determine if they should be improved. Recently projects performed in Quebec have proposed disease management models to identify asthma care gaps and improve translation of current Guidelines into day-to-day care. Conclusions: Although the human and socio-economical burden of chronic diseases is still increasing, their current management is still often deficient. In the recent decades, Practice Guidelines have been developed to guide Practitioners toward, optimal care, but implementation of these Guides is still poor. Recent Canadian and International initiatives have proposed valid models to help address current care gaps.

Boulos, M. N., et al. (2006). "Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education." BMC Medical Education 6: 41.
	BACKGROUND: We have witnessed a rapid increase in the use of Web-based 'collaborationware' in recent years. These Web 2.0 applications, particularly wikis, blogs and podcasts, have been increasingly adopted by many online health-related professional and educational services. Because of their ease of use and rapidity of deployment, they offer the opportunity for powerful information sharing and ease of collaboration. Wikis are Web sites that can be edited by anyone who has access to them. The word 'blog' is a contraction of 'Web Log' - an online Web journal that can offer a resource rich multimedia environment. Podcasts are repositories of audio and video materials that can be "pushed" to subscribers, even without user intervention. These audio and video files can be downloaded to portable media players that can be taken anywhere, providing the potential for "anytime, anywhere" learning experiences (mobile learning). DISCUSSION: Wikis, blogs and podcasts are all relatively easy to use, which partly accounts for their proliferation. The fact that there are many free and Open Source versions of these tools may also be responsible for their explosive growth. Thus it would be relatively easy to implement any or all within a Health Professions' Educational Environment. Paradoxically, some of their disadvantages also relate to their openness and ease of use. With virtually anybody able to alter, edit or otherwise contribute to the collaborative Web pages, it can be problematic to gauge the reliability and accuracy of such resources. While arguably, the very process of collaboration leads to a Darwinian type 'survival of the fittest' content within a Web page, the veracity of these resources can be assured through careful monitoring, moderation, and operation of the collaborationware in a closed and secure digital environment. Empirical research is still needed to build our pedagogic evidence base about the different aspects of these tools in the context of medical/health education. SUMMARY AND CONCLUSION: If effectively deployed, wikis, blogs and podcasts could offer a way to enhance students', clinicians' and patients' learning experiences, and deepen levels of learners' engagement and collaboration within digital learning environments. Therefore, research should be conducted to determine the best ways to integrate these tools into existing e-Learning programmes for students, health professionals and patients, taking into account the different, but also overlapping, needs of these three audience classes and the opportunities of virtual collaboration between them. Of particular importance is research into novel integrative applications, to serve as the "glue" to bind the different forms of Web-based collaborationware synergistically in order to provide a coherent wholesome learning experience.

Boulos, M. N. K. and S. Wheeler (2007). "The emerging Web 2.0 social software: An enabling suite of sociable technologies in health and health care education." Health Information and Libraries Journal 24(1): 2-23.
	Web 2.0 sociable technologies and social software are presented as enablers in health and health care, for organizations, clinicians, patients and laypersons. They include social networking services, collaborative filtering, social bookmarking, folksonomies, social search engines, file sharing and tagging, mashups, instant messaging, and online multi-player games. The more popular Web 2.0 applications in education, namely wikis, blogs and podcasts, are but the tip of the social software iceberg. Web 2.0 technologies represent a quite revolutionary way of managing and repurposing/remixing online information and knowledge repositories, including clinical and research information, in comparison with the traditional Web 1.0 model. The paper also offers a glimpse of future software, touching on Web 3.0 (the Semantic Web) and how it could be combined with Web 2.0 to produce the ultimate architecture of participation. Although the tools presented in this review look very promising and potentially fit for purpose in many health care applications and scenarios, careful thinking, testing and evaluation research are still needed in order to establish 'best practice models' for leveraging these emerging technologies to boost our teaching and learning productivity, foster stronger 'communities of practice', and support continuing medical education/professional development (CME/CPD) and patient education. © 2007 Health Libraries Group.

Boult, C., et al. (2010). "The urgency of preparing primary care physicians to care for older people with chronic illnesses." Health Affairs 29(5): 811-818.
	Population trends are driving an undeniable imperative: The United States must begin training its primary care physicians to provide higher-quality, more cost-effective care to older people with chronic conditions. Doing so will require aggressive initiatives to educate primary care physicians to apply principles of geriatrics--for example, optimizing functional autonomy and quality of life--within emerging models of chronic care. Policy options to drive such reforms include the following: providing financial support for medical schools and residency programs that adopt appropriate educational innovations; tailoring Medicare's educational subsidy to reform graduate medical education; and invoking state requirements that physicians obtain geriatric continuing education credits to maintain their licensure or to practice as Medicaid providers or medical directors of nursing homes. This paper also argues that the expertise of geriatricians could be broadened to include educational and leadership skills. These geriatrician-leaders could then become teachers in the educational programs of many disciplines. This would require changes inside and outside academic medicine.

Bouma, A. B., et al. (2014). "Shared Decision Making in the Safety Net: Where Do We Go from Here?" Journal of the American Board of Family Medicine 27(2): 292-294.
	Background: Shared decision making (SDM) is an interactive process between clinicians and patients in which both share information, deliberate together, and make clinical decisions. Clinics serving safety net patients face special challenges, including fewer resources and more challenging work environments. The use of SDM within safety net institutions has not been well studied. Methods: We recruited a convenience sample of 15 safety net primary care clinicians (13 physicians, 2 nurse practitioners). Each answered a 9-item SDM questionnaire and participated in a semistructured interview. From the transcribed interviews and questionnaire data, we identified themes and suggestions for introducing SDM into a safety net environment. Results: Clinicians reported only partially fulfilling the central components of SDM (sharing information, deliberating, and decision making). Most clinicians expressed interest in SDM by stating that they "selected a treatment option together" with patients (8 of 15 in strong or complete agreement), but only a minority (3 of 15) "thoroughly weighed the different treatment options" together with patients. Clinicians attributed this gap to many barriers, including time pressure, overwhelming visit content, patient preferences, and lack of available resources. All clinicians believed that lack of time made it difficult to practice SDM. Conclusions: To increase use of SDM in the safety net, efficient SDM interventions designed for this environment, team care, and patient engagement in SDM will need further development. Future studies should focus on adapting SDM to safety net settings and determine whether SDM can reduce health care disparities.

Boutsioli, Z. (2007). "Concentration in the Greek private hospital sector: A descriptive analysis." Health Policy 82(2): 212-225.
	Over the last 20 years, governments all around the world have attempted to boost the role of market and competition in health care industries in order to increase efficiency and reduce costs. The increased competition and the significant implications on costs and prices of health care services resulted in health care industries being transformed. Large firms are merging and acquiring other firms. If this trend continues, few firms will dominate the health care markets. In this study, I use the simple concentration ratio (CR) for the largest 4, 8 and 20 companies to measure the concentration of Greek private hospitals during the period 1997-2004. Also, the Gini coefficient for inequality is used. For the two different categories of hospitals used (a) general and neuropsychiatric and (b) obstetric/gynaecological it is evident that the top four firms of the first category accounted for 43% of sales in 1997, and 52% in 2004, while the four largest firms of the second category accounted for almost 83% in 1997, and 81% in 2004. Also, the Gini coefficient increases over the 8-year period examined from 0.69 in 1997 to 0.82 in 2004. It explains that the market of the private health care services becomes less equal in the sense that fewer private hospitals and clinics hold more and more of the share of the total sales. From a cross-industry analysis it is clear that the private hospital sector has the highest concentration rate. Finally, it appears that the market structure of the private hospitals in Greece resembles more closely to an oligopoly rather than a monopolistic competition, since very few firms dominate the market. © 2006 Elsevier Ireland Ltd. All rights reserved.

Bowden, V. M., et al. (2006). "Health information Hispanic outreach in the Texas Lower Rio Grande Valley." Journal of the Medical Library Association 94(2): 180-189.
	Purpose: This paper provides an overview of the two-year Texas Lower Rio Grande Valley Health Information Hispanic Outreach (HI HO) project. The project included a needs assessment, four pilot projects, and focus groups on the use of MedlinePlus and MedlinePlus en español. The needs assessment included a survey of physicians' information usage and a review of the circuit librarian program that had been established in 1989. The pilot projects were located at a high school, a rural health clinic, an urban health clinic, and a community center. Diffusion of innovation theory provided a framework for interpreting the results of the pilot projects. Methods: The survey of physicians' information usage partially replicated a similar 1990 survey. The review of the circuit librarian program included usage statistics, interviews of administrators, and a survey of participants. Pilot project methodology varied by site. At the high school, four students were trained to instruct their peers in the use of MedlinePlus. At the two clinics, a computer workstation was installed for patients to access MedlinePlus. At the community center, staff were trained to use MedlinePlus en español to train community residents. Project evaluation included surveys, focus groups, and interviews. Indicators of success included increased level of consumer use of MedlinePlus, reports by key informants and consumers of how MedlinePlus was used, reports about training, and development of self-sustaining activity. Results: The physician survey documented usage of health information resources in 2002 compared to 1990. The review of the circuit librarian program documented the change in program usage between 1989 and 2003. The pilot project at the high school was the most successful of the four pilot projects in introducing MedlinePlus to a large number of people, followed by the community center project. In the high school and community center projects, the participating institutions had reinforcing educational missions and paid staff who were highly motivated to achieve the project goals. The computer workstations projects at the two clinics were less successful, due in part to limited staff commitment and conflicting priorities. Conclusions: The HI HO project tested methods of reaching the Hispanic community in the Lower Rio Grande Valley region of Texas. The four HI HO pilot projects varied in achieving their stated objectives. But taken as a whole, the HI HO project significantly contributed to a better understanding of health information outreach to the Hispanic community, knowledge that should be useful to others with similar outreach activities.

Bowen, J. L. (1998). "Adapting residency training. Training adaptable residents." Western Journal of Medicine 168(5): 371-377.
	Graduate medical education has been criticized for failing to adequately prepare young physicians to enter the workforce upon completion of their training. In addressing this criticism, the author makes arguments both for and against this assertion. Broad qualitative changes (graduate medical education training position allocation, subspecialists' role in health care delivery, educational quality, faculty development, and faculty promotion) that graduate medical education has undergone and is undergoing are discussed. Population health management, clinical resource management, teamwork, continuous quality improvement, ethics, and evidence-based medicine are addressed as important curricular elements for residency training. Innovations in graduate medical education that are being introduced as well as those that should be tried are discussed. Finally, the author asserts that although residency education should not be vocationally driven by the needs of managed care organizations, a powerful opportunity exists for collaborative educational research between academic medicine and managed care organizations. In a health care environment undergoing rapid changes, the primary goals of graduate medical education have not significantly changed: to produce compassionate physicians with a passion for lifelong learning who have leadership skills, are critical thinkers, skilled at self-assessment, and able to adapt to the needs of the health care marketplace. [References: 24]

Bowen, J. L., et al. (2010). "Developing measures of educational change for academic health care teams implementing the chronic care model in teaching practices." Journal of General Internal Medicine 25(SUPPL. 4): S586-S592.
	BACKGROUND: The Chronic Care Model (CCM) is a multidimensional framework designed to improve care for patients with chronic health conditions. The model strives for productive interactions between informed, activated patients and proactive practice teams, resulting in better clinical outcomes and greater satisfaction. While measures for improving care may be clear, measures of residents' competency to provide chronic care do not exist. This report describes the process used to develop educational measures and results from CCM settings that used them to monitor curricular innovations. SUBJECTS: Twenty-six academic health care teams participating in the national and California Academic Chronic Care Collaboratives. METHOD: Using successive discussion groups and surveys, participants engaged in an iterative process to identify desirable and feasible educational measures for curricula that addressed educational objectives linked to the CCM. The measures were designed to facilitate residency programs' abilities to address new accreditation requirements and tested with teams actively engaged in redesigning educational programs. ANALYSIS: Field notes from each discussion and lists from work groups were synthesized using the CCM framework. Descriptive statistics were used to report survey results and measurement performance. RESULTS: Work groups generated educational objectives and 17 associated measurements. Seventeen (65%) teams provided feasibility and desirability ratings for the 17 measures. Two process measures were selected for use by all teams. Teams reported variable success using the measures. Several teams reported use of additional measures, suggesting more extensive curricular change. CONCLUSION: Using an iterative process in collaboration with program participants, we successfully defined a set of feasible and desirable education measures for academic health care teams using the CCM. These were used variably to measure the results of curricular changes, while simultaneously addressing requirements for residency accreditation. © 2010 Society of General Internal Medicine.

Bowen, S. A. K., et al. (2010). "Assessing Levels of Adaptation During Implementation of Evidence-Based Interventions: Introducing the Rogers-Rütten Framework." Health Education and Behavior 37(6): 815-830.
	Most HIV-prevention funding agencies require the use of evidence-based behavioral interventions, tested and proven to be effective through outcome evaluation. Adaptation of programs during implementation is common and may be influenced by many factors, including agency mission, time constraints, and funding streams. There are few theoretical frameworks to understand how these organizational and program-related factors influence the level of adaptation. This study used constructs from both Rogers's diffusion theory and Rütten's framework for policy analysis to create a conceptual framework that identifies determinants hypothesized to affect the level of adaptation. Preliminary measures of these constructs were also developed. This framework and its measures assess organizational and program-related factors associated with adaptation and could serve as a model to assess implementation and adaptation in fields outside of HIV prevention. © 2010 by SOPHE.

Bower, E. A., et al. (2008). "Barriers to innovation in continuing medical education." Journal of Continuing Education in the Health Professions 28(3): 148-156.
	INTRODUCTION: Criteria for maintenance of certification (MOC) emphasize the importance of competencies such as communication, professionalism, systems-based care, and practice performance in addition to medical knowledge. Success of this new competency paradigm is dependent on physicians' willingness to engage in activities that focus on less traditional competencies. We undertook this analysis to determine whether physicians' preferences for CME are barriers to participation in innovative programs.
METHODS: A geographically stratified, random sample of 755 licensed, practicing physicians in the state of Oregon were surveyed regarding their preferences for type of CME offering and instructional method and plans to recertify.
RESULTS: Three hundred seventy-six of 755 surveys were returned for +/-5% margin of error at 95% confidence level; 91% of respondents were board certified. Traditional types of CME offerings and instructional methods were preferred by the majority of physicians. Academic physicians were less likely than clinical physicians to prefer nontraditional types of CME offerings and instructional methods. Multiple regression analyses did not reveal any significant differences based on demography, practice location, or physician practice type.
DISCUSSION: Physicians who participate in CME select educational opportunities that appeal to them. There is little attraction to competency-based educational activities despite their requirement for MOC. The apparent disparity between the instructional methods a learner prefers and those that are the most effective in changing physician behavior may represent a barrier to participating in more innovative CME offerings and instructional methods. These findings are important for medical educators and CME program planners developing programs that integrate studied and effective educational methods into CME programs that are attractive to physicians.

Bowry, A. D. K., et al. (2015). "The Burden of Cardiovascular Disease in Low- and Middle-Income Countries: Epidemiology and Management." Canadian Journal of Cardiology 31(9): 1151-1159.
	Cardiovascular disease (CVD) is the second leading cause of mortality worldwide, accounting for 17 million deaths in 2013. More than 80% of these cases were in low- and middle-income countries (LMICs). Although the risk factors for the development of CVD are similar throughout the world, the evolving change in lifestyle and health behaviours in LMICs-including tobacco use, decreased physical activity, and obesity-are contributing to the escalating presence of CVD and mortality. Although CVD mortality is falling in high-income settings because of more effective preventive and management programs, access to evidence-based interventions for combating CVD in resource-limited settings is variable. The existing pressures on both human and financial resources impact the efforts of controlling CVD. The implementation of emerging innovative interventions to improve medication adherence, introducing m-health programs, and decentralizing the management of chronic diseases are promising methods to reduce the burden of chronic disease management on such fragile health care systems.

Boyd, E. A. (1998). "Bureaucratic authority in the "company of equals": The interactional management of medical peer." American Sociological Review 63(2): 200-224.
	I examine the negotiation of treatment decisions and the management of professional relationships during medical peer review. Using audio recordings of reviews conducted by telephone, I examine three recurrent interactional junctures in the review: (1) the reviewer's formulation of an initial request for information about the patient; (2) the doctor's immediately subsequent description of the patient; and (3) the reviewer's announcement of a decision about the appropriateness of the proposed procedure. Through the practices that accomplish these actions, doctors and reviewers orient to tensions between collegial and bureaucratic pressures, and manage these tensions through a set of interactional and institutional resources that may minimize the potential challenge to the collegial relationship. In doing so, the participants work to presence the ideal of professional autonomy, even while it may be compromised by the review process itself.

Boyd, J. H., et al. (2005). "Inadequate community knowledge about sickle cell disease among African-American women." Journal of the National Medical Association 97(1): 62-67.
	Background: Federal legislation was passed in 1972 initiating genetic screening and community education about sickle cell disease (SCID). Few assessments have examined the impact of these programs. The aim, of this study is to assess existing knowledge about SCID among African-American women in St. Louis, MO. Methods: We conducted a cross-sectional telephone survey of African-American women, 18-30 years of age. Participants were recruited through random-digit dialing in six ZIP codes with greater than 75% African-American residents. The survey contained questions exploring four content domains about SCD: general knowledge, genetics, management and educational resources. Results: A total of 264 women were contacted; 30% were unable to complete the survey and participate further because they were unaware of SCD. One-hundred-sixty-two women met eligibility criteria, agreed to be surveyed and were included in the study. Ninety-one percent of the participants believed that SCD was a hereditary blood disorder, but only 9.3% understood the inheritance pattern. Eleven percent of the women were unaware of their sickle cell trait status. Most women recognized pain (94%), infections (80%) and strokes (40%) as complications of SCD. Conclusion: New strategies are needed to enhance awareness of SCD among African-American women of childbearing age.

Boyer, S., et al. (2011). "Non-adherence to antiretroviral treatment and unplanned treatment interruption among people living with HIV/AIDS in Cameroon: Individual and healthcare supply-related factors." Social Science & Medicine 72(8): 1383-1392.
	In low-income countries, health system deficiencies may undermine treatment continuity and adherence to antiretroviral therapy (ART) that are crucial for the success of large-scale public ART programs. In addition to examining the effects of individual characteristics, on non-adherence to ART and treatment interruption behaviors - i.e. treatment interruption for more than 2 consecutive days during the previous 4 weeks, this study aims to extend our knowledge on the role played by healthcare supply-related characteristics in shaping these two treatment outcomes. These effects are examined using multilevel logistic models applied to a sub-sample of 2381 ART-treated patients followed-up in 27 treatment centers in Cameroon (ANRS-EVAL survey, 2006-2007). Multivariate models show that factors common to both non-adherence and treatment interruption include binge drinking (at the individual-level) and large hospital size (at the healthcare supply-level). Among the individual factors, financial difficulties of paying for HIV-care are the major correlates of treatment interruption [Adjusted Odds Ratio (AOR) 95% confidence interval (CI) = 11.73(7.24-19.00)]. By contrast, individual factors associated with an increased risk of non-adherence include: having a main partner but not living in a couple compared to patients living in a couple [AOR(95%CI) = 1.51(1.14-2.01)]; experience of discrimination in the family environment [AOR(95%CI) = 1.74(1.14-2.65)]; a lack of regular meals [AOR(95%CI) = 1.93(1.44-2.57)], and switching antiretroviral drugs (ARV) regimen [AOR(95% CI) = 1.36(1.08-1.70)]. At healthcare facility-level, the main correlate of ART interruption was antiretroviral stock-outs [AOR(95%CI) = 1.76(1.01-3.32)] whereas the lack of psychosocial support from specialized staff and lack of task-shifting to nurses in medical follow-up were both associated with a higher-risk of non-adherence [respective AOR (95%CI) = 2.81(1.13-6.95) and 1.51(1.00-3.40)]. Results reveal different patterns of factors for non-adherence and treatment interruption behaviors. They also suggest that psychosocial support interventions targeted at the individual patient-level will not be sufficient to achieve favorable treatment outcomes if not combined with interventions focused on strengthening health systems, including appropriate drug supplies and human resources policies, as well as sustainable and equitable financing mechanisms. (C) 2011 Elsevier Ltd. All rights reserved.

Boyle, J., et al. (2007). "A randomised controlled trial and economic evaluation of direct versus indirect and individual versus group modes of speech and language therapy for children with primary language impairment." Health Technology Assessment 11(25): 1-+.
	Objectives: To compare language outcomes following direct individual therapy [speech and language therapist (SLT) working individually with a child], indirect individual therapy [speech and language therapy assistant (SLTA) working individually with a child], direct group therapy (SLT working with a small group of children) and indirect group therapy (SLTA working with a small group of children) for primary school-age children with persistent primary receptive and/or expressive language impairment relative to a comparison group receiving current models and levels of SLT service. Design: The trial had a 2 x 2 factorial design (direct/indirect versus individual/group therapy) together with a control group that received existing levels of community-based speech and language therapy and served as a comparator for the economic analysis. All postintervention language outcome measures were blind assessed. A short-run economic evaluation across the four different modes of therapy was carried out using the primary outcome measure. A comparable method was used for estimating the costs of providing services in the community for children allocated to the control group. Setting: Research intervention took place in school settings in Scotland, with some of the children randomised to group therapies transported to join a group in a different school. Participants: Children aged between 6 and 11 years, attending a mainstream school, with standard scores on the Clinical Evaluation of Language Fundamentals (CELF-3(UK)) of less than -1.25 SD (receptive and/or expressive) and non-verbal IQ on the Wechsler Abbreviated Scale of Intelligence (WASI) above 75, and no reported hearing loss, no moderate/severe articulation/phonology/dysfluency problems or otherwise requiring individual SLT work. Informed, written parental consent was required. Interventions: A therapy manual was constructed that provided a range of procedures and activities for intervention in areas identified by a search of the research and professional literature for examples of language therapies of proven effectiveness. SLTs planned activities for children seen by therapists and SLTAs, using the manual. Main outcome measures: Primary outcome measures were standardised scores on tests of expressive and receptive language. Secondary outcome measures were scores on a test of receptive vocabulary, together with questionnaire, rating scale and focus group data from parents, teachers, project SLTs and SLTAs, and an audit of therapy sessions. Results: There was no evidence that the five modes involved in the project were different at the onset in terms of primary outcome measures, although there were significant gender differences. The results from both the intention-to-treat analyses of the outcomes from the 161 children randomised who met the eligibility criteria and the protocol analyses of the outcomes from the 152 children for whom postbaseline data were available revealed that there were no significant postintervention differences between direct and indirect modes of therapy on the one hand, or between individual and group modes on the other on any of the primary language outcome measures. However, there was evidence of some benefits from direct therapy from an SLT in secondary outcome measures. Intervention delivered three times a week for 30-40 minutes over a 15-week period also yielded significant improvements in age-corrected standardised scores for expressive language, although not for receptive language, relative to those receiving community-based SLT services. Children with specific expressive language delay were more likely to show improvement than those with mixed receptive-expressive difficulties, and non-verbal IQ was not a significant moderating variable. The within-trial economic evaluation identified indirect therapy, particularly indirect group therapy, as the least costly of the modes investigated in the study, with direct individual therapy as the most costly option. Conclusions: SLTAs can act as effective surrogates for SLTs in the delivery of services within primary schools to children with primary language impairment who do not to require the specialist skills of an SLT. Generalising the central estimates of the relative cost of different therapy modes to other educational/health systems is possible, but the precise differences reported in resource use need to be qualified by the level of programme intensity and other characteristic features of education and therapy services that may differ from those observed in this trial. Further research is needed into effective interventions for receptive language problems and also investigations of the efficacy of the relationship between dose and treatment effect in both expressive and receptive language. Research is also needed into models of integrative service delivery, cluster models of delivery via integrated community schools, and the involvement of class teachers, classroom assistants and parents/carers. There is also a need for studies to identify the characteristics of children who are most likely to succeed with indirect intervention approaches, and also to evaluate alternative methods of working with those who may benefit from different modes. Finally, research to refine the therapy manual would also be helpful.

Braathen, S. H., et al. (2013). "Understanding the local context for the application of global mental health: a rural South African experience." International Health 5(1): 38-42.
	The global mental health movement has supplied ample evidence of treatment gaps for mental health care in low and middle-income countries. It is also clear that substantial progress has been made in developing an evidence base for innovative treatments which have been shown to work. It is only through rich and detailed understandings of local contexts and individual experiences that the challenges global mental health faces can be fully appreciated. In this article, we use a single, qualitative case study from one context and of one family affected by mental disorder. This is to elucidate core issues which we regard as key to further developments in the global mental health agenda. Core issues are poor mental health literacy, transport and lack of outreach, limitations of formal health care, challenges at the interface with indigenous health care and lack of follow-up and rehabilitation. We propose shifting the focus of mental health care from cure to promotion and prevention, using an interdisciplinary team of lay and trained health workers from the professional, folk and popular sectors. The challenges are complex, as this small study shows, but it is only by looking closely at local conditions that it is possible to develop interventions which are contextually appropriate and make optimal use of local resources.

Brada, B. (2011). ""Not Here": Making the Spaces and Subjects of "Global Health" in Botswana." Culture Medicine and Psychiatry 35(2): 285-312.
	This essay argues that what makes "global health" "global" has more to do with configurations of space and time, and the claims to expertise and moral stances these configurations make possible, than with the geographical distribution of medical experts or the universal, if also uneven, distribution of threats to health. Drawing on a study of public-private partnerships supporting Botswana's HIV/AIDS treatment program, this essay demonstrates ethnographically the processes by which "global health" and its quintessential spaces, namely "resource-limited" or "resource-poor settings," are constituted, reinforced, and contested in the context of medical education and medical practice in Botswana's largest hospital. Using Silverstein's work on orders of indexicality, I argue that the terms of "global health" are best understood as chronotopic, and demonstrate how actors orient themselves and others spatio-temporally, morally, and professionally by using or refuting those terms. I conclude by arguing that taking "global health" on its own terms obscures the powerful forces by which it becomes intelligible. At stake are the frames within which medical anthropologists understand their objects of study, as well as the potential for the spaces of "global health" intervention to expand ever outward as American medical personnel attempt to calibrate their experiences to their expectations.

Bradley, E. H., et al. (2012). "A model for scale up of family health innovations in low-income and middle-income settings: a mixed methods study." BMJ Open 2(4).
	BACKGROUND: Many family health innovations that have been shown to be both efficacious and cost-effective fail to scale up for widespread use particularly in low-income and middle-income countries (LMIC). Although individual cases of successful scale-up, in which widespread take up occurs, have been described, we lack an integrated and practical model of scale-up that may be applicable to a wide range of public health innovations in LMIC.
OBJECTIVE: To develop an integrated and practical model of scale-up that synthesises experiences of family health programmes in LMICs.
DATA SOURCES: We conducted a mixed methods study that included in-depth interviews with 33 key informants and a systematic review of peer-reviewed and grey literature from 11 electronic databases and 20 global health agency web sites.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: We included key informants and studies that reported on the scale up of several family health innovations including Depo-Provera as an example of a product innovation, exclusive breastfeeding as an example of a health behaviour innovation, community health workers (CHWs) as an example of an organisational innovation and social marketing as an example of a business model innovation. Key informants were drawn from non-governmental, government and international organisations using snowball sampling. An article was excluded if the article: did not meet the study's definition of the innovation; did not address dissemination, diffusion, scale up or sustainability of the innovation; did not address low-income or middle-income countries; was superficial in its discussion and/or did not provide empirical evidence about scale-up of the innovation; was not available online in full text; or was not available in English, French, Spanish or Portuguese, resulting in a final sample of 41 peer-reviewed articles and 30 grey literature sources.
STUDY APPRAISAL AND SYNTHESIS METHODS: We used the constant comparative method of qualitative data analysis to extract recurrent themes from the interviews, and we integrated these themes with findings from the literature review to generate the proposed model of scale-up. For the systematic review, screening was conducted independently by two team members to ensure consistent application of the predetermined exclusion criteria. Data extraction from the final sample of peer-reviewed and grey literature was conducted independently by two team members using a pre-established data extraction form to list the enabling factors and barriers to dissemination, diffusion, scale up and sustainability.
RESULTS: The resulting model-the AIDED model-includes five non-linear, interrelated components: (1) assess the landscape, (2) innovate to fit user receptivity, (3) develop support, (4) engage user groups and (5) devolve efforts for spreading innovation. Our findings suggest that successful scale-up occurs within a complex adaptive system, characterised by interdependent parts, multiple feedback loops and several potential paths to achieve intended outcomes. Failure to scale up may be attributable to insufficient assessment of user groups in context, lack of fit of the innovation with user receptivity, inability to address resistance from stakeholders and inadequate engagement with user groups.
LIMITATIONS: The inductive approach used to construct the AIDED model did not allow for simultaneous empirical testing of the model. Furthermore, the literature may have publication bias in which negative studies are under-represented, although we did find examples of unsuccessful scale-up. Last, the AIDED model did not address long-term, sustained use of innovations that are successfully scaled up, which would require longer-term follow-up than is common in the literature.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Flexible strategies of assessment, innovation, development, engagement and devolution are required to enable effective change in the use of family health innovations in LMIC.

Bram, J. T., et al. (2015). "Utilization and Monetization of Healthcare Data in Developing Countries." Big Data 3(2): 59-66.
	In developing countries with fledgling healthcare systems, the efficient deployment of scarce resources is paramount. Comprehensive community health data and machine learning techniques can optimize the allocation of resources to areas, epidemics, or populations most in need of medical aid or services. However, reliable data collection in low-resource settings is challenging due to a wide range of contextual, business-related, communication, and technological factors. Community health workers (CHWs) are trusted community members who deliver basic health education and services to their friends and neighbors. While an increasing number of programs leverage CHWs for last mile data collection, a fundamental challenge to such programs is the lack of tangible incentives for the CHWs. This article describes potential applications of health data in developing countries and reviews the challenges to reliable data collection. Four practical CHW-centric business models that provide incentive and accountability structures to facilitate data collection are presented. Creating and strengthening the data collection infrastructure is a prerequisite for big data scientists, machine learning experts, and public health administrators to ultimately elevate and transform healthcare systems in resource-poor settings.

Brand, M. K. and R. Slifkin (2016). "Innovations in Oral Health Education and Practice." Journal of the California Dental Association 44(3): 165-166.
	
Brandon, J. E. and B. Majumdar (1997). "An introduction and evaluation of problem-based learning in health professions education." Family & Community Health 20(1): 1-15.
	Problem-based learning (PBL) is a curricular innovation whose distinguishing characteristic is the use of real or simulated problems as the stimulus to student-centered learning. PBL is promoted as facilitating among students the development of critical thinking skills, resource identification, and greater retention of information. This article presents an evaluation of the benefits and concerns related to the use of PBL. Several studies suggested that while PBL may prepare practitioners as well as traditional programs do, its superiority as a teaching method needs further documentation. Such research should be conducted in other health care professions education programs in addition to medical education. PBL is an ideal method for promoting interdisciplinary education for health care professions. An example of the use of the PBL model in an interdisciplinary public health course is presented. Other considerations, including costs, that must be included in any decision to adopt the PBL approach, are also reviewed.

Brantley-Sieders, D. M., et al. (2012). "Local Breast Cancer Spatial Patterning: A Tool for Community Health Resource Allocation to Address Local Disparities in Breast Cancer Mortality." PLoS ONE [Electronic Resource] 7(9): 11.
	Despite available demographic data on the factors that contribute to breast cancer mortality in large population datasets, local patterns are often overlooked. Such local information could provide a valuable metric by which regional community health resources can be allocated to reduce breast cancer mortality. We used national and statewide datasets to assess geographical distribution of breast cancer mortality rates and known risk factors influencing breast cancer mortality in middle Tennessee. Each county in middle Tennessee, and each ZIP code within metropolitan Davidson County, was scored for risk factor prevalence and assigned quartile scores that were used as a metric to identify geographic areas of need. While breast cancer mortality often correlated with age and incidence, geographic areas were identified in which breast cancer mortality rates did not correlate with age and incidence, but correlated with additional risk factors, such as mammography screening and socioeconomic status. Geographical variability in specific risk factors was evident, demonstrating the utility of this approach to identify local areas of risk. This method revealed local patterns in breast cancer mortality that might otherwise be overlooked in a more broadly based analysis. Our data suggest that understanding the geographic distribution of breast cancer mortality, and the distribution of risk factors that contribute to breast cancer mortality, will not only identify communities with the greatest need of support, but will identify the types of resources that would provide the most benefit to reduce breast cancer mortality in the community.

Brassolotto, J. and T. Daly (2016). "Scarcity discourses and their impacts on renal care policy, practices, and everyday experiences in rural British Columbia." Social Science & Medicine 152: 138-146.
	Drawing from a qualitative case study in rural British Columbia, Canada, this paper examines the discourse of kidney scarcity and its impact on renal care policies and practices. Our findings suggest that at different levels of care, there are different discourses and treatment foci. We have identified three distinct scarcity discourses at work. At the macro policy level, the scarcity of transplantable kidneys is the dominant discourse. At the meso health care institution level, we witnessed a discourse regarding the scarcity of health care and human resources. At the micro community level, there was a discourse of the scarcity of health and life-sustaining resources. For each form of scarcity, particular responses are encouraged. At the macro level, renal care and transplant organizations emphasize the benefits of kidney transplantation and procuring more donors. At the meso level, participants from the regional health care system increasingly encourage home hemodialysis and patient-led care. At the micro level, community health care professionals push for rural renal patients to attend dialysis and maintain their care plans. This work contributes to critical, interdisciplinary organ transfer discourse by contextualizing kidney scarcity. It reveals the tension between these discourses and the implications of pursuing kidney donations without addressing the conditions in which individuals experience kidney failure. (C) 2016 Elsevier Ltd. All rights reserved.

Braude, R. M., et al. (2001). "Republican Scientific-Medical Library, The Republic of Armenia: progress and programs." Bulletin of the Medical Library Association 89(1): 45-50.
	In 1990, the Republican Scientific-Medical Library (RSML) of the Ministry of Health of Armenia in collaboration with the Fund for Armenian Relief created a vision of a national library network supported by information technology. This vision incorporated four goals: (1) to develop a national resource collection of biomedical literature accessible to all health professionals, (2) to develop a national network for access to bibliographic information, (3) to develop a systematic mechanism for sharing resources, and (4) to develop a national network of health sciences libraries. During the last decade, the RSML has achieved significant progress toward all four goals and has realized its vision of becoming a fully functional national library. The RSML now provides access to the literature of the health sciences including access to the Armenian medical literature, provides education and training to health professionals and health sciences librarians, and manages a national network of libraries of the major health care institutions in Armenia. The RSML is now able to provide rapid access to the biomedical literature and train health professionals and health sciences librarians in Armenia in information system use. This paper describes the evolution of the RSML and how it was accomplished.

Braun, M. W. and K. D. Kearns (2008). "Improved Learning Efficiency and Increased Student Collaboration Through Use of Virtual Microscopy in the Teaching of Human Pathology." Anatomical Sciences Education 1(6): 240-246.
	The implementation of virtual microscopy in the teaching of pathology at the Bloomington, Indiana extension of the Indiana University School of Medicine permitted the assessment of student attitudes, use and academic performance with respect to this new technology. A gradual and integrated approach allowed the parallel assessment with respect to both the virtual and optical microscopes. Student survey data indicated that the virtual imaging technology was enthusiastically received, and aggregate grade comparisons with the previous classes showed no decrease in content mastery. Survey questions assessing a variety of parameters reveal improved time and resource utilization, as well as increased student collaboration. Even so, 50% of the respondents indicated having both optical and virtual microscopes available was preferable. Anat Sci Ed 1:240-246, 2008. (C) 2008 American Association of Anatomists.

Braun, R., et al. (2013). "Community Health Workers and Mobile Technology: A Systematic Review of the Literature." PLoS ONE [Electronic Resource] 8(6): 6.
	Introduction: In low-resource settings, community health workers are frontline providers who shoulder the health service delivery burden. Increasingly, mobile technologies are developed, tested, and deployed with community health workers to facilitate tasks and improve outcomes. We reviewed the evidence for the use of mobile technology by community health workers to identify opportunities and challenges for strengthening health systems in resource-constrained settings. Methods: We conducted a systematic review of peer-reviewed literature from health, medical, social science, and engineering databases, using PRISMA guidelines. We identified a total of 25 unique full-text research articles on community health workers and their use of mobile technology for the delivery of health services. Results: Community health workers have used mobile tools to advance a broad range of health aims throughout the globe, particularly maternal and child health, HIV/AIDS, and sexual and reproductive health. Most commonly, community health workers use mobile technology to collect field-based health data, receive alerts and reminders, facilitate health education sessions, and conduct person-to-person communication. Programmatic efforts to strengthen health service delivery focus on improving adherence to standards and guidelines, community education and training, and programmatic leadership and management practices. Those studies that evaluated program outcomes provided some evidence that mobile tools help community health workers to improve the quality of care provided, efficiency of services, and capacity for program monitoring. Discussion: Evidence suggests mobile technology presents promising opportunities to improve the range and quality of services provided by community health workers. Small-scale efforts, pilot projects, and preliminary descriptive studies are increasing, and there is a trend toward using feasible and acceptable interventions that lead to positive program outcomes through operational improvements and rigorous study designs. Programmatic and scientific gaps will need to be addressed by global leaders as they advance the use and assessment of mobile technology tools for community health workers.

Braveman, P. and E. Tarimo (1996). "Health screening, development, and equity." Journal of Public Health Policy 17(1): 14-27.
	Given the worldwide epidemiologic transition and the lure of technology aggressively promoted by those profiting from it, policy-makers in developing as well as industrialized countries now frequently face decisions on the introduction of screening into routine health services. Concerns regarding development and equity raise issues that may not arise within the scientific, technical, or individually-focused ethical frameworks used in prior work on screening policy. Screening can divert attention from primary prevention of a society's most important threats to health, especially when primary prevention faces political challenges and screening costs are viewed in isolation from the overall strategy required to make it useful. For secondary prevention of diseases with easily recognizable symptoms, public education promoting timely self-referral to accessible medical services is preferable to ''screening'' unselected populations. In any country, but perhaps especially in developing countries, screening may waste scarce resources: it could also lead to widened inequities.

Brazil, K., et al. (2005). "From theory to practice: Improving the impact of health services research." BMC Health Services Research 5.
	Background: While significant strides have been made in health research, the incorporation of research evidence into healthcare decision-making has been marginal. The purpose of this paper is to provide an overview of how the utility of health services research can be improved through the use of theory. Integrating theory into health services research can improve research methodology and encourage stronger collaboration with decision-makers. Discussion: Recognizing the importance of theory calls for new expectations in the practice of health services research. These include: the formation of interdisciplinary research teams; broadening the training for those who will practice health services research; and supportive organizational conditions that promote collaboration between researchers and decision makers. Further, funding bodies can provide a significant role in guiding and supporting the use of theory in the practice of health services research. Summary: Institutions and researchers should incorporate the use of theory if health services research is to fulfill its potential for improving the delivery of health care. © 2005 Brazil et al; licensee BioMed Central Ltd.

Breban, R., et al. (2014). "Effect of preventive and curative interventions on hepatitis C virus transmission in Egypt (ANRS 1211): a modelling study." Lancet Global Health 2(9): E541-E549.
	Background Most hepatitis C virus (HCV) transmission in Egypt is related to medical injections and procedures. To control the spread of HCV, the Egyptian Ministry of Health initiated awareness and education campaigns, strengthened infection control in health-care facilities, and subsidised anti-HCV treatment. We aimed to investigate the effect of these interventions on the spread of HCV by mathematical modelling. Methods We developed a mathematical model of HCV transmission in Zawyat Razin, a typical rural community. Our model assumes that each individual has two distinct types of medical procedures: injections and more invasive medical procedures. To quantify the severity of the spread of HCV, we used the notion of the basic reproduction number R-0, a standard threshold parameter signalling whether transmission of an infectious disease is self-sustained and maintains an epidemic. If R-0 is greater than 1, HCV is self-sustained; if R-0 is 1 or less, HCV transmission is not self-sustained. We investigated whether heterogeneity in the rate of injection or invasive medical procedures is the determinant factor for HCV transmission and whether most iatrogenic transmission is caused by a small group of individuals who receive health-care interventions frequently. We then assessed whether interventions targeted at this group could reduce the spread of HCV. Findings The R-0 of the spread of HCV without treatment was 3.54 (95% CI 1.28-6.18), suggesting a self-sustained spread. Furthermore, the present national treatment programme only decreased R-0 from 3.54 to 3.03 (95% CI 1.10-5.25). Individuals with high rates of medical injections seem to be responsible for the spread of HCV in Egypt; the R-0 of the spread of HCV without treatment would be 0.64 (95% CI 0.41-0.93) if everybody followed the average behaviour. The effect of treatment on HCV transmission is greatly enhanced if treatment is provided a mean of 2.5 years (95% CI 0.1-9.2) after chronic infection and with drug regimens with more than 80% efficacy. With these treatment parameters, preventive and curative interventions targeting individuals with high rates of medical injections might decrease R-0 below 1 for treatment coverage lower than 5%. Interpretation Targeting preventive and curative interventions to individuals with high rates of medical injections in Egypt would result in a greater reduction the spread of HCV than would untargeted allocation. Such an approach might prove beneficial in other resource-limited countries with health-care-driven epidemics. Copyright (C) Breban et al. Open Access article distributed under the terms of CC BY-NC-ND.

Brehaut, J. C., et al. (2006). "Will a new clinical decision rule be widely used? The case of the Canadian C-Spine Rule." Academic Emergency Medicine 13(4): 413-420.
	Objectives: The reasons why some clinical decision rules (CDRs) become widely used and others do not are not well understood. The authors wanted to know the following: 1) To what extent is widespread use of a new, relatively complex CDR an attainable goal? 2) How do physician perceptions of the new CDR compare with those of a widely used rule? 3) To what extent do physician subgroups differ in likelihood to use a new rule? Methods: A survey of 399 Canadian emergency physicians was conducted using Dillman's Tailored Design Method for postal surveys. The physicians were queried regarding the Canadian Cervical-Spine Rule (C-Spine Rule). Results were analyzed via frequency distributions, tests of association, and logistic regression. Results: Response rate was 69.2% (262/376). Most respondents (83.6%) reported having already seen the Canadian C-Spine Rule, while 63.0% reported already using it. Of those who did not currently use the rule, 74.2% reported that they would consider using it in the future despite the fact that, compared with another widely used rule (the Ottawa Ankle Rules), the C-Spine Rule was rated as less easy to learn (z = 6.68, p &lt; 0.001), remember (z = 7.37, p &lt; 0.001), and use (z = 5.90, p &lt; 0.001). Those who had never seen the rule before were older (χ2 (2) = 5.10, p = 0.007) and more likely to work part-time (χ2 (2) = 7.31, p = 0.026). The best predictors of whether the rule would be used was whether it had first been seen during training (odds ratio [OR], 2.62; 95% confidence interval [CI] = 1.14 to 6.04), was perceived as an efficient use of time (OR, 4.44; 95% CI = 1.12 to 16.89), and was too much trouble to apply (OR, 0.25; 95% CI = 0.08 to 0.77). Conclusions: Widespread use of a relatively complex rule is possible. Older and part-time physicians were less likely to have seen the Canadian C-Spine Rule but not less likely to use it once they had seen it. Targeting hard-to-reach subpopulations while stressing the safety and convenience of these rules is most likely to increase use of new CDRs. © 2006 by the Society for Academic Emergency Medicine.

Breitenstein, S. M., et al. (2010). "Measuring implementation fidelity in a community-based parenting intervention." Nursing Research 59(3): 158-165.
	BACKGROUND: Establishing the feasibility and validity of implementation fidelity monitoring strategies is an important methodological step in implementing evidence-based interventions on a large scale. OBJECTIVES: The objective of the study was to examine the reliability and validity of the Fidelity Checklist, a measure designed to assess group leader adherence and competence delivering a parent training intervention (the Chicago Parent Program) in child care centers serving low-income families. METHOD: The sample included 9 parent groups (12 group sessions each), 12 group leaders, and 103 parents. Independent raters reviewed 106 audiotaped parent group sessions and coded group leaders' fidelity on the Adherence and Competence Scales of the Fidelity Checklist. Group leaders completed self-report adherence checklists and a measure of parent engagement in the intervention. Parents completed measures of consumer satisfaction and child behavior. RESULTS: High interrater agreement (Adherence Scale = 94%, Competence Scale = 85%) and adequate intraclass correlation coefficients (Adherence Scale = .69, Competence Scale = .91) were achieved for the Fidelity Checklist. Group leader adherence changed over time, but competence remained stable. Agreement between group leader self-report and independent ratings on the Adherence Scale was 85%; disagreements were more frequently due to positive bias in group leader self-report. Positive correlations were found between group leader adherence and parent attendance and engagement in the intervention and between group leader competence and parent satisfaction. Although child behavior problems improved, improvements were not related to fidelity. DISCUSSION: The results suggest that the Fidelity Checklist is a feasible, reliable, and valid measure of group leader implementation fidelity in a group-based parenting intervention. Future research will be focused on testing the Fidelity Checklist with diverse and larger samples and generalizing to other group-based interventions using a similar intervention model. Copyright © 2010 Lippincott Williams and Wilkins.

Bremne R, M. N., et al. (2014). "Integrating Reiki and community-engaged scholarship: An interdisciplinary educational innovation." Journal of Nursing Education 53(9): 541-543.
	To provide students with a meaningful holistic care experience while integrating community-engaged scholarship, students partnered with a Reiki-prepared faculty member within a nurse-managed community clinic to offer Reiki to the clients and participate in the evaluation of the effectiveness of the modality. This article describes how students and faculty integrated holistic care, scholarship, and community engagement. This experience provided the students with an opportunity to embrace the art and science of holistic nursing while obtaining experience in measuring outcomes. © SLACK Incorporated.

Brenner, H., et al. (2011). "Protection From Colorectal Cancer After Colonoscopy A Population-Based, Case-Control Study." Annals of Internal Medicine 154(1): 22-U156.
	Background: Colonoscopy with detection and removal of adenomas is considered a powerful tool to reduce colorectal cancer (CRC) incidence. However, the degree of protection achievable in a population setting with high-quality colonoscopy resources remains to be quantified. Objective: To assess the association between previous colonoscopy and risk for CRC. Design: Population-based case-control study. Setting: Rhine-Neckar region of Germany. Patients: A total of 1688 case patients with colorectal cancer and 1932 control participants aged 50 years or older. Measurements: A detailed lifetime history of CRC risk factors and preventive factors, including history and results of previous colonoscopies, and of medical data obtained by self-reports and medical records. Odds ratios of CRC associated with colonoscopy in the preceding 10 years were estimated, after adjustment for sex, age, education level, participation in a general health screening examination, family history of CRC, smoking status, body mass index, and use of nonsteroidal anti-inflammatory drugs or hormone replacement therapy. Results: Overall, colonoscopy in the preceding 10 years was associated with 77% lower risk for CRC. Adjusted odds ratios for any CRC, right-sided CRC, and left-sided CRC were 0.23 (95% CI, 0.19 to 0.27), 0.44 (CI, 0.35 to 0.55), and 0.16 (CI, 0.12 to 0.20), respectively. Strong risk reduction was observed for all cancer stages and all ages, except for right-sided cancer in persons aged 50 to 59 years. Risk reduction increased over the years in both the right and the left colon. Limitation: The study was observational, with potential for residual confounding and selection bias. Conclusion: Colonoscopy with polypectomy can be associated with strongly reduced risk for CRC in the population setting. Aside from strong risk reduction with respect to left-sided CRC, risk reduction of more than 50% was also seen for right-sided colon cancer.

Brenton, H., et al. (2007). "Using multimedia and Web3D to enhance anatomy teaching." Computers & Education 49(1): 32-53.
	Anatomy teaching is undergoing significant changes due to time constraints, limited availability of cadavers and technological developments in the areas of three-dimensional modelling and computer-assisted learning. This paper gives an overview of methods used to teach anatomy to undergraduate medical students and discusses the educational advantages and disadvantages of using three-dimensional computer models. A 'work in progress' account is then given of a project to develop two Web3D resources to enhance undergraduate tuition of the nervous system. Our approach is to support existing curricula using advanced modelling tools and a variety of delivery mechanisms. The first resource is a three-dimensional model of the adult brachial plexus: a network of nerves extending from the neck down to the shoulder, arm, hand, and fingers. This will be incorporated into existing didactic classroom teaching under the supervision of an anatomy teacher. The second resource is a piece of online courseware which will teach the embryological development of the brachial plexus. The delivery method will be the WebSET framework, a collaborative environment that allows a teacher to manipulate 3D models over the Web in real time whilst providing explanation and help to students. In this way the courseware can be used for both self-directed study and 'virtual anatomy demonstrations' within an online peer group. (c) 2005 Elsevier Ltd. All rights reserved.

Breslau, E. S., et al. (2015). "The Implementation Road: Engaging Community Partnerships in Evidence-Based Cancer Control Interventions." Health Promotion Practice 16(1): 46-54.
	Southern rural and underserved counties have high proportions of individuals with increased mortality for cervical and breast cancers. To improve the integration of behavioral research into practice, the dissemination and implementation of efficacious interventions to encourage the use of screening have increased in recent years. This study addressed gaps in the dissemination and implementation of evidence-based interventions with a pilot called Team Up. Qualitative interviews with 24 key individuals in six state-level partnerships explored partnership characteristics that influenced selection and use of evidence-based interventions among low-income, rarely or never screened women. Guided by diffusion of innovations theory and the Lasker and Weiss partnership functioning model, interviews about the intervention centered on (a) knowledge surrounding evidence base; (b) identification, selection, and adoption; (c) planning and adaptation; (d) implementation; and (e) partnership reflections and impact. Using grounded theory and content analysis, data revealed that lack of communication and high partner turnover hindered adoption and adaptation, whereas failure of partnership leaders to engage local stakeholders and lack of sufficient funds hampered implementation. Delivery of evidence-based interventions was more effective when partnerships included local partners in early decision making and when coaches were introduced to facilitate strategic thinking about translating evidence-based interventions into practice. A challenge for public health partnerships was the translation of interventions into successful programs, such that underserved communities benefited from early detection intervention research.

Brewer, B. B., et al. (2009). "A Collaborative Approach to Building the Capacity for Research and Evidence-Based Practice in Community Hospitals." Nursing Clinics of North America 44(1): 11-25.
	The use of best evidence to support nursing practice and the generation of new knowledge to use in practice are hallmarks of excellence. Nurses at the bedside, however, often lack the resources and knowledge necessary to change the traditional nursing culture to one in which the use of evidence is incorporated into daily care. This article describes the experience in two hospitals using a program designed to give nurses the skills needed to engage in evidence-based care. © 2009 Elsevier Inc. All rights reserved.

Brewer, L. and D. Chu (2008). "Caregivers at risk: The implications of health disparities." Journal of Loss & Trauma 13(2-3): 205-221.
	Stress, trauma, and crisis are experienced by individuals and families in a wide range of circumstances. This article explores the interaction between caregiver risk, family caregiving capacity, and health disparities. Such disparities not only result in negative health outcomes for individuals, but may also result in multiple needs for long-term care within families, placing family caregivers at risk in terms of their own physical and emotional well-being. This article identifies a tool, the Caregiver Risk Screen, which could aid in the early identification of caregivers at risk so that resources could be target more efficiently to those in greatest need.

Bricker, L. A., et al. (2014). "'She Has to Drink Blood of the Snake': Culture and prior knowledge in science|health education." International Journal of Science Education 36(9): 1457-1475.
	In this analysis, we argue that science education should attend more deeply to youths' cultural resources and practices (e.g. material, social, and intellectual). Inherent in our argument is a call for revisiting conceptions of 'prior knowledge' to theorize how people make sense of the complex ecologies of experience, ideas, and cultural practices that undergird any learning moment. We illustrate our argument using examples from the domain of personal health, chosen because of its tremendous societal impact and its significant areas of overlap with biology, chemistry, physics, and other scientific disciplines taught as core subjects in schools. Using data from a team ethnography of young people's science and technology learning across settings and over developmental timescales, we highlight two youths' experiences and understandings related to personal health, and how those experiences and understandings influenced the youths' sense-making about the natural world. We then discuss the implications of our argument for science education.

Brienza, R. S., et al. (2005). "Evaluation of a women's safe shelter experience to teach internal medicine residents about intimate partner violence." Journal of General Internal Medicine 20(6): 536-540.
	Although intimate partner violence (IPV) remains a major public health problem, physicians often fail to screen female patients. Reported IPV training approaches suffer from weak study designs and limited outcome assessments. We hypothesized that an educational experience for residents at a women's safe shelter would have significantly greater impact on IPV competencies, screening, and care for victims than a workshop seminar alone. In a pre-post randomized controlled trial, we compared residents exposed to the workshop seminar alone (controls) to residents exposed to these methods plus an experience at a women's safe shelter (cases). Competencies were assessed by written questionnaire and included knowledge, skills, attitudes, resource awareness, and screening behaviors. Of the 36 residents in the trial, 22 (61%) completed both pre- and postquestionnaires. Compared to controls, cases showed significantly greater pre- post improvement in the knowledge composite subscale. There were no significant differences between cases and controls in the subscales of skills, attitudes, or resource awareness. Cases increased their self-reported screening frequency but this did not differ significantly from the controls. Enhancing traditional IPV curriculum with a women's safe shelter educational experience may result in small improvements in residents' knowledge about IPV.

Brigley, S., et al. (2009). "Placing learning needs in context: Distance learning for clinical officers in Tanzania." Medical Teacher 31(4): E169-E176.
	Background: Poor public health indicators in Tanzania have led to the upgrading of nursing and clinical personnel who currently have just core training. Clinical officers (COs) have 3 years training in basic and applied medicine and are responsible for healthcare of large and dispersed rural populations. Aims: UNESCO-Wales has funded colleagues in Wales (UK) to assist the upgrade of COs. An inquiry into their learning needs and the Tanzanian context has produced a framework for design of a module for COs on sexually transmissible infections and HIV AIDS by distance learning. Methods: Face-to-face discussions were held with the Ministry of Health, healthcare workers, educators and administrators in Tanzania; a review of training documents was carried out; and a follow-up questionnaire issued to COs. Results: The discussions and review highlighted teacher-centred approaches, and management, infrastructure and resources obstacles to curriculum change. Principal learning needs of COs around STIs were: counselling, syndromic management, drugs management, laboratory diagnosis, health education, resources, staffing and service morale. Conclusions: Placing learning needs in context in dialogue with Tanzanian colleagues was an advance on simple transfer of educational technologies and expertise. The inquiry resulted in a draft study guide and resources pack that were positively reviewed by Tanzanian tutors. Management and resources issues raised problems of sustainability in the module implementation.

Briley, A. (2007). "A little knowledge is a dangerous thing." Practising Midwife 10(9): 52-53.
	
Brindle, R., et al. (2000). "Oral health in Hlabisa, KwaZulu/Natal - a rural school and community based survey." International Dental Journal 50(1): 13-20.
	To investigate rates of dental caries and periodontal disease, available dental services and resources and perceived needs in a rural South African community. Design: A cross-sectional field study including situational analysis and focus group discussions. Setting: KwaZulu/ Natal, South Africa. Participants: A total of 520 children, adolescents and adults. Methods: WHO caries scores and periodontal CPI score were determined through clinical examinations in five age groups, 5-6 years, 12y, 15y, 35-54y, 55y+. focus groups included ten 15-year-old children and ten adults. Results: Caries prevalences and (mean scores) were 5-6y 64% (dmft 3.0), 12y 24% (DMFT 0.4), 15y 27% (DMFT 0.8), 35-54 69% (DFT 2.6) and 55y+ 80% (DFT 2.7). Most caries was untreated and where present, treatment had been extraction. Dental caries rates were low and except for 5-6y were within WHO targets for the year 2000. Periodontal disease prevalence was high but would respond to improved oral hygiene. Knowledge of oral health was rudimentary. Conclusions: A district-wide oral health promotion programme is required preceded by research to define effective health education messages. Access to simple but effective preventive and curative services would seem reasonable. In view of the lack of resources ART is suggested as caries treatment.

Brinjikji, W., et al. (2015). "Racial and insurance based disparities in the treatment of carotid artery stenosis: a study of the Nationwide Inpatient Sample." Journal of Neurointerventional Surgery 7(9): 695-702.
	Background and purpose Minorities and uninsured/underinsured patients have poorer access to healthcare system resources, especially preventative treatments. We sought to determine whether racial and insurance based disparities existed in the treatment of carotid artery stenosis. Methods Using the Nationwide Inpatient Sample, hospitalizations for carotid artery stenting and carotid endarterectomy for symptomatic and asymptomatic carotid artery stenosis from 2005 to 2011 were identified. We calculated (2) tests, and bivariate and multivariable logistic regression models were fit to assess differences in the characteristics of patients receiving carotid revascularization for asymptomatic compared with symptomatic carotid artery stenosis. Demographic characteristics studied included race/ethnicity (white, black, Hispanic, Asian/Pacific Islander) and primary payer status (Medicare, Medicaid, private insurance, self-pay and no charge). Results Between 2005 and 2011, 890680 patients underwent carotid revascularization for the treatment of carotid artery stenosis (92.1% asymptomatic and 7.9% symptomatic). Multivariate logistic regression analysis demonstrated that Medicaid (OR=0.87, 95% CI 0.83 to 0.92, p<0.0001) and self-pay patients (OR=0.48, 95% CI 0.45 to 0.51, p<0.0001) had a lower odds of being revascularized for asymptomatic carotid artery stenosis compared with private insurance patients. Black (OR=0.81, 95% CI -0.77 to 0.84, p<0.0001) and Hispanic (OR=0.86, 95% CI -0.83 to 0.90, p<0.0001) patients had significantly lower odds of revascularization for asymptomatic carotid artery stenosis compared with white patients. Conclusions Minorities and self-pay/Medicaid patients were less likely to receive carotid revascularization when asymptomaticrather they were more likely to have treatment only after symptoms had developed. These findings suggest possible disparities in the degree of morbidity related to carotid artery stenosis, the likelihood of early detection, and/or the likelihood of treatment conditional on indication.

Brinjikji, W., et al. (2012). "Racial and Ethnic Disparities in the Treatment of Unruptured Intracranial Aneurysms A Study of the Nationwide Inpatient Sample 2001-2009." Stroke 43(12): 3200-3206.
	Background and Purpose-Minorities in the United States have less access to healthcare system resources, especially preventative treatments. We sought to determine whether racial and sex disparities existed in the treatment of unruptured intracranial aneurysms. Methods-Using the Nationwide Inpatient Sample, hospitalizations for clipping and coiling of intracranial aneurysms from 2001 to 2009 were identified by cross-matching International Classification of Diseases, 9th Revision codes for diagnosis of unruptured aneurysm and subarachnoid hemorrhage (SAH) with procedure codes for clipping or coiling of cerebral aneurysms. Demographic information analyzed included age (<50, 50-64, 65-79, and >= 80 years), race (white, black, Hispanic, Asian/Pacific Islander), sex, income quartile, primary payer (Medicare, Medicaid, private insurance, self-pay, no charge, other), and Charlson comorbidity index. Results-When compared with patients treated for SAH, those treated for unruptured intracranial aneurysm were significantly more likely to be women (75.0% versus 69.0%; P<0.0001). In all, 9.7% of patients receiving treatment for SAH were self-payers versus 3.0% of patients being treated for unruptured intracranial aneurysm (P<0.0001). In all, 62.2% of patients receiving treatment for SAH were white compared with 76.4% of patients being treated for unruptured intracranial aneurysm (P<0.0001). There was a higher proportion of black, Hispanic, and Asian patients in the SAH treatment group when compared with the unruptured aneurysm treatment group (P<0.0001 for all groups). Conclusions-When compared with patients undergoing treatment for SAH, patients undergoing surgical and endovascular treatment for unruptured intracranial aneurysm are generally from higher socioeconomic strata and are more likely to be insured, women, and white. Future studies are needed to determine the underlying causes and solutions for this disparity. (Stroke. 2012; 43: 3200-3206.)

Brock, D. W. (2010). "Ethical and Value Issues in Insurance Coverage for Cancer Treatment." Oncologist 15: 36-42.
	Many new cancer drugs provide only limited benefits, but at very great cost, for example, $200,000-$300,000 per quality-adjusted life year produced. By most standards of value or cost-effectiveness, this does not represent good value. I first review several of the causes of this value failure, including monopoly patents, prohibitions on Medicare's negotiating on drug prices, health insurance protecting patients from costs, and financial incentives of physicians to use these drugs. Besides value or cost-effectiveness, the other principal aim in health care resource allocation should be equity among the population served. I examine several equity considerations-priority to the worse off, aggregation and special priority to life extension, and the rule of rescue-and argue that none justifies greater priority for cancer treatment on the grounds of equity. Finally, I conclude by noting two recent policy changes that are in the wrong direction for achieving value in cancer care, and suggesting some small steps that could take us in the right direction. The Oncologist 2010;15(suppl 1):36-42

Brocklehurst, P., et al. (2012). "Relative performance of different dental professional groups in screening for occlusal caries." Community dentistry and oral epidemiology 40(3): 239-246.
	Brocklehurst P, Ashley J, Walsh T, Tickle M. Relative performance of different dental professional groups in screening for occlusal caries. Community Dent Oral Epidemiol 2012. (C) 2012 John Wiley & Sons A/S Abstract Objectives: The use of role substitution, where different levels of practitioner undertake the duties of the most qualified clinician, is common in medicine and dentistry. Proponents argue that role substitution has the potential to increase dentists efficiency and effectiveness, thereby freeing up resources to improve access and reduce oral health inequalities. Given the current global economic climate, many countries are re-examining models of service provision to utilize role substitution. The objective of this study was to determine whether different members of the dental team could meet the diagnostic threshold set by the World Health Organization, when screening photographs of occlusal surfaces for dental caries. Methods: Participants were sampled purposively and included; final-year dental students, final-year hygiene-therapy students, primary care dentists, hygiene-therapists and dental nurses. Following a brief training package, participants were asked to score 102 clinical photographs of both carious and noncarious extracted teeth and determine whether the tooth was healthy or had suspected decay. The time delay between consecutive photographs was set at 8-s. Judgment decisions were compared against the International Caries Detection and Assessment System as the gold standard, with scores of two or less representing healthy. Sensitivity, specificity and predictive values were determined for each participant and clinical group. Kappa was calculated to determine testretest reliability. Results: Dental nurses had the highest median sensitivity (87.9%), although all groups were comparable. The median specificity for the groups was lower than their sensitivity scores, with dentists scoring the highest (71.0%). Dentists also scored the highest median positive predictive value (57.8%), whilst dental nurses scored the highest negative predictive value (91.3%). The median level of agreement was high for all groups; the highest median score was for the final-year dental students (88.9%). Conclusions: Even with minimal training, different members of the dental team show the potential to screen for occlusal caries to a similar standard as primary care dentists. This requires further testing in vivo, but has important implications for the productivity and design of the future dental workforce.

Bronstein, J. M., et al. (2012). "Providing General and Preconception Health Care to Low Income Women in Family Planning Settings: Perception of Providers and Clients." Maternal and Child Health Journal 16(2): 346-354.
	This study examines both provider and client perceptions of the extent to which general health concerns are addressed in the context of publicly supported family planning care. A mail survey of family planning providers (n = 459) accepting Medicaid-covered clients in Arkansas and Alabama gathered data on reported actions and resource referral availability for ten categories of non-contraceptive health concerns. A telephone survey of recent family planning clients of these providers (n = 1991) gathered data on the presence of 16 health concerns and whether and how they were addressed by the family planning provider. Data were collected in 2006-2007. More than half (56%) of clients reported having one or more general health concerns. While 43% of those concerns had been discussed with the family planning providers, only 8% had been originally identified by these providers. Women with higher trust in physicians and usual sources of general health care were more likely to discuss their concerns. Of those concerns discussed, 39% were reportedly treated by the family planning provider. Similarly, over half of responding providers reported providing treatment for acute and chronic health conditions and counseling on health behaviors during family planning visits. Lack of familiarity with referral resources for uninsured clients was identified as a significant concern in the provision of care to these clients. Greater engagement by providers in identifying client health concerns and better integration of publicly supported family planning with other sources of health care for low income women could expand the existing potential for delivering preconception or general health care in these settings.

Brooks, P. M., et al. (2001). "Expansion and diversification of medical education in Australia, 1951-2000." Medical Journal of Australia 174(1): 25-28.
	Australia's present diverse and dynamic medical education environment has been shaped by: university funding increases by governments in the 1960s and 70s to promote Australia as a "clever" country; the Karmel Report's recommendations of increases in student numbers, new medical schools and a community focus for medical education; the successful innovations in entrance requirements and curricula of the most recent medical schools -Newcastle and Flinders; the formation of the Australian Medical Council, with a mandate to replace the British General Medical Council's accreditation of and restrictions on Australian medical school courses; the Doherty Report, which identified the close relationship between medical education, funding and workforce issues; the change to graduate entry and a four-year course for several Australian medical schools; and changing patterns of healthcare delivery, the imperative for increasing access to healthcare in rural areas, and the communication revolution made possible by information technology.

Brosnan, C. (2011). "The Significance of Scientific Capital in UK Medical Education." Minerva 49(3): 317-332.
	For decades, debates over medical curriculum reform have centred on the role of science in medical education, but the meaning of 'science' in this domain is vague and the persistence of the debate has not been explained. Following Bourdieu, this paper examines struggles over legitimate knowledge and the forms of capital associated with science in contemporary UK medical education. Data are presented from a study of two UK medical schools, one with a traditional, science-oriented curriculum, another with an integrated curriculum. Constructions of legitimate knowledge were explored at both schools through six months participant observation, interviews with faculty members (n=15) and students (n=37) and documentary analysis. Findings show that medical schools compete for both scientific and clinical capital, but ultimately science has greater legitimacy. 'Science' is defined in accordance with the structure of the traditional curriculum and has become a symbolic resource - a mark of distinction for both medical schools and medical students - which is equated with clinical competence. The significance of science is circumscribed by the medical education field, yet the struggles for scientific capital there have ramifications beyond medical education itself. It is argued that Bourdieu's concepts are particularly useful tools for studying the meanings that science takes on outside of the scientific field.

Brosseau, L., et al. (2015). "Internet-Based Implementation of Non-Pharmacological Interventions of the "People Getting a Grip on Arthritis" Educational Program: An International Online Knowledge Translation Randomized Controlled Trial Design Protocol." Jmir Research Protocols 4(1): 19.
	Background: Rheumatoid arthritis (RA) affects 2.1% of the Australian population (1.5% males; 2.6% females), with the highest prevalence from ages 55 to over 75 years (4.4-6.1%). In Canada, RA affects approximately 0.9% of adults, and within 30 years that is expected to increase to 1.3%. With an aging population and a greater number of individuals with modifiable risk factors for chronic diseases, such as arthritis, there is an urgent need for co-care management of arthritic conditions. The increasing trend and present shifts in the health services and policy sectors suggest that digital information delivery is becoming more prominent. Therefore, it is necessary to further investigate the use of online resources for RA information delivery. Objective: The objective is to examine the effect of implementing an online program provided to patients with RA, the People Getting a Grip on Arthritis for RA (PGrip-RA) program, using information communication technologies (ie, Facebook and emails) in combination with arthritis health care professional support and electronic educational pamphlets. We believe this can serve as a useful and economical method of knowledge translation (KT). Methods: This KT randomized controlled trial will use a prospective randomized open-label blinded-endpoint design to compare four different intervention approaches of the PGrip-RA program to a control group receiving general electronic educational pamphlets self-management in RA via email. Depending on group allocation, links to the Arthritis Society PGrip-RA material will be provided either through Facebook or by email. One group will receive feedback online from trained health care professionals. The intervention period is 6 weeks. Participants will have access to the Internet-based material after the completion of the baseline questionnaires until the final follow-up questionnaire at 6 months. We will invite 396 patients from Canadian and Australian Arthritis Consumers' Associations to participate using online recruitment. Results: This study will build on a pilot study using Facebook, which revealed promising effects of knowledge acquisition/integration of the evidence-based self-management PGrip educational program. Conclusions: The use of online techniques to disseminate knowledge provides an opportunity to reduce health care costs by facilitating self-management of people with arthritis. Study design strengths include the incorporation of randomization and allocation concealment to ensure internal validity. To avoid intergroup contamination, the Facebook group page security settings will be set to "closed", thus allowing only invited participants to access it. Study limitations include the lack of participant blinding due to the characteristics of this KT randomized controlled trial and a potential bias of recruiting patients only online, though this was proven effective in the previous pilot study.

Brouwer, E. D., et al. (2015). "Provider costs for prevention and treatment of cardiovascular and related conditions in low- and middle-income countries: a systematic review." BMC Public Health 15: 17.
	Background: The burden of cardiovascular disease (CVD) and CVD risk conditions is rapidly increasing in low- and middle-income countries, where health systems are generally ill-equipped to manage chronic disease. Policy makers need an understanding of the magnitude and drivers of the costs of cardiovascular disease related conditions to make decisions on how to allocate limited health resources. Methods: We undertook a systematic review of the published literature on provider-incurred costs of treatment for cardiovascular diseases and risk conditions in low-and middle-income countries. Total costs of treatment were inflated to 2012 US dollars for comparability across geographic settings and time periods. Results: This systematic review identified 60 articles and 143 unit costs for the following conditions: ischemic heart disease, non-ischemic heart diseases, stroke, heart failure, hypertension, diabetes, and chronic kidney disease. Cost data were most readily available in middle-income countries, especially China, India, Brazil, and South Africa. The most common conditions with cost studies were acute ischemic heart disease, type 2 diabetes mellitus, stroke, and hypertension. Conclusions: Emerging economies are currently providing a base of cost evidence for NCD treatment that may prove useful to policy-makers in low-income countries. Initial steps to publicly finance disease interventions should take account of costs. The gaps and limitations in the current literature include a lack of standardized reporting as well as sparse evidence from low-income countries.

Brown, A. K., et al. (2007). "The challenges of integrating ultrasonography into routine rheumatology practice: addressing the needs of clinical rheumatologists." Rheumatology 46(5): 821-829.
	OBJECTIVES: The practice of musculoskeletal ultrasonography (MSKUS) by UK rheumatologists remains limited, despite their reported enthusiasm. This study aimed to investigate factors that may encourage or limit future dissemination of rheumatologist-performed MSKUS and provide insights into perceived clinical importance and learning motivation relating to published recommendations by MSKUS experts.
METHODS: A written questionnaire study was conducted, involving 48 rheumatologists. Questions included the potential role of self-performed MSKUS, skills that they would be willing to learn and factors that may encourage or limit learning and practice. Competency recommendations proposed by imaging experts (142 skills in 7 anatomical areas) were reviewed, and quantitative and qualitative data collected regarding 'value to their practice' and 'learning motivation'.
RESULTS: Eighty-nine percent wished to learn MSKUS. Factors influencing learning and practice included time to achieve competency; relative-added clinical value of MSKUS examination; limited training infrastructure; access to existing imaging service; equipment funding. Skills offering greatest clinical utility were inflammatory arthritis assessment and guided procedures; least useful were evaluation of ligament/muscle lesions and soft tissue masses. There was a close correlation between clinical utility, learning motivation and competency standard.
CONCLUSIONS: A trade-off between added clinical value and time to achieve competency is the major factor influencing practice and training in MSKUS. Most rheumatologists report limited time to devote to training and therefore need to prioritize areas of importance for dedicated learning. Educational programmes need to be highly focused and relevant to clinical and job-plan requirements in order to encourage future dissemination of MSKUS practice by rheumatologists.

Brown, D., et al. (2003). "Graduate health professions education: an interdisciplinary university - community partnership model 1996 - 2001." Education for Health 16(2): 176-188.
	INTRODUCTION: In 1996, East Tennessee State University (ETSU) reinforced its historical commitment to multidisciplinary community engagement by developing a graduate level community partnerships program in the Division of Health Sciences. While the university's earlier health partnership efforts relied primarily on curricular innovation, the approach to graduate health professions education was to seed a series of curricular enhancements and interdisciplinary, community-based learning experiences and service into traditional curricula. This paper presents the experience of one school in crafting a regional network that became the basis of a division-wide graduate level teaching and learning initiative.
INNOVATIONS AND EVALUATION: Carefully selected planning and implementation techniques enabled multidisciplinary practitioners and community members from across a 20-county region to participate with university faculty in training ETSU learners in community-based medical care. By year four of the project, curricular "enhancements" were institutionalized in over five departments across the Division and engaged 1160 medical residents and graduate learners in a give - get model of health education. Programme evaluation methodology was collaboratively defined and documentation of programme effort and outcomes regularly reported and strategically reviewed.
CONCLUSIONS: Programme evaluation demonstrates mutual benefit to community and university. Faculty involvement in programme activity increased fourfold and community involvement in training of health professions graduate learners increased threefold by year four. Educational innovations were adopted into traditional curricula, thousands of hours of clinical services were provided to underserved communities and the university-community team forged by network links continues to promote multidisciplinary interests through joint public policy endeavors.

Brown, F. W. (1998). "Rural telepsychiatry." Psychiatric Services 49(7): 963-964.
	Telepsychiatry is the use of telecommunications technology to connect patients and health care providers, permitting effective diagnosis, education, treatment, consultation, transfer of medical data, research, and other health care activities. Telepsychiatry has been used as a partial solution to the problem of limited psychiatric services for clinics and hospitals in remote areas or areas under-served by psychiatrists and other mental health care specialists. In the United States, eastern Oregon's RodeoNet telepsychiatry program and the telemedicine program of the Kansas University Medical Center, which has a psychiatric component, are excellent models. Telepsychiatric applications can be cost-effective, but careful evaluation is needed.

Brown, J. F. (2008). "Applications of simulation technology in psychiatric mental health nursing education." Journal of Psychiatric and Mental Health Nursing 15(8): 638-644.
	The purpose of this paper is to review the use of simulation in education across the health professionals, to describe the development and implementation of innovative simulation techniques for an undergraduate psychiatric mental-health nursing course, and to identify lessons learned and future directions for successful simulation experiences in psychiatric nursing. © 2008 Blackwell Publishing Ltd.

Brown, J. J., et al. (2011). "Assessment of Core Competencies in Childhood Attention-Deficit/Hyperactivity Disorder Practice." Journal of Child and Adolescent Psychopharmacology 21(1): 33-41.
	The study assessed competencies and practices of a large group of healthcare providers in childhood attention-deficit/ hyperactivity disorder (ADHD), and identified barriers to improving care. Methods were self-assessment using an Internet questionnaire with a standardized patient case; analysis compared with professional association recommendations; and measurement of provider self-efficacy levels. Of 2,103 participants who completed the assessment, 44% were only "somewhat confident" and 20% "not at all confident" in being up-to-date in diagnosis and management of ADHD. Based on American Board of Psychiatry and Neurology's Child and Adolescent Core Competencies and American Academy of Child and Adolescent Psychiatry Practice Parameters, participants selected appropriate responses 60% of the time, 57% for items on diagnosis, and 62% for treatment. Providers under-used the family interview, and relied on ADHD rating scales for diagnosis. Lack of effective communication between provider, child, family, and teachers was the top barrier cited, yet participants rated involving the child and family as very important. In conclusion, education should include training on effective communication with the family to improve care for children with ADHD and dedication of further health education resources in the area of ADHD is needed.

Brown, P., et al. (2004). "Embodied health movements: new approaches to social movements in health." Sociology of Health & Illness 26(1): 50-80.
	Social movements organised around health-related issues have been studied for almost as long as they have existed, yet social movement theory has not yet been applied to these movements. Health social movements (HSMs) are centrally organised around health, and address: (a) access to or provision of health care services; (b) health inequality and inequity based on race, ethnicity, gender, class and/or sexuality; and/or (c) disease, illness experience, disability and contested illness. HSMs can be subdivided into three categories: health access movements seek equitable access to health care and improved provision of health care services; constituency based health movements address health inequality and health inequity based on race, ethnicity, gender, class and/or sexuality differences; and embodied health movements (EHMs) address disease, disability or illness experience by challenging science on etiology, diagnosis, treatment and prevention. These groups address disproportionate outcomes and oversight by the scientific community and/or weak science. This article focuses on embodied health movements, primarily in the US. These are unique in three ways: 1) they introduce the biological body to social movements, especially with regard to the embodied experience of people with the disease; 2) they typically include challenges to existing medical/ scientific knowledge and practice; and 3) they often involve activists collaborating with scientists and health professionals in pursuing treatment, prevention, research and expanded funding. This article employs various elements of social movement theory to offer an approach to understanding embodied health movements, and provides a capsule example of one such movement, the environmental breast cancer movement.

Brown, R. A., et al. (2012). "Clinical simulation in Australia and New Zealand: Through the lens of an advisory group." Collegian 19(3): 177-186.
	Across Australia, innovations in simulation to enhance learning in nursing have been occurring for three decades and nursing is, and needs to be, a leading player in simulation knowledge diffusion. However, expertise is unevenly distributed across health services and education providers. Rather than build on the expertise and achievements of others, there is a tendency for resource duplication and for trial and error problem solving, in part related to a failure to communicate achievements for the benefits of the professional collective. For nursing to become a leader in the use of simulation and drive ongoing development, as well as conducting high quality research and evaluation, academics need to collaborate, aggregate best practice in simulation learning, and disseminate that knowledge to educators working in health services and higher education sectors across the whole of Australia and New Zealand. To achieve this strategic intent, capacity development principles and committed action are necessary. In mid 2010 the opportunity to bring together nurse educators with simulation learning expertise within Australia and New Zealand became a reality. The Council of Deans of Nursing and Midwifery (CDNM) Australia and New Zealand decided to establish an expert reference group to reflect on the state of Australian nursing simulation, to pool expertise and to plan ways to share best practice knowledge on simulation more widely. This paper reflects on the achievements of the first 18 months since the group's establishment and considers future directions for the enhancement of simulation learning practice, research and development in Australian nursing. (C) 2012 Royal College of Nursing, Australia. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.

Browne, A. J., et al. (2009). "Cultural safety and the challenges of translating critically oriented knowledge in practice." Nursing Philosophy 10(3): 167-179.
	Cultural safety is a relatively new concept that has emerged in the New Zealand nursing context and is being taken up in various ways in Canadian health care discourses. Our research team has been exploring the relevance of cultural safety in the Canadian context, most recently in relation to a knowledge-translation study conducted with nurses practising in a large tertiary hospital.We were drawn to using cultural safety because we conceptualized it as being compatible with critical theoretical perspectives that foster a focus on power imbalances and inequitable social relationships in health care; the interrelated problems of culturalism and racialization; and a commitment to social justice as central to the social mandate of nursing. Engaging in this knowledge-translation study has provided new perspectives on the complexities, ambiguities and tensions that need to be considered when using the concept of cultural safety to draw attention to racialization, culturalism, and health and health care inequities. The philosophic analysis discussed in this paper represents an epistemological grounding for the concept of cultural safety that links directly to particular moral ends with social justice implications. Although cultural safety is a concept that we have firmly positioned within the paradigm of critical inquiry, ambiguities associated with the notions of 'culture', 'safety', and 'cultural safety' need to be anticipated and addressed if they are to be effectively used to draw attention to critical social justice issues in practice settings. Using cultural safety in practice settings to draw attention to and prompt critical reflection on politicized knowledge, therefore, brings an added layer of complexity. To address these complexities, we propose that what may be required to effectively use cultural safety in the knowledge-translation process is a 'social justice curriculum for practice' that would foster a philosophical stance of critical inquiry at both the individual and institutional levels.

Brownson, C. A., et al. (2009). "Cost-effectiveness of Diabetes Self-management Programs in Community Primary Care Settings." Diabetes Educator 35(5): 761-769.
	Purpose The purpose of this study is to estimate the cost-effectiveness of diabetes self-management programs in real-world community primary care settings. Estimates incorporated lifetime reductions in disease progression, costs of adverse events, and increases in quality of life. Methods Clinical results and costs were based on programs of the Diabetes Initiative of the Robert Wood Johnson Foundation, implemented in primary care and community settings in disadvantaged areas with notable health disparities. Program results were used as inputs to a Markov simulation model to estimate the long-term effects of self-management interventions. A health systems perspective was adopted. Results The simulation model estimates that the intervention does reduce discounted lifetime treatment and complication costs by $3385, but this is more than offset by the $ 15 031 cost of implementing the intervention and maintaining its effects in subsequent years. The intervention is estimated to reduce long-term complications, leading to an increase in remaining life-years and quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio is $ 39 563/QALY, well below a common benchmark of $ 50 000/QALY. Sensitivity analyses tested the robustness of the model's estimates under various alternative assumptions. The model generally predicts acceptable cost-effectiveness ratios. Conclusions Self-management programs for type 2 diabetes are cost-effective from a health systems perspective when the cost savings due to reductions in long-term complications are recognized. These findings may justify increased reimbursement for effective self-management programs in diverse settings.

Brownson, R. C., et al. (2007). "Evidence-Based Interventions to Promote Physical Activity. What Contributes to Dissemination by State Health Departments." American Journal of Preventive Medicine 33(1 SUPPL.): S66-S78.
	Background: Evidence-based guidelines for promoting physical activity have been produced, yet sparse information exists on the dissemination of effective interventions. The purpose of this study was to better understand the dissemination of physical activity interventions across the United States, focusing particularly on evidence-based guidelines. Design: A cross-sectional study was conducted in the U.S. that was organized around a modified version of the diffusion of innovations theory. Setting/Participants: Respondents (n=49) were the physical activity contact person (e.g., program administrator, health educator) in each state or territorial health department. Main Outcome Measures: Seven specific programs and policies relating to physical activity intervention were examined as dependent variables. Five additional domains-organizational climate, awareness, adoption, implementation, and maintenance-framed a set of independent variables. Results: The most important factor related to decision making was the availability of adequate resources. Most respondents (89.8%) were aware of evidence-based guidelines to promote physical activity. However, less than half of the respondents (41%) had the authority to implement evidence-based programs and policies. A minority of respondents reported having support from their state governor (35.4%) or from most of their state legislators (21.3%). Several key factors were associated with the adoption of evidence-based interventions, including the presence of state funding for physical activity, whether the respondent participated in moderate physical activity, presence of adequate staffing, and presence of a supportive state legislature. Conclusions: Awareness of the importance of promoting physical activity is relatively high in state and territorial health departments; however, the levels of internal support within the health department appear to outweigh any outside support from elected officials. © 2007 American Journal of Preventive Medicine.

Bruck, L. (2008). "Second life: Test-driving real-world innovations." Hospitals and Health Networks 82(10): 50-54.
	
Brucker, P. S., et al. (2005). "The internship training experiences in medical family therapy of doctoral-level marriage and family therapy students." American Journal of Family Therapy 33(2): 131-146.
	Medical family therapy refers to the systemic, biopsychosocial treatment of individuals and families who are experiencing medical problems. Because marriage and family therapists are trained to conceptualize and treat problems from a systemic perspective, marriage and family therapists are well-suited to become medical family therapists. The purpose of this article is to describe seven internship experiences that emphasize training in medical family therapy and are available for doctoral-level marriage and family therapy students. Authors provide a description of the medical settings, interactions with other health professionals, supervision experiences, and educational opportunities. Recommended resources also are provided.

Brunetaud, J. M., et al. (2002). "A resource server for medical training." Methods of Information in Medicine 41(2): 177-182.
	Objectives: We have developed a RESOURCE SERVER to collect and store various elements used by a professor during his lecture. Methods: The server manages four types of objects: ELEMENTS, RESOURCES (set of elements referring to a given topic), INDEXES (to organize the resources for further search and use), and USERS (to identify providers, users, and access rights). If an ELEMENT s modified, the RESOURCE is automatically updated. Results: An example (preparation of an anatomy lecture) explains how the RESOURCE SERVER works in three steps: organization of the training material, indexing, and retrieval. Conclusions: The RESOURCE SERVER will help instructors develop, update and share pedagogic resources for supporting their training courses, lessons and conferences. Moreover, these techniques, based on Internet technologies for easy handling of and access to these resources, allow local and distant access. Within the general framework of the French-speaking Virtual Medical University, the RESOURCE SERVER will represent an important link between data collection and its use in intelligent pedagogic training.

Brunger, F. and P. S. Duke (2012). "The evolution of integration: innovations in clinical skills and ethics in first year medicine." Medical Teacher 34(6): e452-458.
	Critical self-reflection, medical ethics and clinical skills are each important components of medical education but are seldom linked in curriculum development. We developed a curriculum that builds on the existing integration of ethics education into the clinical skills course to more explicitly link these three skills. The curriculum builds on the existing integration of clinical skills and ethics in first year medicine. It refines the integration through scheduling changes; adds case studies that emphasise the social, economic and political context of our province's patient population; and introduces reflection on the "culture of medicine" as a way to have students articulate and understand their own values and moral decision making frameworks. This structured Clinical Skills course is a model for successfully integrating critical self-reflection, reflection on the political, economic and cultural contexts shaping health and healthcare, and moral decision making into clinical skills training.

Bruno, D. M. and P. J. Imperato (2015). "A Global Health Elective for US Medical Students: The 35 Year Experience of the State University of New York, Downstate Medical Center, School of Public Health." Journal of Community Health 40(2): 187-198.
	The School of Public Health at the State University of New York, Downstate Medical Center has sponsored a 6-8 week global health elective for fourth year medical students since 1980. The purpose of this elective is to provide students with an opportunity to observe the health care and public health delivery systems in low-income countries, provide medical service and have a cross-cultural experience. Over the course of the past 35 years, 388 students have participated in this global health elective in more than 41 low-income countries. The most popular sites include the Dominican Republic, Guatemala, India, Kenya and Thailand. Overall, interest in this elective has persisted throughout the course of time, sometimes temporarily increasing or decreasing with outside factors, such as the events of 11 September 2001 and the outbreak of Severe Acute Respiratory Syndrome in Asia. Recent annual applications for this elective have been as high as 44 out of a class of 200 students. Over the past 10 years, annual acceptance rates have varied, ranging from a low of 32 % in 2007-2008 to a high of 74 % in 2010-2011 and 2013-2014. Careful screening, including a written application, review of academic records and personal interviews has resulted in the selection of highly mature, adaptable and dedicated students who have performed well at overseas sites. Student rated satisfaction levels with this elective are almost universally high, with most rating it the best experience of their medical school years. Students undergo extensive preparation prior to their travel overseas, including a review of individual health and safety issues, travel and lodging, and the nature of the host country culture, health care system and assignment site. Downstate medical students are especially experienced in cross-cultural understanding because of the unusual diversity of the patient population in Brooklyn, and the diversity of local hospital staff and the medical school class. The Alumni Fund of the College of Medicine has steadfastly supported this elective with both a philosophical commitment and financial grants to help defray costs since the very early years. The Dr. Michael and Lona B. Kenn,y Endowment, the Joshua H. Weiner endowment, and the LSK Foundation have also provided financial support for this elective. Throughout the course of this elective, overseas preceptors have willingly given of their time and institutional resources to make these experiences available and meaningful for our students.

Bruns, C. J. (2013). "Surgery and teaching." Chirurg 84(10): 833-834.
	
Brunt, L. M. (2014). "Celebrating a decade of innovation in surgical education." Bulletin of the American College of Surgeons 99(11): 10-15.
	
Bryant, D. A. (2004). "The Louis Stokes Health Sciences Library: The Howard University move experience." Journal of the Medical Library Association 92(2): 251-256.
	The Louis Stokes Health Sciences Library attributes its successful move to early planning and preparation. Professional literature on the subject as well as consultation with other experienced library personnel also proved beneficial. Utilizing these resources, the committees devised a strategy that supported the library's mission to provide excellent and complete information services for the advancement of health sciences. This paper describes the Howard University Health Sciences Library move experience and offers practical advice for planning a library move. We hope that the information shared will assist other libraries facing a similar challenge.

Bryant, J. E., et al. (2010). "Evaluation of the incorporation of an innovative writing assignment into a physician assistant basic biomedical course." The Journal of Physician Assistant Education 21(3): 23-26.
	PURPOSE: The purpose of this study was to evaluate first-year physician assistant (PA) students' attitudes towards an applied writing assignment in a basic biomedical course.
METHODS: The assignment required the students to choose a physiology or pathophysiology-related article from a respected media outlet and to select a related original research article. The students summarized, compared, and contrasted the two articles. Finally, the students described how they would explain the media article and related research article to a patient in lay terms that the patient could understand. To evaluate the effectiveness of this assignment the students were given an anonymous survey.
RESULTS: The majority of students agreed that this assignment was relevant to their career training, that the articles they chose were related to an interest of theirs, and that they learned new information about health and/or pathophysiology. Students' comments reinforced their perceived significance of this assignment to their career training and roles as future health care professionals.
CONCLUSIONS: It can be inferred from this study that PA students found this type of writing assignment helpful for independently learning a course topic of interest and that they found the writing exercise applicable to their future careers.

Bucholz, E. M. and H. M. Krumholz (2015). "Women in clinical research what we need for progress." Circulation: Cardiovascular Quality and Outcomes 8: S1-S3.
	
Buckley, L. L., et al. (2003). "Applying a 'stages of change' model to enhance a traditional evaluation of a research transfer course." Journal of Evaluation in Clinical Practice 9(4): 385-390.
	The aim of this study was to utilize an evaluation tool based on Prochaska's model of change in order to assess behaviour change as part of an evaluation process for a research transfer training programme (RTTP). The RTTP was a training programme offered to scientists in a psychiatry department and research institute to gain skills in research transfer. In addition to a traditional course evaluation framework evaluating overall satisfaction with the course and whether or not learning objectives were met, an additional 'stages of change' evaluation tool designed to assess change along a continuum was utilized. This instrument measured change in participants' attitudes, intentions and actions with respect to research transfer practice and consisted of a 12-question survey completed by participants prior to taking the course and 3 months post-course. In two out of the three categories, attitudes and intention to practice, there was positive change from pre- to post-course (P < 0.05). Although there was a trend of increased RT-related action, this was less robust and did not reach significance. For the RTTP transfer course, a 'stages of change' model of evaluation provided an enhanced understanding by showing changes in participants that would otherwise have been overlooked if only changes in RT behaviour were measured. Additionally, evaluating along a change continuum specifically identifies areas for improvement in future courses. The instrument developed for this study could also be used as a pre-course, participant needs assessment to tailor a course to the change needs of participants. Finally, this 'stages of change' approach provides insight into where barriers to change may exist for research transfer action.

Bucknall, T. (2007). "Carrots, sticks and sermons: Is feedback the answer to changing clinicians' behavior?" Worldviews on Evidence-Based Nursing 4(4): 177-178.
	
Buja, L. M., et al. (2013). "A university system's approach to enhancing the educational mission of health science schools and institutions: the University of Texas Academy of Health Science Education." Medical Education Online 18: 1-6.
	BACKGROUND: The academy movement developed in the United States as an important approach to enhance the educational mission and facilitate the recognition and work of educators at medical schools and health science institutions.
OBJECTIVES: Academies initially formed at individual medical schools. Educators and leaders in The University of Texas System (the UT System, UTS) recognized the academy movement as a means both to address special challenges and pursue opportunities for advancing the educational mission of academic health sciences institutions.
METHODS: The UTS academy process was started by the appointment of a Chancellor's Health Fellow for Education in 2004. Subsequently, the University of Texas Academy of Health Science Education (UTAHSE) was formed by bringing together esteemed faculty educators from the six UTS health science institutions.
RESULTS: Currently, the UTAHSE has 132 voting members who were selected through a rigorous, system-wide peer review and who represent multiple professional backgrounds and all six campuses. With support from the UTS, the UTAHSE has developed and sustained an annual Innovations in Health Science Education conference, a small grants program and an Innovations in Health Science Education Award, among other UTS health science educational activities. The UTAHSE represents one university system's innovative approach to enhancing its educational mission through multi- and interdisciplinary as well as inter-institutional collaboration.
CONCLUSIONS: The UTAHSE is presented as a model for the development of other consortia-type academies that could involve several components of a university system or coalitions of several institutions.

Buller, D. B., et al. (2005). "Web-based strategies to disseminate a sun safety curriculum to public elementary schools and state-licensed child-care facilities." Health Psychology 24(5): 470-476.
	The Sunny Days, Healthy Ways curriculum, which has been effective in previous trials, was disseminated to public elementary schools (n = 2,030) and state-licensed child-care facilities (n = 3,755) in 4 states. Two Web sites were created, varying in the amount and type of information. Mailings referred principals and directors to the sites. Overall 117 unique users made 172 visits to the sites. More repeat visits were made to the enhanced than to the basic site (p = .04). In a survey, 20.0% of principals and directors recalled receiving the mailings and 80.9% of these read them. Web-based strategies were weak, but the low response rate may be typical for such marketing. They will require supplementation by more personal approaches. Copyright 2005 by the American Psychological Association.

Bundred, P. and T. Gibbs (2007). "Medical migration and Africa: an unwanted legacy of educational change." Medical Teacher 29(9-10): 893-896.
	The opportunities given for medical staff to travel, work and remain in countries other than that of their domicile or graduation have led to the phenomenon of medical migration. This has been supported by ease of travel, improved technology and a drive to share good examples of medical education through improved communication. Whilst these opportunities create positive advantages to the individuals and countries involved, through the transfer of knowledge and medical management, the situation does not always lead to long term benefits, and clear disadvantages begin to emerge. The gulf between the developed and developing countries becomes pronounced, leading to a general drift of resources away from the areas where they are most needed and subsequent profound effects upon the indigenous population. This paper suggests that it is a responsibility of medical educators throughout the world to recognize this effect and create opportunities whereby the specialty of medical education positively effects medical migration to the benefit of the less fortunate areas of the world.

Bunning, K., et al. (2014). "Survey of rehabilitation support for children 0-15 years in a rural part of Kenya." Disability and Rehabilitation 36(12): 1033-1041.
	Purpose: Information regarding the nature, availability and distribution of rehabilitation services for children with disabilities across developing countries is scarce, and data that do exist are of variable quality. If planning and development are to progress, information about service provision is vital. The aim was to establish the scope and nature of rehabilitation support available to children with disabilities (0-15 years) and their families in rural Kenya. Method: A comprehensive sample comprising service provision in the health and special education sectors was established. Non-governmental and community-based organisations were also included. A survey of rehabilitation services was conducted through examination of service-related documentation and key informant interviews with the heads of services. Results: Rehabilitation comprised hospital-based occupational therapy, physiotherapy and orthopaedic technology; and seven special education establishments plus an education assessment resource centre. There was one non-government organisation and one community-based organisation relevant to children with disabilities. Activities focused on assessment, diagnosis and raising community awareness. Provision was challenged by inadequate staffing, resources and transport. Government funding was supplemented variously by donations and self-sufficiency initiatives. Rehabilitation approaches appeared to be informed by professional background of practitioner, rather than the needs of child. Service documentation revealed use of inconsistent recording methods. Conclusions: The data highlight the challenges of rehabilitation, demanding greater investment in personnel and their training, more material resources, improved access to the community and better recording mechanisms.

Burdick, W. P., et al. (2012). "Faculty development projects for international health professions educators: Vehicles for institutional change?" Medical Teacher 34(1): 38-44.
	Background: Projects are an important tool in faculty development, and project emphasis may offer insights into perceived education priorities. Impact of projects has been focused on individuals, not institutions or health. Aim: Education innovation projects of Fellows in an international faculty development program were examined to better understand perceived needs in health professions education and institutional impact of projects. Method: Four hundred and thirty-five projects were analyzed to identify focus areas. Fellows were asked to identify changes in their schools and communities resulting from their projects. Results: New education methods and curriculum change were common project focus areas. Regional differences were evident with a higher percentage of education methods projects by Fellows residing in India (52%), compared with South Africa (25%) and Brazil (24%). Fifty-six percent of projects were incorporated into the curriculum and/or incorporated as institutional policy. One-third to two-thirds of respondents noted improved teaching quality, collaboration, education research interest, assessment, student performance, and curriculum alignment with community health needs. Conclusion: National differences in project focus may offer insight into local conditions and needs. High rates of diffusion of projects and impact on faculty, students, and curriculum suggest that faculty development projects may be a strategy for institutional change in resource limited environments.

Burgard, S. A. and P. V. Chen (2014). "Challenges of health measurement in studies of health disparities." Social Science & Medicine 106: 143-150.
	Health disparities are increasingly studied in and across a growing array of societies. While novel contexts and comparisons are a promising development, this commentary highlights four challenges to finding appropriate and adequate health measures when making comparisons across groups within a society or across distinctive societies. These challenges affect the accuracy with which we characterize the degree of inequality, limiting possibilities for effectively targeting resources to improve health and reduce disparities. First, comparisons may be challenged by different distributions of disease and second, by variation in the availability and quality of vital events and census data often used to measure health. Third, the comparability of self-reported information about specific health conditions may vary across social groups or societies because of diagnosis bias or diagnosis avoidance. Fourth, self-reported overall health measures or measures of specific symptoms may not be comparable across groups if they use different reference groups or interpret questions or concepts differently. We explain specific issues that make up each type of challenge and show how they may lead to underestimates or inflation of estimated health disparities. We also discuss approaches that have been used to address them in prior research, note where further innovation is needed to solve lingering problems, and make recommendations for improving future research. Many of our examples are drawn from South Africa or the United States, societies characterized by substantial socioeconomic inequality across ethnic groups and wide disparities in many health outcomes, but the issues explored throughout apply to a wide variety of contexts and inquiries. (C) 2014 Elsevier Ltd. All rights reserved.

Burgener, S. C. (2001). "Scholarship of practice for a practice profession." Journal of Professional Nursing 17(1): 46-54.
	At a time of shrinking resources, rapidly changing health care environments, and increased demands for solutions to pressing health issues, concerns regarding the relevance of nursing research for practice are again being raised. After the national debate surrounding definitions of scholarship across disciplines and having established respectability for past and current contributions to knowledge development, nursing may now begin to reconceptualize what constitutes scholarship in a practice profession. This article addresses two central questions related to the scholarship of nursing practice: (1) How is scholarship of practice in a practice of profession defined? and (2) What characteristics differentiate the new conceptualizations of scholarship of practice from traditional research models? The results include a delineation of scholarship of practice and a differentiation of characteristics between scholarship of practice and traditional research approaches. Implications for nursing education are also addressed. J Prof Nurs 17: 46-54, 2001. Copyright © 2001 by W.B. Saunders Company.

Burke, C. and K. Sheldon (2010). "Encouraging workplace innovation using 'World Cafe' model." Nursing management (Harrow, London, England : 1994) 17(7): 14-19.
	To ensure that community health services are as good as they can be, professional leaders in Bassetlaw, Nottinghamshire, decided to engage staff using a method attributed to the World Café movement. The adopted model gives staff an opportunity to influence the development of services, and focuses on six areas: end of life care; health and wellbeing and reducing inequalities; children, young people and families; rehabilitation; acute care closer to home; and long-term conditions. Staff have appreciated being involved and there is now an action plan for each service area to continue its improvement.

Burke, J. (2004). "Infant HIV infection: Acceptability of preventive strategies in central Tanzania." AIDS Education and Prevention 16(5): 415-425.
	Safe, cost-effective interventions are being developed to reduce HIV transmission to children, suitable for lower income countries such as Tanzania. The interventions include Nevirapine treatment, replacement feeding, exclusive breast-feeding and heat-treating breast milk. This article reports on research to explore factors, which may influence the acceptability of these interventions. Data collection methods used were qualitative in-depth interviews with 12 health workers and focus group discussions with five community groups. Findings are presented with reference to the theory of diffusion of innovation, which seeks to explain how new ideas and products are disseminated through a community. Respondents describe the factors that may help and hinder this process. They propose ways to maximize this diffusion, such as integrating HIV and antenatal services, encouraging male participation, community-wide education, offering free HIV testing, and training health workers as change agents.

Burke, L. M. (2000). "Education and training consortia: leading the way for the new British NHS." Journal of Advanced Nursing 31(4): 865-874.
	In November 1997 The New NHS - Modern, Dependable was published, describing the British Labour government's plans to introduce major changes to the NHS (National Health Service). Education and Training Consortia (ETCs) were only briefly referred to and no direct changes were proposed to them. It can be argued that this was because they had not fitted well within the Conservative government's competitive culture of the NHS internal market. Education Consortia members share information, make plans collectively and work collaboratively, activities much more appropriate for the 'New NHS' which is underpinned by the concepts of partnership, openness and local ownership. In this paper it is argued that there are many valuable lessons that the key individuals involved in implementing the policies of the New NHS can learn from Education and Training Consortia. Data have been drawn from a qualitative study in which the aim was to explore the development, implementation and management of consortia and contracting for non-medical education and training (NMET) from a stakeholder's perspective. One of the unexpected themes that emerged from the analysis of the data, was that the development of ETCs could be utilized as a model for many of the innovations in the New NHS, particularly in relation to the formation of primary care groups.

Burkhalter, J. E., et al. (2013). "At the Intersection of HIV/AIDS and Cancer: A Qualitative Needs Assessment of Community-Based HIV/AIDS Service Organizations." Health Education & Behavior 40(4): 493-503.
	Due to advances in treatment, persons living with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) are living longer, but with aging, immune deficits, and lifestyle factors, they are at increased risk for cancer. This challenges community-based AIDS service organizations (ASOs) to address the growing cancer needs of persons living with HIV/AIDS (PLWHA). Community-based participatory research was applied to engage ASOs in exploring their capacities and needs for integrating cancer-focused programming into their services. Focus groups were conducted with a community advisory board (CAB) representing 10 community-based organizations serving PLWHA. Three 90-minute, serial focus groups were conducted with a mean number of seven participants. Topics explored CAB members' organizational capacities and needs in cancer prevention, detection, treatment, and survivorship. Transcript analyses identified six themes: (a) agencies have limited experience with cancer-focused programs, which were not framed as cancer specific; (b) agencies need resources and collaborative partnerships to effectively incorporate cancer services; (c) staff and clients must be educated about the relevance of cancer to HIV/AIDS; (d) agencies want to know about linkages between HIV/AIDS and cancer; (e) cancer care providers should be culturally competent; and (f) agencies see opportunities to improve their services through research participation but are wary. Agency capacities were strong in relationships with clients and cultural competency, a holistic view of PLWHA health, expertise in prevention activities, and eagerness to be on the cutting edge of knowledge. Cancer education and prevention were of greatest interest and considered most feasible, suggesting that future projects develop accordingly. These findings suggest a high level of receptivity to expanding or initiating cancer-focused activities but with a clear need for education and awareness building. Qualitative findings will inform a large quantitative survey to validate identified themes, which will be applied in developing interventions to assist ASOs in adopting or expanding cancer-focused activities.

Burks, K. J. (2001). "Intentional action." Journal of Advanced Nursing 34(5): 668-675.
	Aim. The purpose of this paper is to present a concept analysis of intentional action. Background. Intentional action is a relevant concept for nurses because health behaviour involves action by the client of care. In addition, nurses take action when they assist their clients. Intentional action is a type of action distinguished by the presence of specific developmental skills and by intent or purpose. Design. This concert analysis reflects a comprehensive review of the action literature. Findings. This review revealed two views of intentional action: as social behaviour and as self-regulated behaviour influenced hy external and internal factors. Based on these findings, the antecedents and consequences of this type of action are identified and the process of action is described. Conclusions. The concept model illustrates the relationship of intentional action with external and internal factors and demonstrates its continuous nature. Areas for further inquiry include exploration of the effect of factors such as self-efficacy, motivation, self-esteem, managed care and reduced health care resources on intention and subsequent action; as well as the efficacy of nursing interventions designed to influence health behaviour such as health promotion education and treatment counselling.

Burlew, A. K., et al. (2013). "Does cultural adaptation have a role in substance abuse treatment?" Social Work in Public Health 28(3-4): 440-460.
	The changing ethnic composition of the nation and increasing requirements to use evidence-based treatments (EBTs) challenge mental health professionals to adapt treatments and interventions to be appropriate for their clients. This article applies the available information on cultural adaptation to substance abuse. The authors' review suggests that the most common approaches for adapting substance use interventions include some combination of either community involvement in the adaptation, existing research and literature, and/or consultation from experts to adapt EBTs. The challenges facing the development of culturally adapted interventions include the need for additional research to determine which specific EBTs warrant adaptation, the responsibility of maintaining the balance between fidelity and adaptation, and the challenge of intragroup diversity. © 2013 Taylor and Francis Group, LLC.

Burnette, P. (2011). "Mobile technology and medical libraries: Worlds collide." Reference Librarian 52(1): 98-105.
	Use of mobile technology in medicine has steadily gained momentum over the past 10 years. With the advent of new mobile devices that offer superior functionality and connectivity, medical librarians have an opportunity to expand mobile services and resources that have the potential to enhance user experience, medical education, and clinical practice. This article looks at the genesis of mobile medicine from the early adopters to today's always connected user. © Taylor & Francis Group, LLC.

Burr, S. (2009). "Integrating teaching innovations in medical education." British Journal of Hospital Medicine 70(2): 104-106.
	Teaching is changing, but the goal remains the same. This article provides a balanced foundation in the theory of modern medical education for those involved in teaching at any level.

Burton, A., et al. (2011). "An analysis of the existing resources in relation to education and treatment of diabetes in four European countries: Estonia, Finland, Ireland, and Lithuania." Applied Nursing Research 24(2): 118-123.
	Diabetes has reached pandemic proportions worldwide. To address and assist health care professionals in maintaining and updating their knowledge base on diabetes care, a multilateral project within the framework of the Lifelong Learning Programme and the Erasmus Curriculum Development - sub programme was initiated in 2008. Four European countries are involved in the project - Estonia, Finland, Ireland and Lithuania. Across all four countries the prevalence of diabetes is rising rapidly. The project's (DIPRA - Counselling for Practice - a pilot of improving counselling quality of diabetes) main product will be an on-line study module on patient education and counselling for health care professionals. The management of diabetes demands a broad range of skills which include, communication, leadership, counselling, teaching and research to name but a few. While it is acknowledged that nurses can incorporate these skills into practice and so benefit the care of the patient there is no uniformity across the four countries studied as to what constitutes a specialist diabetes nurse. The study module and all the materials (databank, on-line lectures, and interactive exercises) will be developed in English and translated into partners' national languages (Estonian, Finnish, Lithuanian) to maximize the accessibility of all professionals in partner countries. (C) 2011 Elsevier Inc. All rights reserved.

Busch, A. B., et al. (2015). "Thirty-Day Hospital Readmission for Medicaid Enrollees with Schizophrenia: The Role of Local Health Care Systems." Journal of Mental Health Policy and Economics 18(3): 115-124.
	Background: Examining health care system characteristics possibly associated with 30-day readmission may reveal opportunities to improve healthcare quality as well as reduce costs. Aims of the Study: Examine the relationship between 30-day mental health readmission for persons with schizophrenia and county-level community treatment characteristics. Methods: Observational study of 18 state Medicaid programs (N = 274 counties, representing 103,967 enrollees with schizophrenia-28,083 of whom received >= 1 mental health hospitalization) using Medicaid administrative and United States Area Health Resource File data from 2005. Medicaid is a federal-state program and major health insurance provider for low income and disabled individuals, and the predominant provider of insurance for individuals with schizophrenia. The Area Health Resource File provides county-level estimates of providers. We first fit a regression model examining the relationship between 30-day mental health readmission and enrollee characteristics (e.g., demographics, substance use disorder [SUD], and general medical comorbidity) from which we created a county-level demographic and comorbidity case-mix adjuster. The case-mix adjuster was included in a second regression model examining the relationship between 30-day readmission and county-level factors: (i) quality (antipsychotic/visit continuity, post-hospital follow-up); (ii) mental health hospitalization (length of stay, admission rates); and (iii) treatment capacity (e.g., population-based estimates of outpatient providers/clinics). We calculated predicted probabilities of readmission for significant patient and county-level variables. Results: Higher county rates of mental health visits within 7-days post-hospitalization were associated with lower readmission probabilities (e.g., county rates of 7-day follow up of 55% versus 85%, readmission predicted probability (PP) [95%CI] =16.1% [15.8%-16.4%] versus 13.3% [12.9%-13.6%]). In contrast, higher county rates of mental health hospitalization were associated with higher readmission probabilities (e.g., country admission rates 10% versus 30%, readmission predicted probability = 11.3% [11.0%-11.6%] versus 16.7% [16.4%-17.0%]). Although not our primary focus, enrollee comorbidity was associated with higher predicted probability of 30-day mental health readmission: PP [95%CI] for enrollees with SUD = 23.9% [21.5%-26.3%] versus 14.7% [13.9%-15.4%] for those without; PP [95%CI] for those with = three chronic medical conditions = 25.1% [22.1%-28.2%] versus none = 17.7% [16.3%-19.1]. Discussion: County rates of hospitalization and 7-day follow-up post hospital discharge were associated with readmission, along with patient SUD and general medical comorbidity. This observational design limits causal inference and utilization patterns may have changed since 2005. However, overall funding for U.S. Medicaid programs remained constant since 2005, reducing the likelihood significant changes. Last, our inability to identify community capacity variables associated with readmission may reflect imprecision of some variables as measured in the Area Health Resource File. Implications for Health Care Provision and Use & for Health Policies: Healthcare policy and programming to reduce 30-day mental health readmissions should focus on county-level factors that contribute to hospitalization in general and improving transitions to community care, as well as patient comorbidity. Implications for Further Research: Given the likely importance of local care systems, to reduce readmission future research is needed to refine community-level capacity variables that are associated with reduced readmissions; and to evaluate models of care coordination in this population.

Busch, A. B., et al. (2013). "The Effects of Mental Health Parity on Spending and Utilization for Bipolar, Major Depression, and Adjustment Disorders." American Journal of Psychiatry 170(2): 180-187.
	Objective: The Mental Health Parity and Addiction Equity Act requires insurance parity for mental health/substance use disorder and general medical services. Previous research found that parity did not increase mental health/substance use disorder spending and lowered out-of-pocket spending. Whether parity's effects differ by diagnosis is unknown. The authors examined this question in the context of parity implementation in the Federal Employees Health Benefits (FEHB) Program. Method: The authors compared mental health/substance use disorder treatment use and spending before and after parity (2000 and 2002, respectively) for two groups: FEHB enrollees diagnosed in 1999 with bipolar disorder, major depression, or adjustment disorder (N=19,094) and privately insured enrollees unaffected by the policy in a comparison national sample (N=10,521). Separate models were fitted for each diagnostic group. A difference-in-difference design was used to control for secular time trends and to better reflect the specific impact of parity on spending and utilization. Results: Total spending was unchanged among enrollees with bipolar disorder and major depression but decreased for those with adjustment disorder (-$62, 99.2% CI=-$133, -$11). Out-of-pocket spending decreased for all three groups (bipolar disorder: -$148, 99.2% CI=-$217, -$85; major depression: -$100, 99.2% CI=-$123, -$77; adjustment disorder: -$68, 99.2% CI=-$84, -$54). Total annual utilization (e.g., medication management visits, psychotropic prescriptions, and mental health/substance use disorder hospitalization bed days) remained unchanged across all diagnoses. Annual psychotherapy visits decreased significantly only for individuals with adjustment disorders (-12%, 99.2% CI=-19%, -4%). Conclusions: Parity implemented under managed care improved financial protection and differentially affected spending and psychotherapy utilization across groups. There was some evidence that resources were preferentially preserved for diagnoses that are typically more severe or chronic and reduced for diagnoses expected to be less so. (Am J Psychiatry 2013; 170:180-187)

Buse, K. and S. Hawkes (2015). "Health in the sustainable development goals: ready for a paradigm shift?" Globalization and Health 11: 8.
	The Millennium Development Goals (MDGs) galvanized attention, resources and accountability on a small number of health concerns of low-and middle-income countries with unprecedented results. The international community is presently developing a set of Sustainable Development Goals as the successor framework to the MDGs. This review examines the evidence base for the current health-related proposals in relation to disease burden and the technical and political feasibility of interventions to achieve the targets. In contrast to the MDGs, the proposed health agenda aspires to be universally applicable to all countries and is appropriately broad in encompassing both communicable and non-communicable diseases as well as emerging burdens from, among other things, road traffic accidents and pollution. We argue that success in realizing the agenda requires a paradigm shift in the way we address global health to surmount five challenges: 1) ensuring leadership for intersectoral coherence and coordination on the structural (including social, economic, political and legal) drivers of health; 2) shifting the focus from treatment to prevention through locally-led, politically-smart approaches to a far broader agenda; 3) identifying effective means to tackle the commercial determinants of ill-health; 4) further integrating rights-based approaches; and 5) enhancing civic engagement and ensuring accountability. We are concerned that neither the international community nor the global health community truly appreciates the extent of the shift required to implement this health agenda which is a critical determinant of sustainable development.

Bushy, A. (2008). "Conducting culturally competent rural nursing research." Annual review of nursing research 26: 221-236.
	The face of America is changing. In efforts to provide services to and meet the needs of consumers of different ethnicities and cultures, cultural competence has become a driving force not only in health care but also in business, education, and research. Lack of cultural competence among caregivers has been linked to health disparities, decreased client satisfaction, and decreased client adherence to recommended medical regimens. The depth of rural research in general, and by nurse researchers focusing on rural cultural groups in particular, is limited. This chapter focuses on conducting rural nursing research with rural cultural groups, highlights methodological issues that are commonly encountered with rural populations, and proposes strategies to address them. Addressing methodological challenges will contribute to the limited knowledge base related to culture and ethnicity in rural nursing research.

Busse, H., et al. (2013). "Creating Change Through Collaboration: A Twinning Partnership to Strengthen Emergency Medicine at Addis Ababa University/Tikur Anbessa Specialized Hospital-A Model for International Medical Education Partnerships." Academic Emergency Medicine 20(12): 1310-1318.
	BackgroundMorbidity and mortality due to the lack of an organized emergency medical care system are currently high in Ethiopia. Doctors, nurses, and other medical staff often have limited or no formal training on how to handle emergencies. Because of insufficient human and resource capacity needed to assess and treat acutely ill patients, many who are injured may die unnecessarily, at the site of injury, during transport, or at the hospital. ObjectivesThis article describes the development of a twinning partnership between Addis Ababa University (AAU), the University of Wisconsin-Madison (UW), and the nonprofit organization People to People (P2P), to strengthen emergency care at Tikur Anbessa Specialized Hospital (TASH) and increase the number of trained emergency medical professionals. MethodsThe partnership applied the six-phase twinning partnership model, with the overall goal of enhancing and strengthening emergency and trauma care by building institutional and human resource capacity. This was achieved by 1) developing local leaders in emergency medicine (EM), 2) creating training modules adapted to the Ethiopian context, 3) launching an emergency training center, and 4) supporting academic program development. The authors evaluated the program's effectiveness based on our achievements toward these goals. ResultsResults include: 1) eight Ethiopian faculty completed a condensed EM fellowship in the United States. Now six Ethiopian physicians serve as EM faculty and two as pediatric EM faculty. 2) Nine emergency training modules were adapted to the Ethiopian context. 3) An emergency training center was opened in 2010 and to date has trained over 4,000 Ethiopian medical professionals. 4) Two academic training programs (EM residency and masters nursing programs) were initiated. ConclusionsWith many complex factors affecting the burden of emergency care, innovative and interdisciplinary collaborations are needed in Ethiopia to train medical workers, build local leadership capacity, strengthen infrastructure, and inform policies. The short-term achievements of this twinning model could suggest that long-term, institution-to-institution collaborations that are driven by local stakeholders are an effective strategy to create equitable relationships and build sustainable health systems and may serve as a model for other global health partnerships. (C) 2013 by the Society for Academic Emergency Medicine

Bussing, R., et al. (2006). "What "Dr. Mom" ordered: A community-based exploratory study of parental self-care responses to children's ADHD symptoms." Social Science & Medicine 63(4): 871-882.
	Little is known about family initiated self-care interventions in response to symptoms of attention deficit/hyperactivity disorder (ADHD), and how self-care may co-exist with professional treatments. This paper explores parental self-care strategies for children with hyperactivity or attention problems, and examines factors and domains that influence their use from the mixed method perspective. As part of a longitudinal cohort study of ADHD detection and service use, caregivers of a representative US community sample of 266 children at high risk for ADHD completed a questionnaire that assessed five self-care strategies (behavior modification, coping, diet, over-the-counter medication use and religious practices), and made open-ended inquiry about discipline changes in response to behavioral concerns. Questionnaire responses were analyzed using logistic regression approaches. Open-ended answers were open coded; secondary analysis followed Spradley's model of domain analysis. Quantitative findings showed that behavior modification was the most commonly tried self-care strategy, followed by coping, diet, and religious practices. Over-the-counter trial was least common. The parents of professionally treated children were more likely to have employed behavior modification, coping strategies and over-the-counter medications than the parents of untreated children. Two-thirds of parents had changed their disciplinary action within three domains that were identified through qualitative analysis, including changes related to (a) the prevention of disciplinary problems (e.g., sustain eye contact, activation, consistency, clear instructions), (b) the solution of disciplinary problems (e.g., time-outs; privilege removal), and (c) parental coping associated with disciplinary problems (e.g., control own emotions, become less judgmental and more tolerant, and develop more appropriate expectations). These findings suggest that self-care strategies are commonly employed and appear to co-exist with professional treatment. Therefore, healthcare providers should actively explore parents' use of such strategies as some of them may interfere with prescribed treatments (e.g., over-the-counter) or absorb parental resources without likely benefit (e.g., diet). (c) 2006 Elsevier Ltd. All rights reserved.

Butler, M. J., et al. (2013). "Are low income patients receiving the benefits of electronic health records? A statewide survey." Health Informatics Journal 19(2): 91-100.
	There are concerns that physicians serving low-income, Medicaid patients, in the United States are less likely to adopt electronic health records and, if so, that Medicaid patients will be denied the benefits from electronic health record use. This study seeks to determine whether physicians treating Medicaid patients were less likely to have adopted electronic health records. Physician surveys completed during physicians' license renewal process in Arizona were merged with the physician licensing data and Medicaid administrative claims data. Survey responses were received from 50.7 percent (6,780 out of 13,380) of all physicians practicing in Arizona. Physician survey responses were used to identify whether the physician used electronic health records and the degree to which the physician exchanged electronic health records with other health-care providers. Medicaid claims data were used to identify which physicians provided health care to Medicaid beneficiaries. The primary outcome of interest was whether Medicaid providers were more or less likely to have adopted electronic health records. Logistic regression analysis was used to estimate average marginal effects. In multivariate analysis, physicians with 20 or more Medicaid patients during the survey cycle were 4.1 percent more likely to use an electronic health record and 5.2 percent more likely to be able to transmit electronic health records to at least one health-care provider outside of their practice. These effects increase in magnitude when the analysis is restricted to solo practice physicians This is the first study to find a pro-Medicaid gap in electronic health record adoption suggesting that the low income patients served by Arizona's Health Care Cost Containment System are not at a disadvantage with regard to electronic health record access and that Arizona's model of promoting electronic health record adoption merits further study. © 2013 The Author(s).

Butterfield, P. and J. Postma (2009). "The TERRA framework: Conceptualizing rural environmental health inequities through an environmental justice lens." Advances in Nursing Science 32(2): 107-117.
	The deleterious consequences of environmentally associated diseases are expressed differentially by income, race, and geography. Scientists are just beginning to understand the consequences of environmental exposures under conditions of poverty, marginalization, and geographic isolation. In this context, we developed the TERRA (translational environmental research in rural areas) framework to explicate environmental health risks experienced by the rural poor. Central to the TERRA framework is the premise that risks exist within physical-spatial, economic-resources, and cultural-ideologic contexts. In the face of scientific and political uncertainty, a precautionary risk reduction approach has the greatest potential to protect health. Conceptual and technical advances will both be needed to achieve environmental justice. © 2009 Wolters Kluwer Health | Lippincott Williams and Wilkins.

Byatt, N., et al. (2012). "Patient, provider, and system-level barriers and facilitators to addressing perinatal depression." Journal of Reproductive and Infant Psychology 30(5): 436-449.
	Objective: To explore perinatal health care professionals' perspectives on barriers and facilitators to addressing perinatal depression. Background: Perinatal depression is common and associated with deleterious effects on mother, foetus, child and family. Although the regular contact between mothers and perinatal health care professionals may make the obstetric setting ideal for addressing depression, barriers persist, and depression remains under-diagnosed and under-treated. Methods: Four 90-minute focus groups were conducted with perinatal health care professionals, including obstetric resident and attending physicians, licensed independent practitioners, nurses, patient care assistants, social workers and administrative support staff. Focus groups were transcribed, and resulting data were analysed using a grounded theory approach. Results: Participants identified patient-, provider-and system-level barriers and facilitators to addressing perinatal depression. Provider-level barriers included lack of resources, skills and confidence needed to diagnose, refer and treat perinatal depression. Limited access to mental health care and resources were identified as system-level barriers. Facilitators identified included targeted training for perinatal health care professionals', structured screening and referral processes, and enhanced support and guidance from mental health providers. Conclusion: A complex set of interactions between women and perinatal health care professionals contributes to perinatal depression being untreated. Service gaps could be closed by addressing identified barriers through integrated obstetric and depression care and enhanced collaborations. Future intervention testing could include targeted training, improved access, and mental health provider support to empower perinatal health care professionals' to address perinatal depression, and thereby improve delivery of depression treatment in obstetric settings.

Bydder, S., et al. (2010). "Lung cancer multidisciplinary team meetings: A survey of participants at a national conference." Journal of Medical Imaging and Radiation Oncology 54(2): 146-151.
	P>Multidisciplinary meetings (MDMs) are a useful aid for the development of comprehensive treatment plans for cancer patients. However, little is known about the requirements for effective MDM function. Attendees at a national lung cancer conference who participated at least weekly in lung cancer MDMs were surveyed. The survey addressed the attendees' perceptions regarding the aims of MDMs, and for their own institutional MDMs, the importance and need for improvement for each of: (i) the attendance of nine discipline groups; and (ii) 15 aspects related to MDM function derived from the literature. The survey also asked participants if MDMs met their needs. There was a general agreement on the aims of the meetings. There was also an agreement on the importance of various groups' attendance and each of the examined aspects of MDMs. However, many respondents reported their meetings required moderate or substantial improvements in one or more areas. More than 20% of the respondents indicated improvement was required for the attendance of three discipline groups (palliative care physicians, pathologists and cardiothoracic surgeons) and 10 of the 15 examined aspects (more than half in the case of computerised databases). Only 9% of the respondents reported that none of the features surveyed needed either moderate or substantial improvement. MDMs met the needs of 79% of the respondents. We found general agreement on the aims of the meetings, the importance of various groups' attendance at MDMs and each of the examined aspects of MDMs. However, moderate or substantial improvements were thought to be required by many respondents. The performance of individual institutions' MDMs and the resources they have available to achieve their aims should be assessed and periodically reviewed. The survey applied here may provide a framework for MDM members to do this.

Byerley, J. S. and K. Gable (2014). "The pediatrics primary care residency program at the University of North Carolina." North Carolina Medical Journal 75(1): 28-32.
	The Pediatrics Primary Care Residency Program at the University of North Carolina School of Medicine will graduate its first class in 2014. Funded by the Health Resources and Services Administration through the Patient Protection and Affordable Care Act, this innovative program has a unique curriculum that offers several benefits, but sustainability of the program remains a challenge.

Byford, S., et al. (2015). "Cost-effectiveness analysis of a communication-focused therapy for pre-school children with autism: results from a randomised controlled trial." Bmc Psychiatry 15: 13.
	Background: Autism is associated with impairments that have life-time consequences for diagnosed individuals and a substantial impact on families. There is growing interest in early interventions for children with autism, yet despite the substantial economic burden, there is little evidence of the cost-effectiveness of such interventions with which to support resource allocation decisions. This study reports an economic evaluation of a parent-mediated, communication-focused therapy carried out within the Pre-School Autism Communication Trial (PACT). Methods: 152 pre-school children with autism were randomly assigned to treatment as usual (TAU) or PACT + TAU. Primary outcome was severity of autism symptoms at 13-month follow-up. Economic data included health, education and social services, childcare, parental productivity losses and informal care. Results: Clinically meaningful symptom improvement was evident for 53 % of PACT + TAU versus 41 % of TAU (odds ratio 1.91, p = 0.074). Service costs were significantly higher for PACT + TAU (mean difference 4,489 pound, p < 0.001), but the difference in societal costs was smaller and non-significant (mean difference 1,385 pound, p = 0.788) due to lower informal care rates for PACT + TAU. Conclusions: Improvements in outcome generated by PACT come at a cost. Although this cost is lower when burden on parents is included, the cost and effectiveness results presented do not support the cost-effectiveness of PACT + TAU compared to TAU alone.

Bynum, A. B., et al. (2010). "Satisfaction with a Distance Continuing Education Program for Health Professionals." Telemedicine Journal and e-Health 16(7): 776-786.
	This study assessed differences in program satisfaction among health professionals participating in a distance continuing education program by gender, ethnicity, discipline, and community size. A one-group posttest design was used with a sample of 45,996 participants in the University of Arkansas for Medical Sciences, Rural Hospital, Distance Continuing Medical Education Program during 1995-2007. This program provided 2,219 continuing education programs for physicians (n = 7,047), nurses (n = 21,264), allied health (n = 3,230) and dental (n = 305) professionals, pharmacists (n = 4,088), administrators (n = 1,211), and marketing/finance/human resources professionals (n = 343). These programs were provided in Arkansas hospitals, clinics, and area health education centers. Interactive video technology and the Internet were used to deliver these programs. The program satisfaction instrument demonstrated adequate internal consistency reliability (Cronbach's alpha = 0.91) and construct validity. Participants had high levels of satisfaction regarding knowledge and skills, use of information to enhance patient care, program quality, and convenience of the technology (mean total satisfaction score = 4.44, range: 1-5). Results from the t-test for independent samples and one-way analysis of variance indicated that men (p = 0.01), African-Americans and Hispanics (p < 0.01), dental professionals (p < 0.01), and participants in larger urban communities (population of 75,001-185,000) (p < 0.01) had significantly greater satisfaction. Nurses and physicians had significantly greater satisfaction regarding the use of information in practice to enhance patient care (p < 0.01). Results suggest that socioeconomic and demographic factors can affect satisfaction with distance continuing education programs.

Byrne, E., et al. (2016). "The use of technology enhanced learning in health research capacity development: lessons from a cross country research partnership." Globalization and Health 12: 14.
	Background: With the recognition of the need for research capacity strengthening for advancing health and development, this research capacity article explores the use of technology enhanced learning in the delivery of a collaborative postgraduate blended Master's degree in Malawi. Two research questions are addressed: (i) Can technology enhanced learning be used to develop health research capacity?, and: (ii) How can learning content be designed that is transferrable across different contexts? Methods: An explanatory sequential mixed methods design was adopted for the evaluation of technology enhanced learning in the Masters programme. A number of online surveys were administered, student participation in online activities monitored and an independent evaluation of the programme conducted. Results: Remote collaboration and engagement are paramount in the design of a blended learning programme and support was needed for selecting the most appropriate technical tools. Internet access proved problematic despite developing the content around low bandwidth availability and training was required for students and teachers/trainers on the tools used. Varying degrees of engagement with the tools used was recorded, and the support of a learning technologist was needed to navigate through challenges faced. Conclusion: Capacity can be built in health research through blended learning programmes. In relation to transferability, the support required institutionally for technology enhanced learning needs to be conceptualised differently from support for face-to-face teaching. Additionally, differences in pedagogical approaches and styles between institutions, as well as existing social norms and values around communication, need to be embedded in the content development if the material is to be used beyond the pilot resource-intensive phase of a project.

Byrnes, J. A., et al. (2004). "Information-seeking behavior changes in community-based teaching practices." Journal of the Medical Library Association 92(3): 334-340.
	A National Library of Medicine information access grant allowed for a collaborative project to provide computer resources in fourteen clinical practice sites that enabled health care professionals to access medical information via PubMed and the Internet. Health care professionals were taught how to access quality, cost-effective information that was user friendly and would result in improved patient care. Selected sites were located in medically underserved areas and received a computer, a printer, and, during year one, a fax machine. Participants were provided dial-up Internet service or were connected to the affiliated hospital's network. Clinicians were trained in how to search PubMed as a tool for practicing evidence-based medicine and to support clinical decision making. Health care providers were also taught how to find patient-education materials and continuing education programs and how to network with other professionals. Prior to the training, participants completed a questionnaire to assess their computer skills and familiarity with searching the Internet, MEDLINE, and other health-related databases. Responses indicated favorable changes in information-seeking behavior, including an increased frequency in conducting MEDLINE searches and Internet searches for work-related information.

Byyny, R. L. (2012). "Mentoring and coaching in medicine." Pharos of Alpha Omega Alpha Honor Medical Society 75(1): 1-3.
	
Caballero, J. B., et al. (2012). "Hepatitis B Prevention and Care for Asian Americans, Native Hawaiians and Pacific Islanders at Community Health Centers." Journal of Health Care for the Poor and Underserved 23(4): 1547-1557.
	Introduction. A needs assessment was conducted of hepatitis B education, screening, vaccination, and care within community health centers (CHCs) serving Asian Americans, Native Hawaiians, and Pacific Islanders. Methods. Written surveys were administered to health education directors from 13 CHCs and 75 medical providers from 14 CHCs in the U.S. and affiliated Pacific Islands. Results. Although hepatitis B is within the mission of CHCs and clients are screened regardless of insurance status, little financial or staffing resources are dedicated to hepatitis B services. Lack of funding is considered the greatest barrier. Better coordination between HBV prevention and primary and specialty medical services is needed. Discussion. HBV cross-training for providers and allied staff, particularly around identification and screening of high risk groups and case management, would greatly enhance services along with additional funding. Findings support national hepatitis B strategy recommendations made by the Institute of Medicine and Office of Minority Health.

Cadarette, S. M., et al. (2007). "Access to osteoporosis treatment is critically linked to access to dual-energy x-ray absorptiometry testing." Medical Care 45(9): 896-901.
	Objective: To determine if inequities in access to osteoporosis investigation [dual-energy x-ray absorptiometry (DXA) testing] and treatment (bisphosphonate, calcitonin, and/or raloxifene) exist among older women in a region with universal health care coverage. Methods: Community-dwelling women aged 65-89 years residing within 2 regions of Ontario, Canada were randomly sampled. Data were collected by standardized telephone interview. Potential correlates of DXA testing (verified by physician records), and current treatment were grouped by type as: "predisposing characteristics," "enabling resources," or "need factors" based on hypothesized relationships formulated before data collection. Variables associated with each outcome independent of "need factors" identified inequities in the system. Results: Of the 871 participants (72% response rate), 55% had been tested by DXA and 20% were receiving treatment. Using multiple variable logistic regression to adjust for need factors, significant inequities in access to DXA testing existed by age, health beliefs, education, income, use of preventive health services, region, and provider sex. DXA testing mediated access to treatment; 34% of those having had a DXA were treated compared with 2% of those who did not. Among women with osteoporosis, correctly reporting that their DXA test indicated osteoporosis and higher perceived benefits of taking pharmacological agents for osteoporosis were associated with treatment. Conclusions: Significant inequities in access to fracture prevention exist in a region with universal health care coverage. Improved access to DXA and better communication to patients of both their DXA results and the benefits of treatment has the potential to reduce the burden of osteoporosis.

Cady, B. (2005). "Re: "acceptance of sentinel lymph node biopsy of the breast by all general surgeons in kentucky," by Conn et al." Breast Journal 11(4): 229-230.
	
Cai, H., et al. (2016). "Application of Telemedicine in Gansu Province of China." PLoS ONE [Electronic Resource] 11(6): 11.
	Telemedicine has become an increasingly popular option for long-distance health care and continuing education. As information and communication technology is underdeveloped in China, telemedicine develops slowly. At present, telemedicine consultation centers are situated mainly in developed cities, such as Beijing, Shanghai, and Guangzhou. In many less developed regions, such as northwest China, the conditions or related facilities are not available for the application of a better medical service. Accordingly, the aim of this paper was to introduce the construction and application of a telemedicine consultation center in Gansu Province in the northwest of China. In addition, the function of Gansu Provincial Telemedicine Consultation Center on emergency public events was introduced. As a whole, there was a great demand for telemedicine service in the local medical institutions. In the telemedicine consultation center, the telemedicine equipments and regulations were needed to be improved. The function of telemedicine service was not fully used, there was a large space to be applied and the publicity of telemedicine service was important. What is important was that telemedicine played a significance role in promoting the medical policy reform, improving the medical environment and launching the remote rescue in the emergency public events. This paper emphasizes the health care challenges of poor regions, and indicates how to share the high-quality medical service of provincial hospitals effectively and how to help residents in resource-poor environments.

Cain, T. J., et al. (2005). "Managing knowledge and technology to foster innovation at The Ohio State University Medical Center." Academic Medicine 80(11): 1026-1031.
	Biomedical knowledge is expanding at an unprecedented rate-one that is unlikely to slow anytime in the future. While the volume and scope of this new knowledge poses significant organizational challenges, it creates tremendous opportunities to release and direct its power to the service of significant goals. The authors explain how the Center for Knowledge Management at The Ohio State University Medical Center, created during the academic year 2003-04, is doing just that by integrating numerous resource-intensive, technology-based initiatives-including personnel, services and infrastructure, digital repositories, data sets, mobile computing devices, high-tech patient simulators, computerized testing, and interactive multimedia-in a way that enables the center to provide information tailored to the needs of students, faculty and staff on the medical center campus and its surrounding health sciences colleges. The authors discuss how discovering, applying, and sharing new knowledge, information assets, and technologies in this way is a collaborative process. This process creates open-ended opportunities for innovation and a roadmap for working toward seamless integration, synergy, and substantial enhancement of the academic medical center's research, educational, and clinical mission areas.

Cairns, C. B., et al. (2016). "A Transformative Approach to Academic Medicine: The Partnership Between the University of Arizona and Banner Health." Academic Medicine 30: 30.
	The University of Arizona Health Network (UAHN) was a modestly successful health care delivery organization with a vibrant academic portfolio and stable finances. By 2013, however, market forces, health care financing changes, and the burden of technology and informatics upgrades led to a compromised financial position at UAHN, a situation experienced by many academic medical centers. Concurrently, Banner Health had been interested in forming an academic partnership to enhance innovation, including the incorporation of new approaches into health care delivery, and to recruit high-quality providers to the organization. In 2015, the University of Arizona (UA) and Banner Health entered into a unique partnership known as Banner University Medicine. The objective was to create a statewide system that provides reliable, compassionate, high-quality health care across all of its providers and facilities and to make a 30-year commitment to UA's College of Medicine in Tucson (COM-T) and the College of Medicine in Phoenix (COM-P) to support the State of Arizona's position as a first-tier research and training destination with world-class physicians. The goal of the Banner University Medicine partnership is to create a nationally leading organization that transforms health care by delivering better care, enhanced service, and lower costs through new approaches focused on wellness. Key elements of this partnership are highlighted in this Commentary, including the unique governance structure of the Academic Management Council, the creation of the Academic Enhancement Fund to support COM-T and COM-P, and novel approaches to medical education, research, innovation, and care.

Caldeira, K. M., et al. (2009). "College students rarely seek help despite serious substance use problems." Journal of Substance Abuse Treatment 37(4): 368-378.
	The prevalence of substance use disorders (SUD) and aspects of the help-seeking process among a high-risk sample of 946 students at one large public university were assessed in personal interviews during the first 3 years of college. After statistically adjusting for purposive sampling, an estimated 46.8%(wt) of all third-year students met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for SUD involving alcohol and/or marijuana at least once. Of 548 SUD cases, 3.6% perceived a need for help with substance use problems; 16.4% were encouraged by someone else to seek help. Help-seeking was rare among SUD cases (8.8%) but significantly elevated among individuals who perceived a need (90.0%) or experienced social pressures from parents (32.5%), friends (34.2%), or another person (58.3%). Resources accessed for help included educational programs (37.8%), health professionals (27.0%), and 12-step programs (18.9%). College students have high rates of substance use problems but rarely recognize a need for treatment or seek help. Results highlight the opportunity for early intervention with college students with SUD. (C) 2009 Elsevier Inc. All rights reserved.

Calderon, T. A., et al. (2015). "Formative evaluation of a proposed mHealth program for childhood illness management in a resource-limited setting in Peru." Revista Panamericana De Salud Publica-Pan American Journal of Public Health 38(2): 144-151.
	Objective. To conduct a formative evaluation of a proposed mobile health (mHealth) program designed to educate caregivers about management of common childhood illnesses. Methods. A cluster-randomized sample (n = 220) of mothers in Cono Norte, Arequipa, Peru with at least one child under five completed an iPad-based survey. This descriptive study examined trends in mobile phone ownership and feasibility of and interest in mHealth across sociodemographic categories. Fisher's exact tests were used to evaluate associations. Univariate logistic regression models were fitted to calculate odds ratios and 95% confidence intervals. Results. Of 220 participants, 82.3% and 95.0% reported mobile phone ownership and access, respectively. Ownership was significantly associated with educational level (P = 0.031); however, even among mothers with the lowest education, ownership approached 80%. Educational level and age, respectively, were associated with the ability to open (P < 0.001; P < 0.001), read (P < 0.001; P < 0.001), write (P < 0.001; P < 0.001), and send (P = 0.006; P = 0.047) text messages. Over 85% of mothers were interested in using their mobile phones to receive health advice for their child and to seek help during illness. Regression analyses revealed that ability to use a mobile phone was positively associated with the mother's intention to participate in the mHealth program. Conclusions. The study findings confirm widespread access to mobile phones and sufficient ability to utilize text messaging within this population of caregivers. In addition to access and feasibility, high levels of interest in using mobile phones for health-related purposes suggest the potential value associated with an mHealth program designed to improve childhood illness management in this community.

Caldwell, J. T., et al. (2016). "Intersection of Living in a Rural Versus Urban Area and Race/Ethnicity in Explaining Access to Health Care in the United States." American Journal of Public Health 106(8): 1463-1469.
	Objectives. To examine whether living in a rural versus urban area differentially exposes populations to social conditions associated with disparities in access to health care. Methods. We linked Medical Expenditure Panel Survey (2005-2010) data to geographic data from the American Community Survey (2005-2009) and Area Health Resource File (2010). We categorized census tracts as rural and urban by using the Rural-Urban Commuting Area Codes. Respondent sample sizes ranged from 49 839 to 105 306. Outcomes were access to a usual source of health care, cholesterol screening, cervical screening, dental visit within recommended intervals, and health care needs met. Results. African Americans in rural areas had lower odds of cholesterol screening (odds ratio[OR] = 0.37; 95% confidence interval[CI] = 0.25,0.57) andcervical screening(OR = 0.48; 95% CI = 0.29, 0.80) than African Americans in urban areas. Whites had fewer screenings and dental visits in rural versus urban areas. There were mixed results for which racial/ethnic group had better access. Conclusions. Rural status confers additional disadvantage for most of the health care use measures, independently of poverty and health care supply.

Calice-Silva, V., et al. (2015). "Associations Between Global Population Health Indicators and Dialysis Variables in the Monitoring Dialysis Outcomes (MONDO) Consortium." Blood Purification 39(1-3): 125-136.
	Background: The number of patients receiving renal replacement therapy (RRT) increases annually and worldwide. Differences in the RRT incidence, prevalence, and modality vary between regions and countries for reasons yet to be clarified. Aims: Gain a better understanding of the association between hemodialysis (HD)-related variables and general population global health indicators. Methods: The present study included prevalent HD patients from 27 countries/regions from the monitoring dialysis outcomes (MONDO) database from 2006-2011. Global population health indicators were obtained from the 2014 World Health Organization report and the Human Development Index from the Human Development Report Office 2014. The Spearman rank test was used to assess the correlations between population social economic indicators and HD variables. Results: A total of 84,796 prevalent HD patients were included. Their mean age was 63 (country mean 52-71), and 60% were males (country mean 52-85%). Significant correlations were found between HD demographic clusters and population education, wealth, mortality, and health indicators. The cluster of nutrition and inflammation variables were also highly correlated with population mortality, wealth, and health indicators. Finally, cardiovascular, fluid management, and dialysis adequacy clusters were associated with education, wealth, and health care resource indicators. Conclusion: We identified socioeconomic indicators that were correlated with dialysis variables. This hypothesis-generating study may be helpful in the analysis of how global health indicators may interfere with access to HD, treatment provision, dialytic treatment characteristics, and outcomes. (C) 2015 S. Karger AG, Basel

Camosy, P. (1996). "Patient support networks: Something for everyone." Journal of Family Practice 42(3): 278-286.
	With the emphasis of American health care shifting toward patient rights and education, the resources available through patient support networks are a valuable supplement to Physician services. Support networks are groups organized around specific conditions or disorders, their diagnosis, treatment, and prevention. As with other forms of patient education, support networks enable patients to become more informed about their disease and to play a more active role in their health care. Following a summary of patient-physician-support network relationships and the benefits thereof a list of patient support resources is provided.

Campbell, C., et al. (2016). "Use of thermo-coagulation as an alternative treatment modality in a 'screen-and-treat' programme of cervical screening in rural Malawi." International Journal of Cancer 139(4): 908-915.
	The incidence of cervical cancer in Malawi is the highest in the world and projected to increase in the absence of interventions. Although government policy supports screening using visual inspection with acetic acid (VIA), screening provision is limited due to lack of infrastructure, trained personnel, and the cost and availability of gas for cryotherapy. Recently, thermocoagulation has been acknowledged as a safe and acceptable procedure suitable for low-resource settings. We introduced thermo-coagulation for treatment of VIA-positive lesions as an alternative to cryotherapy within a cervical screening service based on VIA, coupled with appropriate, sustainable pathways of care for women with high-grade lesions and cancers. Detailed planning was undertaken for VIA clinics, and approvals were obtained from the Ministry of Health, Regional and Village Chiefs. Educational resources were developed. Thermo-coagulators were introduced into hospital and health centre settings, with theoretical and practical training in safe use and maintenance of equipment. A total of 7,088 previously unscreened women attended VIA clinics between October 2013 and March 2015. Screening clinics were held daily in the hospital and weekly in the health centres. Overall, VIA positivity was 6.1%. Almost 90% received same day treatment in the hospital setting, and 3- to 6-month cure rates of more than 90% are observed. Thermo-coagulation proved feasible and acceptable in this setting. Effective implementation requires comprehensive training and provider support, ongoing competency assessment, quality assurance and improvement audit. Thermo-coagulation offers an effective alternative to cryotherapy and encouraged VIA screening of many more women.

Campbell, C. M. and J. Parboosingh (2013). "The Royal College Experience and Plans for the Maintenance of Certification Program." Journal of Continuing Education in the Health Professions 33: S36-S47.
	The Royal College of Physicians and Surgeons of Canada, in 2001, implemented a mandatory maintenance of certification (MOC) program that is required for fellows to maintain membership and fellowship. Participation in the MOC program is one of the recognized pathways approved by provincial medical regulatory authorities in Canada by which specialists can demonstrate their commitment to continued competent performance in practice. This article traces the historical beginnings of the MOC program, highlighting the educational foundation and scientific evidence that influenced its philosophy, goals, and strategic priorities. The MOC program has evolved into a complex system of continuing professional development to facilitate and enable a cultural shift'' in how we conceptualize and support the continuing professional development (CPD) of specialists. The MOC program is an educational strategy that supports a learning culture where specialists are able to design, implement and document their accomplishments from multiple learning activities to build evidence-informed practices. In the future, the MOC Program must evolve from assisting fellows to use effective educational resources for credit to enable fellows, leveraging a competency-based CPD model, to demonstrate their capacity to continuously improve practice. This will require innovative methods to capture learning and practice improvements in real time, integrate learning during the delivery of health care, expand automation of reporting strategies, and facilitate new sociocultural methods of emergent learning and practice change. Collectively, these directions will require a research agenda that will generate evidence for how transformative cultural change in continuing professional education of the profession can be realized.

Campbell, N. R. C. (2008). "Hypertension prevention and control in Canada." Journal of the American Society of Hypertension 2(2): 97-105.
	Canada has a similar prevalence of hypertension to the U S. which a lower than the prevalence in many European countries In contrast, Canada had similar treatment and control rates of hypertension to Europe, Which are Substantially lower than those or to U S To address INS disparity. a national strategic Man was developed. While the strategy never received government resources for implementation. the Canadian hypertension community has successfully initiated certain aspects of the strategy To date, programs include a health professional education program, a national surveillance program, a public awareness program, and a program to reduce dietary sodium. The initiatives rely heavily Oil volunteers and oil collaboration between many organizations and various government departments. Initially largely supported by corporate donations, the programs have received Increased government resources over the last 2 years. The development of a funded leadership position beginning in 2006 (Canadian Institutes or Health Research Canada Chair in Hypertension Prevention and Control) has accelerated the initiatives. In the first 4 years of the health professional education program, there were large increases in the diagnosis and treatment of hypertension with corresponding reductions m cardiovascular disease The Canadian programs could be adopted by countries with an organized and committed hypertension community. (C) 2008 American Society of Hypertension All rights reserved

Cancedda, C., et al. (2014). "Enhancing Formal Educational and In-Service Training Programs in Rural Rwanda: A Partnership Among the Public Sector, a Nongovernmental Organization, and Academia." Academic Medicine 89(8): 1117-1124.
	Global disparities in the distribution, specialization, diversity, and competency of the health workforce are striking. Countries with fewer health professionals have poorer health outcomes compared with countries that have more. Despite major gains in health indicators, Rwanda still suffers from a severe shortage of health professionals. This article describes a partnership launched in 2005 by Rwanda's Ministry of Health with the U.S. nongovernmental organization Partners In Health and with Harvard Medical School and Brigham and Women's Hospital. The partnership has expanded to include the Faculty of Medicine and the School of Public Health at the National University of Rwanda and other Harvard-affiliated academic medical centers. The partnership prioritizes local ownership and-with the ultimate goals of strengthening health service delivery and achieving health equity for poor and underserved populations-it has helped establish new or strengthen existing formal educational programs (conferring advanced degrees) and in-service training programs (fostering continuing professional development) targeting the local health workforce. Harvard Medical School and Brigham and Women's Hospital have also benefited from the partnership, expanding the opportunities for training and research in global health available to their faculty and trainees. The partnership has enabled Rwandan health professionals at partnership-supported district hospitals to acquire new competencies and deliver better health services to rural and underserved populations by leveraging resources, expertise, and growing interest in global health within the participating U.S. academic institutions. Best practices implemented during the partnership's first nine years can inform similar formal educational and in-service training programs in other low-income countries.

Candler, C. S. and M. D. Andrews (1999). "Avoiding the great train wreck: Standardizing the architecture for online curricula." Academic Medicine 74(10): 1091-1095.
	The advent of the World Wide Web-and related technologies has encouraged medical schools to generate a wealth of online curricular materials. Unfortunately, the diversity and abundance of user-friendly authoring tools have enabled individual instructors within and among medical schools to proliferate educational resources with often widely dissimilar architectures. Because there are no universal standards for educational technology, the resulting information islands cannot be easily managed, reused, or shared with other educators and institutions. Thoughtful planning and reuse of online educational materials could allow instructors re, present subject matter more consistently across the curriculum, discover new teaching resources, easily create new materials, reduce unnecessary duplication, and better integrate the basic and clinical sciences. To make this possible, standardized, Object-oriented architecture is needed. While several excellent HTML authoring tools and integrated courseware packages are available, differences in their technologies and methods impede inter-operability between the various products and the materials they create. Through the National Learning Infrastructure Initiative, the Instructional Management Systems (IMS) specification has emerged as a global standard for online teaching and learning environments. This proposed standard defines a common architecture for content management and delivery.

Candler, C. S., et al. (2003). "Introducing HEAL: The Health Education Assets Library." Academic Medicine 78(3): 249-253.
	Digital multimedia, such as images and videos, are playing an increasingly important role in health sciences education. Educators, however, often do not have the time or resources to create high-quality materials. The authors describe the development of a new Health Education Assets Library (HEAL), a freely accessible, national library of high-quality digital multimedia to support all levels of health sciences education. HEAL's primary mission is to provide educators with high-quality and free multimedia materials (such as images and videos) to augment health science education. In addition, HEAL is working with other organizations to establish a network of distributed databases of high-quality teaching resources. By using state-of-the-art Internet technologies HEAL enables educators across the country to efficiently search and retrieve teaching materials from a variety of sources.

Cannon-Diehl, M. R. (2009). "Simulation in healthcare and nursing: State of the science." Critical Care Nursing Quarterly 32(2): 128-136.
	The face of nursing education and continuing education as we currently know it is changing at a phenomenal pace. The state of the science of simulation in nursing and healthcare exist on a continuum of various types of simulation. Several driving forces have influenced the development and diffusion of the science of simulation. Today's consumers of education have higher expectations for curricula. Helathcare is evolving with fewer resources and more complex roles. Advancing technology is creating a dependence on simulation as a teaching and learning strategy. Society in general, in the form of both public and professional organizations, supports simulation as a viable teaching and learning strategy. Current use and future research will decide the fate of simulation and if it will become embedded in nursing and healthcare education. © 2009 Lippincott Williams & Wilkins, Inc.

Cantarovich, F. (2005). "Public opinion and organ donation suggestions for overcoming barriers." Annals of Transplantation 10(1): 22-25.
	Getting organs for transplantation depends on people's decision; thus, public opinion is essential to finding a solution to this problem. Efforts to improve organ shortage focus on: 1) Living, unrelated donation, 2) increasing marginal donors and 3) proposing economic support for donors. Paradoxically, no initiative has been suggested to modify public opinion towards cadaver donors. Several reasons explain the resistance to donating cadaver organs: Lack of awareness, religious uncertainties, distrust of medicine, hostility to new ideas, and misinformation. Education should be used to reshape public opinion about the use of organs for transplantation. Society should accept that "using" body parts is moral and offers a source of health for everybody. The concept that using cadaver organs implies sharing a source of health might be a social agreement between all members of Society. Suggestions for improving organ shortage include: 1) Society should understand that during one's life one may be just as easily a potential organ receiver as one is an organ donor. 2) Cadaver organs are an irreplaceable source of health. 3) As self-interest is one obstacle to donating cadaver organs, the "concept that allowing the use of our organs after death represents a chance of sharing health for everybody" may be useful for a change of attitude. Even though a poll among transplant professionals supported this suggestion, an international public survey should be carried out to evaluate people's reaction to this message. [References: 41]

Cantarovich, M., et al. (2013). "First global forum on education on organ donation and transplantation for schools." Pediatric Transplantation 17(1): 12-18.
	Cantarovich M, Birk P, Ekbeg H, Delmonico F, Schoenberg R, Garcia C, Manyalich M, Wall W, Arbogast H, Sherry W, Young-Kipp S, Cantarovich F. First global forum on education on organ donation and transplantation for schools. Abstract: The Transplantation Society, in collaboration with the Canadian Society of Transplantation, organized a forum on education on ODT for schools. The forum included participants from around the world, school boards, and representatives from different religions. Participants presented on their countries experience in the area of education on ODT. Working groups discussed about technologies for education, principles for sharing of resources globally, and relationships between education, and health authorities and non-governmental organizations. The forum concluded with a discussion about how to best help existing programs and those wishing to start educational programs on ODT.

Cantor, S. B., et al. (2003). "Decision science and cervical cancer." Cancer 98(9): 2003-2008.
	Mathematical modeling is an effective tool for guiding cervical cancer screening, diagnosis, and treatment decisions for patients and policymakers. This article describes the use of mathematical modeling as outlined in five presentations from the Decision Science and Cervical Cancer session of the Second International Conference on Cervical Cancer held at The University of Texas M. D. Anderson Cancer Center, April 11-14, 2002. The authors provide an overview of mathematical modeling, especially decision analysis and cost-effectiveness analysis, and examples of how it can be used for clinical decision making regarding the prevention, diagnosis, and treatment of cervical cancer. Included are applications as well as theory regarding decision science and cervical cancer. Mathematical modeling can answer such questions as the optimal frequency for screening, the optimal age to stop screening, and the optimal way to diagnose cervical cancer. Results from one mathematical model demonstrated that a vaccine against high-risk strains of human papillomavirus was a cost-effective use of resources, and discussion of another model demonstrated the importance of collecting direct non-health care costs and time costs for cost-effectiveness analysis. Research presented indicated that care must be taken when applying the results of population-wide, cost-effectiveness analyses to reduce health disparities. Mathematical modeling can encompass a variety of theoretical and applied issues regarding decision science and cervical cancer. The ultimate objective of using decision-analytic and cost-effectiveness models is to identify ways to improve women's health at an economically reasonable cost. (C) 2003 American Cancer Society.

Caplan, C. and K. Griffin (2000). "Complementary and alternative medicine: the road less traveled?" Issue Brief (Public Policy Institute (American Association of Retired Persons)(IB46): 1-14.
	
Caplan, R. (1996). "Informationally challenged." Iowa Medicine 86(1): 35.
	
Capoccia, V., et al. (2007). "Letter to the Editor." Journal of Substance Abuse Treatment 33(2): 219-220.
	
Caporale, J. E., et al. (2013). "Diabetes in Argentina: cost and management of diabetes and its complications and challenges for health policy." Globalization and Health 9: 10.
	Background: Diabetes is an expensive disease in Argentina as well as worldwide, and its prevalence is continuously rising affecting the quality of life of people with the disease and their life expectancy. It also imposes a heavy burden to the national health care budget and on the economy in the form of productivity losses. Aims: To review and discuss a) the reported evidence on diabetes prevalence, the degree of control, the cost of care and outcomes, b) available strategies to decrease the health and economic disease burden, and c) how the disease fits in the Argentinian health care system and policy. Finally, to propose evidence-based policy options to reduce the burden of diabetes, both from an epidemiological as well as an economic perspective, on the Argentinian society. The evidence presented is expected to help the local authorities to develop and implement effective diabetes care programmes. Methodology: A comprehensive literature review was performed using databases such as MEDLINE, EMBASE and LILACS (Latin American and Caribbean Health Sciences). Literature published from 1980 to 2011 was included. This information was complemented with grey literature, including data from national and provincial official sources, personal communications and contacts with health authorities and diabetes experts in Argentina. Results: Overall diabetes prevalence increased from 8.4% in 2005 to 9.6% 2009 at national level. In 2009, diabetes was the seventh leading cause of death with a mortality rate of 19.2 per 100,000 inhabitants, and it accounted for 1,328,802 DALYs lost in the adult population, mainly affecting women aged over fifty. The per capita hospitalisation cost for people with diabetes was significantly higher than for people without the disease, US$ 1,628 vs. US$ 833 in 2004. Evidence shows that implementation of combined educative interventions improved quality of care and outcomes, decreased treatment costs and optimised the use of economic resources. Conclusions: Based on the evidence reviewed, we believe that the implementation of structured health care programmes including diabetes education at every level, could improve quality of care as well as its clinical, metabolic and economic outcomes. If implemented across the country, these programmes could decrease the disease burden and optimise the use of human and economic resources.

Cardoso, F., et al. (2013). "Supportive care during treatment for breast cancer: Resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement." Breast 22(5): 593-605.
	Breast cancer patients may have unmet supportive care needs during treatment, including symptom management of treatment-related toxicities, and educational, psychosocial, and spiritual needs. Delivery of supportive care is often a low priority in low-and middle-income settings, and is also dependent on resources available. This consensus statement describes twelve key recommendations for supportive care during treatment in low-and middle-income countries, identified by an expert international panel as part of the 5th Breast Health Global Initiative (BHGI) Global Summit for Supportive Care, which was held in October 2012, in Vienna, Austria. Panel recommendations are presented in a 4-tier resource-stratified table to illustrate how health systems can provide supportive care services during treatment to breast cancer patients, starting at a basic level of resource allocation and incrementally adding program resources as they become available. These recommendations include: health professional and patient and family education; management of treatment related toxicities, management of treatment-related symptoms of fatigue, insomnia and non-specific pain, and management of psychosocial and spiritual issues related to breast cancer treatment. Establishing supportive care during breast cancer treatment will help ensure that breast cancer patients receive comprehensive care that can help 1) improve adherence to treatment recommendations, 2) manage treatment-related toxicities and other treatment related symptoms, and 3) address the psychosocial and spiritual aspects of breast cancer and breast cancer treatments. (C) 2013 The Authors. Published by Elsevier Ltd. All rights reserved.

Cariou, C., et al. (2014). "Adapting and implementing an evidence-based sun-safety education program in rural idaho, 2012." Preventing Chronic Disease 11(5).
	Background: Melanoma incidence and mortality rates in Idaho are higher than national averages. The importance of increased awareness of skin cancer has been cited by state and local organizations. St. Luke's Mountain States Tumor Institute (MSTI) prioritized educational outreach efforts to focus on the implementation of a skin cancer prevention program in rural Idaho. Community Context: As a community cancer center, MSTI expanded cancer education services to include dedicated support to rural communities. Through this expansion, an MSTI educator sought to partner with a community organization to provide sun-safety education. MSTI selected, adapted, and implemented an evidence-based program, Pool Cool. Methods: The education program was implemented in 5 phases. In Phase I, we identified and recruited a community partner; in Phase 2, after thorough research, we selected a program, Pool Cool; in Phase 3, we planned the details of the program, including identification of desired short- and long-term outcomes and adaptation of existing program materials; in Phase 4, we implemented the program in summer 2012; in Phase 5, we assessed program sustainability and expansion. Outcome: MSTI developed a sustainable partnership with Payette Municipal Pool, and in summer 2012, we implemented Pool Cool. Sun-safety education was provided to more than 700 young people aged 2 to 17 years, and educational signage and sunscreen benefitted hundreds of additional pool patrons. Interpretation: Community cancer centers are increasingly being asked to assess community needs and implement evidence-based prevention and screening programs. Clinical staff may become facilitators of evidence-based public health programs. Challenges of implementing evidence-based programs in the context of a community cancer centers are staffing, leveraging of resources, and ongoing training and support.

Carlile, S. and A. J. Sefton (1998). "Healthcare and the information age: implications for medical education." Medical Journal of Australia 168(7): 340-343.
	The information age, combining rapidly developing information technology and massive growth in biomedical and clinical data, is placing special demands on healthcare workers. Further, radical changes in access to information in our society are affecting the doctor-patient relationship. These changes necessitate a new approach to primary and continuing medical education. A number of imperatives for medical education are identified and some practical changes to a medical curriculum are described. [References: 31]

Carline, J. D. (2004). "Funding medical education research: Opportunities and issues." Academic Medicine 79(10): 918-924.
	Medical education research is underfunded. Little research focuses on basic issues of learning and teaching in medicine, and few educational innovations are tested across institutions to insure their generalizability. Despite repeated calls for the development of research organizations that would deal with substantial issues in medical education, funding remains a miniscule portion of the total budget for medical education. The author discusses how medical education research is supported in the present economic environment. The majority of published research is accomplished during the course of the researcher's employment. Many universities support pilot studies that lead to larger grants. Faculty development programs and career or academic awards support some research. Small to moderate amounts of funding are available through a variety of sources including medical specialty associations and private foundations. The author lists a variety of resources and strategies for finding foundations to fund research. Funding for larger research projects, particularly those that require more than a few years to accomplish or that involve multiple institutions, is more difficult to obtain. Federal training grants provide the laboratory for innovation and education research, but include inadequate funds to accomplish in-depth evaluation or research. The lack of emphasis on theory building and failure to prove the usefulness of innovations across schools cannot be overcome with current levels of funding. Medical educators must be advocates for the research support needed to move medical education research from a field with limited influence on practice to one that is able to connect sound insights and ideas with actual practices in education and improved patient health.

Carlisle, C. E., et al. (2012). "Predictors of Psychiatric Aftercare Among Formerly Hospitalized Adolescents." Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie 57(11): 666-676.
	Objective: Timely aftercare can be viewed as a patient safety imperative. In the context of decreasing inpatient length of stay (LOS) and known child psychiatry human resource challenges, we investigated time to aftercare for adolescents following psychiatric hospitalization. Method: We conducted a population-based cohort study of adolescents aged 15 to 19 years with psychiatric discharge between April 1, 2002, and March 1, 2004, in Ontario, using encrypted identifiers across health administrative databases to determine time to first psychiatric aftercare with a primary care physician (PCP) or a psychiatrist within 395 days of discharge. Results: Among the 7111 adolescents discharged in the study period, 24% had aftercare with a PCP or a psychiatrist within 7 days and 49% within 30 days. High socioeconomic status (adjusted hazard ratio [AHR] 1.31; 95% CI 1,21 to 1.43, P < 0.001) and psychotic disorders (AHR 1.24; 95% CI 1.12 to 1.36, P < 0,001) were associated with greater likelihood of aftercare. Youth in the northern part of the province (AHR 0.48; 95% CI 0.32 to 0.71, P < 0.001), rural areas (AHR 0.82; 95% CI 0.76 to 0.89, P < 0.001), and with self-harm or suicide attempts (AHR 0.58; 95% CI 0.53 to 0.64, P < 0.001) and substance use disorders (AHR 0.50; 95% CI 0.44 to 0.56, P < 0.001) were less likely to receive aftercare. Conclusions: Hospitalization is our most intensive, intrusive, and expensive psychiatric treatment setting, yet in our cohort of formerly hospitalized adolescents fewer than 50% received psychiatry-related aftercare in the month postdischarge. Innovations are necessary to address geographic inequities and improve timely access to mental health aftercare for all youth.

Carlo, W. A. (2009). "Translating medical knowledge into practice: Improving health care." Acta Paediatrica, International Journal of Paediatrics 98(8): 1242-1243.
	
Carlson, J. W., et al. (2010). "Partners in Pathology: A Collaborative Model to Bring Pathology to Resource Poor Settings." American Journal of Surgical Pathology 34(1): 118-123.
	Pathology provides a critical bridge between the patients, their physicians and the therapeutic and surgical interventions that can be provided to them. Clinicians caring for patients in resource poor settings may provide basic healthcare, which does not include access to pathologic services; however, the value of pathology in alleviating health disparities for Underserved patients is substantial when implemented. Partners in health is a comprehensive, community-based healthcare organization with clinics in 7 countries-most among the poorest in the world-which has the ability to obtain surgical biopsies and, if a pathologic diagnosis can be rendered, provide treatment, and long-term follow-up. Over the past 5 years, pathologists from the Brigham and Women's Hospital have collaborated with clinicians from partners in health to meet this need which included 129 cases from Haiti and Rwanda and a range of pathology: 64 malignancies, 28 normal tissue or nondiagnostic specimens, 16 infectious or inflammatory cases, 8 benign lesions, and other rare entities. Providing pathology services in resource poor settings through collaboration with clinicians working on-site is only hindered by the establishment of a working collaboration; however, the benefits are enormous and include patient access to curative or tailored therapies, logistical management of treatment resources, and exposure of pathologists to unique and challenging cases.

Carlson, R. W., et al. (2014). "International Adaptations of NCCN Clinical Practice Guidelines in Oncology." Journal of the National Comprehensive Cancer Network 12(5): 643-648.
	The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) are evidence- and consensus-based clinical practice guidelines addressing malignancies that affect more than 97% of all patients with cancer in the United States. The NCCN Guidelines are used extensively in the United States and globally. Use of the guidelines outside the United States has driven the need to adapt the guidelines based on local, regional, or national resources. The NCCN Guidelines Panels created, vetted, and continually update the NCCN Guidelines based on published scientific data on cancer detection, diagnosis, and treatment efficacy. The guidelines are developed within the context of commonly available resources, methods of payment, societal and cultural expectations, and governmental regulations as they exist in the United States. Although many of the cancer management recommendations contained in the NCCN Guidelines apply broadly from a global perspective, not all do. Disparities in availability and access to health care exist among countries, within countries, and among different social groups in the same country, especially regarding resources for cancer prevention, early detection, and treatment. In addition, different drug approval and payment processes result in regional variation in availability of and access to cancer treatment, especially highly expensive agents and radiation therapy. Differences in cancer risk, predictive biomarker expression, and pharmacogenetics exist across ethnic and racial groups, and therefore across geographic locations. Cultural and societal expectations and requirements may also require modification of NCCN Guidelines for use outside the United States. This article describes the adaptation process, using the recent Latin American adaptation of the 2013 NCCN Guidelines for Colorectal Cancer as an example.

Carney, P. A., et al. (2015). "Transforming primary care residency training: a collaborative faculty development initiative among family medicine, internal medicine, and pediatric residencies." Academic Medicine 90(8): 1054-1060.
	PROBLEM: The scope and scale of developments in health care redesign have not been sufficiently adopted in primary care residency programs.
APPROACH: The interdisciplinary Primary Care Faculty Development Initiative was created to teach faculty how to accelerate revisions in primary care residency training. The program focused on skill development in teamwork, change management, leadership, population management, clinical microsystems, and competency assessment. The 2013 pilot program involved 36 family medicine, internal medicine, and pediatric faculty members from 12 residencies in four locations.
OUTCOMES: The percentage of participants rating intention to implement what was learned as "very likely to" or "absolutely will" was 16/32 (50%) for leadership, 24/33 (72.7%) for change management, 23/33 (69.7%) for systems thinking, 25/32 (75.8%) for population management, 28/33 (84.9%) for teamwork, 29/33 (87.8%) for competency assessment, and 30/31 (96.7%) for patient centeredness.Content analysis revealed five key themes: leadership skills are key drivers of change, but program faculty face big challenges in changing culture and engaging stakeholders; access to data from electronic health records for population management is a universal challenge; readiness to change varies among the three disciplines and among residencies within each discipline; focusing on patients and their needs galvanizes collaborative efforts across disciplines and within residencies; and collaboration among disciplines to develop and use shared measures of residency programs and learner outcomes can guide and inspire program changes and urgently needed educational research.
NEXT STEPS: Revise and reevaluate this rapidly evolving program toward widespread engagement with family medicine, internal medicine, and pediatric residencies.

Carney, P. A., et al. (2010). "Utility of the AAMC's Graduation Questionnaire to study behavioral and social sciences domains in undergraduate medical education." Academic Medicine 85(1): 169-176.
	PURPOSE: The Institute of Medicine (IOM) report on social and behavioral sciences (SBS) indicated that 50% of morbidity and mortality in the United States is associated with SBS factors, which the report also found were inadequately taught in medical school. A multischool collaborative explored whether the Association of American Medical Colleges Graduation Questionnaire (GQ) could be used to study changes in the six SBS domains identified in the IOM report.
METHOD: A content analysis conducted with the GQ identified 30 SBS variables, which were narrowed to 24 using a modified Delphi approach. Summary data were pooled from nine medical schools for 2006 and 2007, representing 1,126 students. Data were generated on students' perceptions of curricular experiences, attitudes related to SBS curricula, and confidence with relevant clinical knowledge and skills. The authors determined the sample sizes required for various effect sizes to assess the utility of the GQ.
RESULTS: The 24 variables were classified into five of six IOM domains representing a total of nine analytic categories with cumulative scale means ranging from 60.8 to 93.4. Taking into account the correlations among measures over time, and assuming a two-sided test, 80% power, alpha at .05, and standard deviation of 4.1, the authors found that 34 medical schools would be required for inclusion to attain an estimated effect size of 0.50 (50%). With a sample size of nine schools, the ability to detect changes would require a very high effect size of 107%.
CONCLUSIONS: Detecting SBS changes associated with curricular innovations would require a large collaborative of medical schools. Using a national measure (the GQ) to assess curricular innovations in most areas of SBS is possible if enough medical schools were involved in such an effort.

Carney, T. J., et al. (2015). "Hypothesis generation using network structures on community health center cancer-screening performance." Journal of Biomedical Informatics 57: 288-307.
	Research objectives: Nationally sponsored cancer-care quality-improvement efforts have been deployed in community health centers to increase breast, cervical, and colorectal cancer-screening rates among vulnerable populations. Despite several immediate and short-term gains, screening rates remain below national benchmark objectives. Overall improvement has been both difficult to sustain over time in some organizational settings and/or challenging to diffuse to other settings as repeatable best practices. Reasons for this include facility-level changes, which typically occur in dynamic organizational environments that are complex, adaptive, and unpredictable. This study seeks to understand the factors that shape community health center facility-level cancer-screening performance overtime. This study applies a computational-modeling approach, combining principles of health-services research, health informatics, network theory, and systems science. Methods: To investigate the roles of knowledge acquisition, retention, and sharing within the setting of the community health center and to examine their effects on the relationship between clinical decision support capabilities and improvement in cancer-screening rate improvement, we employed Construct-TM to create simulated community health centers using previously collected point-in-time survey data. Construct-TM is a multi-agent model of network evolution. Because social, knowledge, and belief networks co-evolve, groups and organizations are treated as complex systems to capture the variability of human and organizational factors. In Construct-TM, individuals and groups interact by communicating, learning, and making decisions in a continuous cycle. Data from the survey was used to differentiate high-performing simulated community health centers from low-performing ones based on computer-based decision support usage and self-reported cancer-screening improvement. Results: This virtual experiment revealed that patterns of overall network symmetry, agent cohesion, and connectedness varied by community health center performance level. Visual assessment of both the agent-to-agent knowledge sharing network and agent-to-resource knowledge use network diagrams demonstrated that community health centers labeled as high performers typically showed higher levels of collaboration and cohesiveness among agent classes, faster knowledge-absorption rates, and fewer agents that were unconnected to key knowledge resources. Conclusions and research implications: Using the point-in-time survey data outlining community health center cancer-screening practices, our computational model successfully distinguished between high and low performers. Results indicated that high-performance environments displayed distinctive network characteristics in patterns of interaction among agents, as well as in the access and utilization of key knowledge resources. Our study demonstrated how non-network-specific data obtained from a point-in-time survey can be employed to forecast community health center performance over time, thereby enhancing the sustainability of long-term strategic-improvement efforts. Our results revealed a strategic profile for community health center cancer-screening improvement via simulation over a projected 10-year period. The use of computational modeling allows additional inferential knowledge to be drawn from existing data when examining organizational performance in increasingly complex environments. (C) 2015 Elsevier Inc. All rights reserved.

Carpenter, C. R., et al. (2010). "Incorporating Evidence-based Medicine into Resident Education: A CORD Survey of Faculty and Resident Expectations." Academic Emergency Medicine 17(10): S54-S61.
	Background: The Accreditation Council for Graduate Medical Education (ACGME) invokes evidence-based medicine (EBM) principles through the practice-based learning core competency. The authors hypothesized that among a representative sample of emergency medicine (EM) residency programs, a wide variability in EBM resident training priorities, faculty expertise expectations, and curricula exists. Objectives: The primary objective was to obtain descriptive data regarding EBM practices and expectations from EM physician educators. Our secondary objective was to assess differences in EBM educational priorities among journal club directors compared with non-journal club directors. Methods: A 19-question survey was developed by a group of recognized EBM curriculum innovators and then disseminated to Council of Emergency Medicine Residency Directors (CORD) conference participants, assessing their opinions regarding essential EBM skill sets and EBM curricular expectations for residents and faculty at their home institutions. The survey instrument also identified the degree of interest respondents had in receiving a free monthly EBM journal club curriculum. Results: A total of 157 individuals registered for the conference, and 98 completed the survey. Seventy-seven (77% of respondents) were either residency program directors or assistant/associate program directors. The majority of participants were from university-based programs and in practice at least 5 years. Respondents reported the ability to identify flawed research (45%), apply research findings to patient care (43%), and comprehend research methodology (33%) as the most important resident skill sets. The majority of respondents reported no formal journal club or EBM curricula (75%) and do not utilize structured critical appraisal instruments (71%) when reviewing the literature. While journal club directors believed that resident learners' most important EBM skill is to identify secondary peer-reviewed resources, non-journal club directors identified residents' ability to distinguish significantly flawed research as the key skill to develop. Interest in receiving a free monthly EBM journal club curriculum was widely accepted (89%). Conclusions: Attaining EBM proficiency is an expected outcome of graduate medical education (GME) training, although the specific domains of anticipated expertise differ between faculty and residents. Few respondents currently use a formalized curriculum to guide the development of EBM skill sets. There appears to be a high level of interest in obtaining EBM journal club educational content in a structured format. Measuring the effects of providing journal club curriculum content in conjunction with other EBM interventions may warrant further investigation. ACADEMIC EMERGENCY MEDICINE 2010; 17:S54-S61 (C) 2010 by the Society for Academic Emergency Medicine.

Carpenter, C. R. and J. Sherbino (2010). "How does an "opinion leader" influence my practice?" Canadian Journal of Emergency Medicine 12(5): 431-434.
	
Carpenter, D. A., et al. (2011). "An innovative approach to developing a cultural competency curriculum; efforts at the John A. Burns School of Medicine, Department of Native Hawaiian Health." Hawaii Medical Journal 70(11 Suppl 2): 15-19.
	INTRODUCTION: Initial efforts to teach cultural competency at the University of Hawai'i John A. Burns School of Medicine began in the late 1990s through the Native Hawaiian Center of Excellence. With the formation of the Department of Native Hawaiian Health in 2003, cultural competency training was added as a key area of focus for the department. A multidisciplinary team was formed to do the ground work. Physicians (Family Medicine and Internal Medicine) and an administrator (MBA now at Queens Medical Center) from the Department of Native Hawaiian Health were joined by a cultural anthropologist (Department of Family Medicine and Community Health), a social worker (UH Myron B. Thompson School of Social Work), and a retired DrPH/Registered Dietician from the State Department of Health to form the cultural competency curriculum team. All but one of the team members is Native Hawaiian.
DISCUSSION: As cultural competency training is a relatively new, rapidly developing field, there is no consensus on how to teach it. The department decided early on to focus on a variety of methodologies using Native Hawaiian health as the curriculum's foundation. Many different paths were taken toward the development of the present curriculum which utilized different components within the medical school's curriculum. This paper describes the process and development of a cultural competency training curriculum at the University of Hawai'i medical school. Recent literature recommendations by experts in the field reinforce the current curricular content that resulted from this developmental process.

Carpenter, W. R., et al. (2012). "Translating Research Into Practice The Role of Provider-based Research Networks in the Diffusion of an Evidence-based Colon Cancer Treatment Innovation." Medical Care 50(8): 737-748.
	Background: Provider-based research networks (PBRNs)-collaborative research partnerships between academic centers and community-based practitioners-are a promising model for accelerating the translation of research into practice; however, empirical evidence of accelerated translation is limited. Oxaliplatin in adjuvant combination chemotherapy is an innovation with clinical trial-proven survival benefit compared with prior therapies. The goal of this study is to examine the diffusion of oxaliplatin into community practice, and whether affiliation with the National Cancer Institute's (NCI's) Community Clinical Oncology Program (CCOP)-a nationwide cancer-focused PBRN-is associated with accelerated innovation adoption. Design, Setting, and Participants: This retrospective observational study used linked Surveillance, Epidemiology, and End Results-Medicare and NCI CCOP data to examine Medicare participants with stage III colon cancer initiating treatment in 2003 through 2006, the years surrounding oxaliplatin's Food and Drug Administration approval. A fixed-effects analysis examined chemotherapy use among patients treated outside academic centers at CCOP-affiliated practices compared with non-CCOP practices. Two-group modeling controlled for multiple levels of clustering, year of chemotherapy initiation, tumor characteristics, patient age, race, comorbidity, Medicaid dual-eligibility status, and education. Results: Of 4055 community patients, 35% received 5-fluoruracil, 20% received oxaliplatin, 7% received another chemotherapy, and 38% received no chemotherapy. Twenty-five percent of CCOP patients received oxaliplatin, compared with 19% of non-CCOP patients. In multivariable analysis, CCOP exposure was associated with higher odds of receiving guideline-concordant treatment in general, and oxaliplatin specifically. Conclusions: These findings contribute to a growing set of evidence linking PBRNs with a greater probability of receiving treatment innovations and high-quality cancer care, with implications for clinical and research policy.

Carr, D. B., et al. (2005). "The impact of technology on the analgesic gap and quality of acute pain management." Regional Anesthesia and Pain Medicine 30(3): 286-291.
	National surveys continue to document the undertreatment of acute postoperative pain, despite the availability of evidence-based, clinical practice guidelines and the Joint Commission on Accreditation of Healthcare Organizations standards. This article surveys factors that contribute to persistent gals during the acute pain management process, including deficiencies in providing continuous analgesia, disparities in access tit medical care, the acute pain medicine culture itself, a lack of adequate pain assessment, health care provider biases, and limited health care resources. The role of technology in increasing patients' control over their own pain management and narrowing these gaps is discussed. Patient-controlled analgesia delivery systems are an example of such technology, and they play a key role in improving the quality of acute pain management and increasing the patient's involvement in this process. However, the use of these systems may be limited because of the amount of health care resources necessary for their administration and limitations in payment for professional services. Therefore, there exists a need for additional technologies that will simplify the pain management process and reduce the amount of health care resources necessary it) provide patients with quality acute pain management.

Carr, K. C. (2015). "Using the unfolding case study in midwifery education." Journal of Midwifery & Women's Health 60(3): 283-290.
	One of the challenges in teaching clinicians is helping health care provider students, including midwives, develop the critical thinking and clinical decision-making skills needed for various situations encountered in practice. Health care provider students need to master the required core knowledge and skills but also need to assess, analyze, judge, decide on action, act, and evaluate their actions. Lecture-heavy classroom teaching, which is usually delivered separately from clinical experiences in health care education, focuses on knowledge acquisition, often leaving knowledge application to trial and error. Case studies are commonly used by faculty with a problem-based learning approach, which is more analytic but sometimes static. The unfolding case study presents students with a patient scenario that changes over time and allows for discussion; lecture points as needed; and decision making as the situation or condition changes, reflecting what happens in real-life clinical practice. The use of the unfolding case study moves health care provider education from fact-based lecturing to situation-based discussion and decision making as a person's condition or situation changes. Use of the unfolding case facilitates collaborative learning, covers necessary content, and assists students to think beyond the facts and use their clinical imagination. Unfolding case studies require students to begin to grasp the nature of a clinical situation and adjust interventions as the clinical situation unfolds. Steps in developing and using an unfolding case study for midwifery students are presented, including 2 examples. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. Copyright © 2015 by the American College of Nurse-Midwives.

Carr, S. M. and C. L. Clarke (2010). "The manager's role in mobilizing and nurturing development: Entrenched and engaged approaches to change." Journal of Nursing Management 18(3): 332-338.
	Aims: Drawing on findings from the evaluation of a Health Action Zone (HAZ), this paper explores the manager's role in promoting and nurturing learning. Background: Initiating practice development is a core function of the manager's role. Learning must be nurtured to reach beyond individual to organizational learning and address knowledge exchange as well as creation. In the United Kingdom, HAZs were established to reduce health inequalities. They embraced a variety of service delivery approaches, all with an emphasis on developing new ways of working and innovation. Methods: Qualitative interviews of the HAZ coordinators, performance manager and staff delivering services. Results: Two alternative ways of engagement and entrenchment to practice were identified to developing new ways of working and learning from experience. Conclusions: Development of sustainable and enduring structures which facilitate learning at both individual and organizational levels are key to utilization of knowledge and accumulation of learning. Implications for nursing management: When entrenched and engaged experiential learning in practice are pursued, the role of the manager as a catalyst needs to be highlighted. A tool is proposed to facilitate reflection and promote action plan development. This tool has potential general application, but our experience is that it makes a specific contribution to public health and primary care. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Carr, V. J., et al. (2006). "What is the value of treating schizophrenia?" Australian and New Zealand Journal of Psychiatry 40(11-12): 963-971.
	Objective: Recent generalized cost-effectiveness analyses contrasting schizophrenia with high prevalence mental disorders have noted a need to investigate the mechanisms by which the tensions between equity and efficiency can be reconciled and inform priority setting in resource allocation. This paper explores and illustrates some possible strategies for valuing mental health states, with the broad goal of improving resource allocation decisions. MethodsHealth utility gains derived for current and optimal treatments for schizophrenia, depression and anxiety disorders, potential societal preference weightings, and annual costs per treated case, are used to illustrate the magnitude of the impacts on relative cost-efficiency and societal welfare estimates. These estimates are based on costs per additional quality adjusted life year (QALY) and costs per additional S-QALY (i.e. QALYs adjusted for societal value of health gains) respectively. Results: When broader societal preferences are ignored, current and optimal treatments for depression and anxiety are around 10 times more efficient than those for schizophrenia, but treatments for all three disorders appear to give rise to similar levels of societal welfare when weighting factors reflecting equity concerns are incorporated. Conclusions: There is manifest inequality in health between individuals with schizophrenia and those with high prevalence mental disorders, even with optimal treatment. Schizophrenia is much more costly to treat but other factors require consideration. Inclusion of societal preferences should lead to more rational decision-making and improved societal welfare. In turn, greater effort needs to be given to the development and validation of appropriate weighting factors reflecting distributive preferences in mental health.

Carrera, L. I., et al. (2003). "Implementing a problem-based learning curriculum in an Argentinean medical school: Implications for developing countries." Academic Medicine 78(8): 798-801.
	The authors review the difficulties that Argentina's medical schools, particularly the public ones, are likely to face when implementing a problem-based learning (PBL) curriculum, describe the barriers that were faced by their medical school as it implemented PBL, and point out the implications for medical education in developing countries with conditions and education programs similar to those in Argentina. Specifically, they (1) outline the basic requirements for successful implementation of a PBL curriculum, (2) describe the training contradiction in Argentina between a complex and heterogeneous health care system that forces specialization and medical schools' attempts to train generalists, and (3) review the effects on curriculum change of the size and the training levels of the student population and the availability of human and financial resources. This information indicates the context in which the Rosario University School of Medicine designed a new PBL curriculum and implemented it in 2002. The authors close by suggesting that schools in developing countries that are in circumstances similar to that of Rosario should consider whether a PBL curriculum is even appropriate for them, and should realize the difficulties (discussed in the article) they will have to overcome. Also, uncertainties about the efficacy of PBL create a case for exploring alternatives to PBL, including hybrid curricula. Considering the available research on curricular innovations such as PBL and the particular situations of their countries may help schools anywhere avoid wrong decisions about what curricula to implement.

Carr-Hill, R. A., et al. (2002). "Risk adjustment for hospital use using social security data: cross sectional small area analysis." British Medical Journal 324(7334): 390-392.
	Objectives To identify demographic and socioeconomic determinants of need for acute hospital treatment at small area level. To establish whether there is a relation between poverty and use of inpatient services. To devise a risk adjustment formula for distributing public funds for hospital services using, as far as possible, variables that can be updated between censuses. Design Cross sectional analysis. Spatial interactive modelling was used to quantify the proximity of the population to health service facilities. Two stage weighted least squares regression was used to model use against supply of hospital and community services and a wide range of potential needs drivers including health, socioeconomic census variables, uptake of income support and family credit, and religious denomination. Setting Northern Ireland. Main outcome measure Intensity of use of inpatient services. Results After endogeneity of supply and use was taken into account, a statistical model was produced that predicted use based on five variables: income support, family credit, elderly people living alone, all ages standardised mortality ratio, and low birth weight. The main effect of the formula produced is to move resources from urban to rural areas. Conclusions This work has produced a population risk adjustment formula for acute hospital treatment in which four of the five variables can be updated annually rather than relying on census derived data. Inclusion of the social security data makes a substantial difference to the model and to the results produced by the formula.

Carrion, M., et al. (2004). "Barriers to research utilisation among forensic mental health nurses." International Journal of Nursing Studies 41(6): 613-619.
	This study used a cross-sectional, descriptive design to identify barriers to research utilisation among forensic mental health nurses. A postal questionnaire was sent to the total population of 88 registered nurses working in a forensic mental health hospital in the UK. Forty-seven responded representing a response rate of 53%. Results showed that the greatest barriers to research utilisation were those related to the characteristics of the setting in which nurses work or the personal characteristics of nurses themselves, which seems to be consistent with previous studies undertaken in the area. However, the nurses reported it especially difficult to trust what research shows because they feel that it is not always possible to apply those findings to their particular work environment. The main implications for policy are a need for an increase in support from management, programmes of advanced education to provide nurses with research skills, an improvement in accessibility and availability of research reports and an increase in time available to read and implement research. The main suggestions for future research are that qualitative studies should be carried out to attain a better understanding of mental health nurses' attitudes towards research utilisation. © 2004 Elsevier Ltd. All rights reserved.

Carroll, M., et al. (2011). "Innovation in Indian healthcare: using health information technology to achieve health equity for American Indian and Alaska Native populations." Perspectives in health information management / AHIMA, American Health Information Management Association 8.
	The US Indian health system utilizes a diverse range of health information technology and innovative tools to enhance health service delivery for American Indians and Alaska Natives. This article provides an overview of efforts and experience using such tools to achieve health equity for American Indian and Alaska Native communities. Specific attention is given to the Indian Health Service Electronic Health Record and to two examples of telehealth innovation.

Carroll, R. (2007). "The economic effects of the president's proposal for a standard deduction for health insurance." National Tax Journal 60(3): 419-431.
	Health care costs continue to rise rapidly in the United States, claiming an increasing share of economic resources. One factor contributing to this rise is the favorable tax treatment for employer-sponsored health insurance, whereby employees pay neither income nor payroll taxes on health care that is provided through their employers. This tax treatment, which amounts to a $300-$400 billion per year subsidy for health insurance, has led to greater reliance on employer-sponsored insurance and lower deductible plans. Moreover, individuals who purchase insurance on their own often receive no tax subsidy. This paper discusses a health tax proposal included in President Bush's FY 2009 Budget that would reduce or eliminate these tax biases through a new standard deduction for health insurance (SDHI). The SDHI would be available to all individuals purchasing qualifying insurance and improve incentives by breaking the link between how much an individual pays for insurance and the value of the tax subsidy. The SDHI would increase the number of individuals with health insurance by roughly six to nine million and reorient the tax subsidy more towards lower-income individuals. The paper also considers alternatives to the SDHI proposal, principally a flat refundable health insurance tax credit.

Carruth, A. K., et al. (2010). "Graduate Nursing Online Orientation Course: Transitioning for Success." Journal of Nursing Education 49(12): 687-690.
	Graduate nursing students beginning their graduate education often lack technological preparedness when beginning the journey in a virtual e-learning environment. These gaps in preparedness include lack of understanding course delivery, accessing resources remotely, participating in asynchronous course activities, and use of emerging health care technologies. This article describes an educational innovative online orientation course that simulates course activities so that students get a true perspective of what e-learning entails. With enhanced education through the accelerated learning modules, students became proficient with distance education, which promotes success in an online master's of science in nursing program.

Carter, D., et al. (2016). "Competing Principles for Allocating Health Care Resources." Journal of Medicine and Philosophy 41(5): 558-583.
	We clarify options for conceptualizing equity, or what we refer to as justice, in resource allocation. We do this by systematically differentiating, expounding, and then illustrating eight different substantive principles of justice. In doing this, we compare different meanings that can be attributed to "need" and "the capacity to benefit" (CTB). Our comparison is sharpened by two analytical tools. First, quantification helps to clarify the divergent consequences of allocations commended by competing principles. Second, a diagrammatic approach developed by economists Culyer and Wagstaff offers a visual and conceptual aid. Of the eight principles we illustrate, only two treat as relevant both a person's initial health state and a person's CTB per resource unit expended: (1) allocate resources so as to most closely equalize final health states and (2) allocate resources so as to equally restore health states to population norms. These allocative principles ought to be preferred to the alternatives if one deems relevant both a person's initial health state and a person's CTB per resource unit expended. Finally, we examine some possibilities for conceptualizing benefits as relative to how badly off someone is, extending Parfit's thought on Prioritarianism (a prioritizing of the worst off). Questions arise as to how much intervention effects accruing to the worse off count for more and how this changes with improving health. We explicate some recent efforts to answer these questions, including in Dutch and British government circles. These efforts can be viewed as efforts to operationalize need as an allocative principle. Each effort seeks to maximize in the aggregate quanta of effect that are differentially valued in favor of the worst off. In this respect, each effort constitutes one type of Prioritarianism, which Parfit failed to differentiate from other types.

Carter, J. A. (1997). "Re-inventing the wheel [9]." Anaesthesia 52(1): 89.
	
Carter, R. E. and J. Stoecker (2006). "Descriptors of American Physical Therapy Association physical therapist members' reading of professional publications." Physiotherapy Theory and Practice 22(5): 263-278.
	One of the components of evidence-based practice (EBP) is reading the literature. The purpose of this investigation was 1) to determine which publications are read most frequently by physical therapists (PTs), 2) to identify employment and education characteristics related to reading patterns, and 3) to determine how PTs use information gained from reading professional publications. A survey was constructed, pretested, revised, and then mailed to a random sample of 1,000 physical therapists, 500 from the general American Physical Therapy Association (APTA) membership and 500 from the combined Geriatric and Orthopedic section memberships. The data were analyzed with descriptive statistics. After all mailings, 43.3% of the sample responded. Of those responding, 66.3% were employed as clinicians, 14.7% as clinician-administrators, 6% as educators, and 4.9% as administrators. Overall, and for clinicians, the two most frequently read professional publications were non peer-reviewed. For clinician groups "patient management" was among the top two most selected uses of information from reading professional publications. Educators and those with an advanced doctorate indicated "class lectures" as either their second most frequently selected use or tied for first with "keeping current." Only educators and those with or pursuing an advanced doctorate reported using information from reading professional publications for "research ideas" or "research methods" among their top five uses. Slightly more than 10% of the respondents cited a peer-reviewed published article as having been most influential on their practice. Non peer-reviewed professional publications appear to serve as a more frequent source of information for "patient management" than do peer-reviewed publications. Efforts to increase the use of EBP need to be explored and evaluated for impact on physical therapists' practice. Copyright © Informa Healthcare.

Carter-Jones, C. R. (2011). "Stroke thrombolysis: Barriers to implementation." International Emergency Nursing 19(1): 53-57.
	Stroke is a frequent emergency faced by Emergency Department (ED) staff. Evidence produced from significant trials has led to the introduction of stroke thrombolysis across the world. Campaigns to increase public awareness that 'stroke is a medical emergency,' have led to emergency departments facing necessary adjustment, re-allocation of resources and education of staff. From a review of the associated literature, barriers to implementation of the service include; non-recognition of stroke, inappropriate triage of these patients by both ED staff and ambulance personnel, delays in obtaining neuro-imaging, and inefficient processes of in-hospital emergency stroke care. Further study is required to review the educational needs and resource management, as well as the efficacy of the public education in stroke. © 2010 Elsevier Ltd.

Casado-Munoz, R., et al. (2015). "Active Ageing and Access to Technology: An Evolving Empirical Study." Comunicar(45): 37-46.
	Researchers' interest in seeing the benefits of Internet in elderly people is now growing. The network helps this group to increase communication, avoid isolation and loneliness and to age actively. Europe decided 2012 to be the Year of Active ageing. This paper presents a descriptive study of time series analysis carried out between 2004 and 2012 with the aim of knowing how the evolution in the level, motives and needs of the use of computers and Internet by elderly people in an environment of university training focused on health and life quality is. To obtain results a question paper is to be handed out to a sample of 419 people aged between 55 and 94 and taking part in the "Inter-university Programs of Experiences" from the University of Burgos. The obtained results match up with previous studies that pointed a noticeable increase in the use of the Internet (in frequency, number of users and resources) caused by elderly people's desire to keep active, up-to-date and communicated, as well as their need to continue their learning process through tools linked to the network. Here some suggestions focused on the improvement of elderly people's formation and future research on the perception of the Internet as a tool for social participation.

Casale, M. (2015). "The importance of family and community support for the health of HIV-affected populations in Southern Africa: What do we know and where to from here?" British Journal of Health Psychology 20(1): 21-35.
	PurposeInformal family and community support deriving from social relations can play an important role in protecting mental and physical health in resource-scarce contexts and may help facilitate health service access and uptake. Yet, to date, there has been surprisingly little empirical research investigating the role of social support as a resource for health in HIV-affected Southern African communities, despite the known importance of social connectedness, high rates of physical and mental health conditions, and existing treatment gaps'. MethodsThis paper brings together and discusses findings of multiple linked analyses, from the first large-scale explanatory sequential mixed methods research investigating the relationship between social support and health with caregiver populations in HIV-endemic South Africa. ResultsOverall, findings highlight the protective role of social support for caregiver mental health, the multiple perceived psychological and behavioural mechanisms possibly explaining the relationship between social support and both mental and physical health, and gender differences in the provision, effects, and availability of support. ConclusionsDrawing from these findings and the broader literature, four potential foci for future research in Southern Africa are identified and discussed, as are implications for research design and methodologies. These involve achieving a better understanding of the following: The pathways and processes explaining common and differential effects of social support across different population groups; the potential protective role of social support for physical health; and the role of factors such as gender and social and cultural norms in shaping the relationship between social support and health. Mental and physical health are closely related. HIV increases the risk of mental health conditions. Studies mainly from high-income countries have shown social relations and support to be protective of health. What does this study add? First mixed methods research of this dimension on social support and health in Southern Africa. Highlights importance of social support for mental health among caregivers of children in HIV-endemic South Africa. Points to biological and psychological pathways explaining the support-health relationship in this sample.

Case, S. (2005). "The gluten-free diet: How to provide effective education and resources." Gastroenterology 128(4): S128-S134.
	A strict gluten-free diet (GFD) for life is the only treatment for celiac disease (CD). This article reviews (1) the impact of the GFD on the quality of life of individuals with CD and their families; (2) the causes of poorly controlled CD; (3) the access to and source and quality of information provided by health professionals and other groups; (4) management strategies, including nutritional assessment and education guidelines; (5) a variety of resources available to individuals and health professionals; (6) innovative educational initiatives and partnerships; and (7) specific recommendations to address the increasing numbers of people with CD and the growing need for gluten-free (GF) foods and further education about CD and the GFD. Successful management of CD requires a team approach, including the person with CD and his or her family, physician, dietitian, and celiac support group; an individualized approach; understanding of quality of life issues; use of evidence-based, current information and resources; and regular follow-up to monitor compliance, nutritional status, and additional information and support. The physician must clearly communicate, with a positive attitude, an overview of CD and strongly emphasize the importance of a GFD for life. It is essential that the physician initiate an immediate referral to a dietitian with expertise in CD for nutritional assessment, diet education, meal planning, and assistance with the adaptation to the challenging new gluten-free lifestyle. Good dietary compliance will reduce the risk of further complications and associated health care costs and improve quality of life in patients with CD.

Casey, D. (2007). "Using action research to change health-promoting practice." Nursing and Health Sciences 9(1): 5-13.
	Action research was used as a method to develop an educational skills training program focusing on the health education aspect of nurses' health-promoting role. The program was based on the theoretical concepts of the Transtheoretical Model and Motivational Interviewing. Interviews were used to collect the data on a purposive sample of nurses working in an acute hospital ward. Three main themes were identified: using the skills, barriers to implementing the skills, and facilitators of implementing the skills. Most nurses were more aware of health education and health promotion and were able to incorporate the skills learnt and instigated a change in practice. There was evidence, however, that further training was required. This might focus more on helping nurses to use the skills with patients who are very resistant to change and to better recognize health-promoting opportunities. Ways of offering the training program to other health professionals also should be explored. © 2007 The Author; Journal Compilation © 2007 Blackwell Publishing Asia Pty Ltd.

Cash-Gibson, L., et al. (2015). "SDH-NET: a South-North-South collaboration to build sustainable research capacities on social determinants of health in low- and middle-income countries." Health Research Policy and Systems 13: 9.
	Background: It is desirable that health researchers have the ability to conduct research on health equity and contribute to the development of their national health system and policymaking processes. However, in low- and middle-income countries (LMICs), there is a limited capacity to conduct this type of research due to reasons mostly associated with the status of national (health) research systems. Building sustainable research capacity in LMICs through the triangulation of South-North-South (S-N-S) collaborative networks seems to be an effective way to maximize limited national resources to strengthen these capacities. This article describes how a collaborative project (SDH-Net), funded by the European Commission, has successfully designed a study protocol and a S-N-S collaborative network to effectively support research capacity building in LMICs, specifically in the area of social determinants of health (SDH); this project seeks to elaborate on the vital role of global collaborative networks in strengthening this practice. Methods: The implementation of SDH-Net comprised diverse activities developed in three phases. Phase 1: national level mapping exercises were conducted to assess the needs for SDH capacity building or strengthening in local research systems. Four strategic areas were defined, namely research implementation and system performance, social appropriation of knowledge, institutional and national research infrastructure, and research skills and training/networks. Phase 2: development of tools to address the identified capacity building needs, as well as knowledge management and network strengthening activities. Phase 3: identifying lessons learned in terms of research ethics, and how policies can support the capacity building process in SDH research. Results: The implementation of the protocol has led the network to design innovative tools for strengthening SDH research capacities, under a successful S-N-S collaboration that included national mapping reports, a global open-access learning platform with tools and resources, ethical guidelines for research, policy recommendations, and academic contributions to the global SDH discourse. Conclusions: The effective triangulation of S-N-S partnerships can be of high value in building sustainable research capacity in LMICs. If designed appropriately, these multicultural, multi-institutional, and multidisciplinary collaborations can enable southern and northern academics to contextualize global research according to their national realities.

Casillas, A., et al. (2015). "Is the Front Line Prepared for the Changing Faces of Patients? Predictors of Cross-Cultural Preparedness Among Clinical Nurses and Resident Physicians in Lausanne, Switzerland." Teaching and Learning in Medicine 27(4): 379-386.
	Phenomenon: Assuring quality medical care for all persons requires that healthcare providers understand how sociocultural factors affect a patient's health beliefs/behaviors. Switzerland's changing demographics highlight the importance of provider cross-cultural preparedness for all patientsespecially those at risk for social/health precarity. We evaluated healthcare provider cross-cultural preparedness for commonly encountered vulnerable patient profiles. Approach: A survey on cross-cultural care was mailed to Lausanne University hospital's front-line healthcare providers: clinical nurses and resident physicians at our institution. Preparedness items asked How prepared do you feel to care for ... ? (referring to example patient profiles) on an ascending 5-point Likert scale. We examined proportions of 4 - well/5 - very well prepared and the mean composite score for preparedness. We used linear regression to examine the adjusted effect of demographics, work context, cultural-competence training, and cross-cultural care problem awareness, on preparedness. Findings: Of 885 questionnaires, 368 (41.2%) were returned: 124 (33.6%) physicians and 244 (66.4%) nurses. Mean preparedness composite was 3.30 (SD = 0.70), with the lowest proportion of healthcare providers feeling prepared for patients whose religious beliefs affect treatment (22%). After adjustment, working in a sensitized department ( = 0.21, p = .01), training on the history/culture of a specific group ( = 0.25, p = .03), and awareness regarding (a) a lack of practical experience caring for diverse populations ( = 0.25, p = .004) and (b) inadequate cross-cultural training ( = 0.18, p = .04) were associated with higher preparedness. Speaking French as a dominant language and physician role (vs. nurse) were negatively associated with preparedness ( = -0.26, p = .01; = -0.22, p = .01). Insights: The state of cross-cultural care preparedness among Lausanne's front-line healthcare providers leaves room for improvement. Our study points toward institutional strategies to improve preparedness: notably, making sure departments are sensitized to cross-cultural care resources and increasing provider diversity to reflect the changing Swiss demographic.

Cason, C. L., et al. (2009). "Innovations in basic life support education for healthcare providers: improving competence in cardiopulmonary resuscitation through self-directed learning." Journal for Nurses in Staff Development - JNSD 25(3): E1-E13.
	Providing cardiopulmonary resuscitation is an essential competency for nurses. Nurse educators involved in staff development and continuing education spend numerous hours offering basic life support courses and conducting performance improvement activities such as mock codes. This study provides evidence that cardiopulmonary resuscitation performance skills using self-directed learning methods are as good as or, on a number of parameters, better than those achieved with a more resource- and time-intensive traditional approach.

Casper, T. and D. A. Kindig (2012). "Are Community-Level Financial Data Adequate to Assess Population Health Investments?" Preventing Chronic Disease 9: 5.
	The variation in health outcomes among communities results largely from different levels of financial and nonfinancial policy investments over time; these natural experiments should offer investment and policy guidance for a business model on population health. However, little such guidance exists. We examined the availability of data in a sample of Wisconsin counties for expenditures in selected categories of health care, public health, human services, income support, job development, and education. We found, as predicted by the National Committee on Vital and Health Statistics in 2002, that availability is often limited by the challenges of difficulty in locating useable data, a lack of resources among public agencies to upgrade information technology systems for making data more usable and accessible to the public, and a lack of enterprise-wide coordination and geographic detail in data collection efforts. These challenges must be overcome to provide policy-relevant information for optimal population health resource allocation.

Castaneda, H., et al. (2010). "False hope: Effects of social class and health policy on oral health inequalities for migrant farmworker families." Social Science & Medicine 71(11): 2028-2037.
	Few studies have engaged issues of social class and access related to dental health care policy from an ethnographic perspective. The state of Florida in the US has one of the poorest records in the nation for providing dental care for low-income children, falling especially short for Medicaid-enrolled children. In this paper, we discuss unmet dental health needs of children in migrant farmworker families. Although one of the most marginalized populations, most are eligible for Medicaid and are thus covered for dental services. However, serious disparities have been linked to the lack of access through the public insurance system. This study was informed by participant observation at dental clinics and a Migrant Head Start Center and interviews with dental health providers (n = 19) and migrant farmworker parents (n = 48) during 2009. Our results indicate that some typical factors associated with poor oral health outcomes, such as low dental health literacy, may not apply disproportionately to this population. Instead, we argue that structural features and ineffective policies contribute to oral health care disparities. Dental Medicaid programs are chronically underfunded, resulting in low reimbursement rates, low provider participation, and a severe distribution shortage of dentists within poor communities. We characterize the situation for families in Florida as one of "false hope" because of the promise of services with neither adequate resources nor the urgency to provide them. The resulting system of charity care, which leads dentists to provide pro bono care instead of accepting Medicaid, serves to only further persistent inequalities. We provide several recommendations, including migrant-specific efforts such as programs for sealants and new mothers; improvements to the current system by removing obstacles for dentists to treat low-income children; and innovative models to provide comprehensive care and increase the number of providers. (C) 2010 Elsevier Ltd. All rights reserved.

Castillo-Riquelme, M., et al. (2008). "The Costs of Preventing and Treating Chagas Disease in Colombia." Plos Neglected Tropical Diseases 2(11): 11.
	Background: The objective of this study is to report the costs of Chagas disease in Colombia, in terms of vector disease control programmes and the costs of providing care to chronic Chagas disease patients with cardiomyopathy. Methods: Data were collected from Colombia in 2004. A retrospective review of costs for vector control programmes carried out in rural areas included 3,084 houses surveyed for infestation with triatomine bugs and 3,305 houses sprayed with insecticide. A total of 63 patient records from 3 different hospitals were selected for a retrospective review of resource use. Consensus methodology with local experts was used to estimate care seeking behaviour and to complement observed data on utilisation. Findings: The mean cost per house per entomological survey was $4.4 ( in US$ of 2004), whereas the mean cost of spraying a house with insecticide was $27. The main cost driver of spraying was the price of the insecticide, which varied greatly. Treatment of a chronic Chagas disease patient costs between $46.4 and $7,981 per year in Colombia, depending on severity and the level of care used. Combining cost and utilisation estimates the expected cost of treatment per patient-year is $1,028, whereas lifetime costs averaged $11,619 per patient. Chronic Chagas disease patients have limited access to healthcare, with an estimated 22% of patients never seeking care. Conclusion: Chagas disease is a preventable condition that affects mostly poor populations living in rural areas. The mean costs of surveying houses for infestation and spraying infested houses were low in comparison to other studies and in line with treatment costs. Care seeking behaviour and the type of insurance affiliation seem to play a role in the facilities and type of care that patients use, thus raising concerns about equitable access to care. Preventing Chagas disease in Colombia would be cost-effective and could contribute to prevent inequalities in health and healthcare.

Castro, S., et al. (2014). "Content analysis of Portuguese individualized education programmes for young children with autism using the ICF-CY framework." European Early Childhood Education Research Journal 22(1): 91-104.
	This study analysed 33 Individualised Education Programmes developed for pre-schoolers with autism, attending inclusive special education services in North Portugal, based on the International Classification of Functioning, Disability and Health for Children and Youth. The study identified dimensions of functioning addressed in the Individualised Education Programs and the correspondence between the assessment data on children's functionality and the intervention goals. The extent, to which the functioning dimensions overlap with the dimensions considered as essential to the assessment-intervention of children with autism, was also analysed. Results illustrate: the majority of domains addressed in the Portuguese Individualised Education Programmes relates to Activities and Participation; few domains are included both at the assessment and at the intervention level; Environmental Factors are not included in intervention goals; on average, the Individualised Education Programmes included only 32.8% of the dimensions considered to be essential; none of the eight essential Environmental Factors were included in any of the analysed Individualised Education Programmes, demonstrating a lack of consistency in assessment-intervention and difficulties in shifting paradigm. Results are discussed in light of the Ecological models of development and of the Diffusion of Innovation Theory. © 2012 EECERA.

Catchpole, M. A. (1996). "The role of epidemiology and surveillance systems in the control of sexually transmitted diseases." Genitourinary Medicine 72(5): 321-329.
	Surveillance and epidemiological studies are essential components of effective control programmes for sexually transmitted diseases. While other forms of basic biomedical research may add to our understanding of why an exposure or behaviour causes or prevents disease, only epidemiology allows the quantification of the magnitude of the exposure-disease relationship in humans. It is this measure of the association between risk and disease that is needed to inform rational policy on altering risk through intervention. Surveillance data are used both to determine the need for public health action and to assess the effectiveness of programmes: they are required for the setting of priorities, for planning and resource allocation, for the definition of population subgroups and risky behaviours for targeted interventions, for the development of disease prevention programmes, and for the evaluation of interventions. Data from surveillance systems and epidemiological studies can also inform diagnostic and therapeutic practice, and indicate areas for further research. Over the last 20 years chlamydia infections and viral agents have emerged as the major cause of STD in developed countries, and with this change in the aetiological mix of STD cases the focus of prevention and control of STDs has shifted from treatment and partner notification towards health education. In developing countries there is an urgent need for appropriate surveillance infrastructures, particularly now that there is evidence that STD control programmes, informed by surveillance data, can reduce HIV transmission at the population level. The importance of surveillance and epidemiology in the control of STDs is set to increase in the face of the changing pattern of sexually transmitted pathogens. The challenge to clinicians and epidemiologists is to work together in developing systems that will inform new approaches to control and prevention.

Cathorall, M. L., et al. (2015). "Neighborhood Disadvantage and Variations in Blood Pressure." American Journal of Health Education 46(5): 266-273.
	Purpose: To examine the extent to which neighborhood disadvantage accounts for variation in blood pressure. Methods: Demographic, biometric, and self-reported data from 19 261 health screenings were used. Addresses of participants were geocoded and located within census block groups (n=14 510, 75.3%). Three hierarchical linear models were formulated to identify individual and census block group risk factors for hypertension. Neighborhood-level deprivation was determined using the Townsend Deprivation Index. Results: Of the 14 510 participants, 24% had a systolic blood pressure (SBP) of 140mmHg, and 15% had a diastolic blood pressure (DBP) of 90mmHg, indicating hypertension. At the neighborhood level, significant variation in average SBP and DBP across census block groups (P<.001) was found. Model 2 suggested that deprivation accounts for some of the variability in average SBP and DBP between block groups (P<.001). After controlling for individual-level risk factors in model 3, deprivation remained a significant predictor of average SBP (P=.009). Discussion: The findings highlight the role of individual and neighborhood characteristics on blood pressure, specifically SBP. Modifying neighborhood contexts may help reduce environmental risks of hypertension. Translation to Health Education Practice: Educating officials about health risks for residents associated with neighborhood resources is essential in changing policies and reallocating resources.

Celone, M., et al. (2016). "Increasing the reach: Involving local Muslim religious teachers in a behavioral intervention to eliminate urogenital schistosomiasis in Zanzibar." Acta Tropica 163: 142-148.
	In Zanzibar, United Republic of Tanzania, Madrassa schools are influential institutions, where children and adults can learn about the interpretation of the Koran. We aimed to explore the involvement of Madrassa teachers for behavior change interventions in a randomized operational research trial designed to investigate the impact of multiple approaches to eliminate urogenital schistosomiasis transmission from Zanzibar. Madrassa teachers performing in the 30 communities of the behavior change study arm were trained in new interactive and participatory teaching methods by the local behavioral team and provided with schistosomiasis-teaching tools for teaching about transmission and prevention in their Madrassa. In July 2014, in a qualitative research study, we conducted 25 semi-structured interviews with Madrassa teachers to find out how they perceived their involvement in interventions against schistosomiasis. In 2014, 5926 among the 8497 registered Madrassa students in 30 communities on Unguja and Pemba islands received health education and participated in interactive behavior change exercises about schistosomiasis. Madrassa teachers reported that they valued their inclusion in the study and the opportunity to educate their students about schistosomiasis transmission, prevention, and treatment. They also perceived personal and community benefits as a result of their training and strongly supported the inclusion of additional Madrassa teachers in future intervention activities. Madrassa teachers are influential in the Zanzibari society, and hence are important change agents within our community-level behavioral intervention. They might constitute an untapped resource that can help to expand and increase acceptance of and participation in schistosomiasis and other neglected tropical disease control activities in African Muslim communities. (C) 2016 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license.

Cene, C. W., et al. (2011). "Understanding Social Capital and HIV Risk in Rural African American Communities." Journal of General Internal Medicine 26(7): 737-744.
	BACKGROUND: African Americans (AA) and rural communities often suffer disproportionately from poorer health. Theory-guided research examining how individual- and community-level factors influence health behaviors and contribute to disparities is needed. OBJECTIVE: To understand how a social network model that captures the interplay between individual and community factors might inform community-based interventions to reduce HIV risk in rural AA communities. DESIGN: Qualitative study. SETTING AND PARTICIPANTS: Eleven focus groups with 38 AA 16-24 year olds, 42 adults over age 25, and 13 formerly incarcerated individuals held in community settings in two rural, predominantly AA counties in North Carolina. Thirty-seven semi-structured interviews with multiethnic key informants. APPROACH: Semi-structured interviews and focus groups with open-ended questions assessed a) perceptions of multi-level HIV risk determinants from a social network model (individual, interpersonal, social, economic, political and structural) identified through literature review and b) community needs and assets affecting local HIV rates. Qualitative data was analyzed using directive content analysis guided by a social network model. RESULTS: We identified four themes regarding the interaction between individuals and their communities that mediate HIV risk: interpersonal processes, community structural environment, social disorder, and civic engagement. Communities were characterized as having a high degree of cohesiveness, tension, and HIV-related stigma. The community structural environment-characterized by neighborhood poverty, lack of skilled jobs, segregation, political disenfranchisement and institutional racism-was felt to reduce the availability and accessibility of resources to combat HIV. Adults noted an inability to combat social problems due to social disorder, which fuels HIV risk behaviors. Civic engagement as a means of identifying community concerns and developing solutions is limited by churches' reluctance to address HIV-related issues. CONCLUSION: To combat HIV-related stigma, physicians should follow recommendations for universal HIV testing. Besides asking about individual health behaviors, physicians should ask about the availability of support and local community resources. Physicians might consider tailoring their treatment recommendations based on available community resources. This strategy may potentially improve patient adherence and clinical outcomes.

Cerdas, M. (2006). "Epidemiology and control of hypertension and diabetes in Costa Rica." Renal Failure 28(8): 693-696.
	Costa Rica is one of the countries that make up Central America, neighboring Nicaragua and Panama. Costa Rica shares with its neighbors the social and economic problems characteristic of developing countries; however, one difference is that Costa Rica can derive a great part of its budget and expense to health and education, as it had abolished the army in 1948. It is for this reason that Costa Rica shares diseases characteristic of their region like the Dengue, yet at the same time have a true explosion in the fields of hypertension (HTA), diabetes (DM), and cardiovascular disease. The health system of Costa Rica has nearly universal coverage, reaching 98% of the population with primary and secondary diverse levels of attention that give appropriate and satisfactory treatment to all hypertensive and diabetic patients. The HTA and the DM are true public health problems; however, before 2004, there weren't appropriate data on their prevalence and management. Small studies showed an increase in the prevalence of HTA from 9 to 24%, though no data on the prevalence of DM were available. In 2004, the Multinational Survey of Diabetes and Hypertension and Other Factors of Risk carried out in San Jose, Costa Rica, determined a prevalence of HTA of 25% and of DM of 8%. Likewise, the methodology of the survey allowed an evaluation of the quality of the attention of the HTA (Tracer of Arterial Hypertension) and, consequently, appropriate control of hypertensive patients in Costa Rica; through it, it was determined that greater effort was required for earlier detection and resource optimization to better handle hypertensive and diabetic patients and thus reduce cardiovascular morbidity-mortality and chronic renal disease.

Cervero, R. M. and D. E. Moore (2011). "The Cease Smoking Today (CS2day) initiative: A guide to pursue the 2010 IOM report vision for CPD." Journal of Continuing Education in the Health Professions 31(SUPPL. 1): S76-S82.
	This article reviews the articles in this supplement that describe a smoking cessation project, Cease Smoking Today (CS2day) that demonstrated successful outcomes: physician adoption of a smoking cessation guideline and an increase in smoking quit rates. The authors examine how the activities of the CS2day project compared to the principles and characteristics of the vision for a future system of continuing professional development that was described in the 2010 Institute of Medicine (IOM) report, Redesigning Continuing Education in the Health Professions. While it did not meet all the characteristics of the IOM's vision, the CS2day Initiative met enough of them for the authors to suggest that the momentum that the IOM report generated has been sustained. The authors point out two strengths and two weaknesses that further strategic and organizational efforts should consider. The two strengths were the collaborative nature of the project and an approach to continuous outcomes assessment that was based on competencies derived from a practice guideline. The authors also suggested that future similar efforts should place more emphasis on instructional design and developing a program theory to guide program operations and educational development. The authors encouraged members of the CME profession to consider the accomplishments of the CS2day project as they are planning to move their CME programs toward the vision described in the IOM Report. © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Cervinka, M., et al. (2004). "Our experiences with development of digitised video streams and their use in animal-free medical education." Atla-Alternatives to Laboratory Animals 32: 521-523.
	Alternatives and their teaching are an essential part of the curricula at the Faculty of Medicine. Dynamic screen-based video recordings are the most important type of alternative models employed for teaching purposes. Currently, the majority of teaching materials for this purpose are based on PowerPoint presentations, which are very popular because of their high versatility and visual impact. Furthermore, current developments in the field of image capturing devices and software enable the use of digitised video streams, tailored precisely to the specific situation. Here, we demonstrate that with reasonable financial resources, it is possible to prepare video sequences and to introduce them into the PowerPoint presentation, thereby shaping the teaching process according to individual students' needs and specificities.

Chaillet, N., et al. (2006). "Evidence-based strategies for implementing guidelines in obstetrics: A systematic review." Obstetrics and Gynecology 108(5): 1234-1245.
	OBJECTIVE: To estimate effective strategies for implementing clinical practice guidelines in obstetric care and to identify specific barriers to behavior change and facilitators in obstetrics. DATA SOURCES: The Cochrane Library, EMBASE, and MEDLINE were consulted from January 1990 to June 2005. Additional studies were identified by screening reference lists from identified studies and experts' suggestions. METHODS OF STUDY SELECTION: Studies of clinical practice guidelines implementation strategies in obstetric care and reviews of such studies were selected. Randomized controlled trials, controlled before-after studies, and interrupted time series studies were evaluated according to Effective Practice and Organization of Care criteria standards. TABULATION, INTEGRATION, AND RESULTS: Studies were reviewed by two investigators to assess the quality and the efficacy of each strategy. Discordances between the two reviewers were resolved by consensus. In obstetrics, educational strategies with medical providers are generally ineffective; educational strategies with paramedical providers, opinion leaders, qualitative improvement, and academic detailing have mixed effects; audit and feedback, reminders, and multifaceted strategies are generally effective. These findings differ from data on the efficacy of clinical practice guidelines implementation strategies in other medical specialties. Specific barriers to behavior change in obstetrics and methods to overcome these barriers could explain these differences. The proportion of effective strategies is significantly higher among the interventions that include a prospective identification of barriers to change compared with standardized interventions. CONCLUSION: Prospective identification of efficient strategies and barriers to change is necessary to achieve a better adaptation of intervention and to improve clinical practice guidelines implementation. In the field of obstetric care, multifaceted strategy based on audit and feedback and facilitated by local opinion leaders is recommended to effectively change behaviors. © 2006 The American College of Obstetricians and Gynecologists.

Chakravarti, A., et al. (2016). "Anesthesiology Resident Wellness Program at the University of Saskatchewan: curriculum content and delivery." Canadian Journal of Anaesthesia 14: 14.
	Resident and physician health are increasingly recognized by the Royal College of Physicians and Surgeons of Canada and its CanMEDS framework as integral to residency training in Canada. Resident stress, burnout, and depression also have implications for patient care. Although curricula have been advocated to promote resident wellness and resilience, no such published curricula exist to guide programs in addressing these needs. The purpose of this article is to describe the curriculum content and delivery of the Anesthesiology Residency Wellness Program (ARWP) at the University of Saskatchewan. The ARWP curriculum is comprised of four components: modular curriculum, peer support curriculum, self-directed learning activities, department wellness program. The program matrix illustrates the mission, target population, inputs, outputs, and outcomes of the ARWP. Content and suggestions for delivery of the eight curricular modules are detailed. The described ARWP is a novel innovation in Canadian postgraduate medical education. We believe this ARWP is the first comprehensive, formalized, actualized program in Canada. It also provides a guide and a helpful resource for further development of resident wellness programs by other disciplines in Canada and internationally.

Chalian, A. A. (2009). "Accomplishment and opportunity in geriatric otolaryngology." Ear, Nose and Throat Journal 88(10): 1156-1161.
	Geriatric otolaryngology is an emerging medical subspecialty developed in response to a pressing societal need. In this article, the author explains the rationale for this new subspecialty, reviews the landmark events that led to the creation of an organizational structure, celebrates the accomplishments that have been achieved thus far, and discusses the challenges that remain and the opportunities for future growth. © 2009, Vendome Group, LLC. All rights reserved.

Chalya, P. L., et al. (2014). "Ten-year experience with testicular cancer at a tertiary care hospital in a resource-limited setting: a single centre experience in Tanzania." World Journal of Surgical Oncology 12: 8.
	Background: Testicular cancers constitute major therapeutic challenges in resource-limited countries and still carry poor outcomes. There is a paucity of published data regarding testicular cancer in Tanzania, and Bugando Medical Centre in particular. This study describes the clinicopathological pattern, treatment outcome and challenges in the management of testicular cancer in our local setting. Methods: This was a retrospective study including all patients who had had histopathologically confirmed testicular cancer at Bugando Medical Centre between February 2004 and January 2014. Results: A total of 56 testicular cancer patients were enrolled in the study, representing 0.9% of all malignancies. The median age of patients at presentation was 28 years, with a peak incidence in the 21-to-30-year age group. A family history of testicular cancer was reported in four (5.4%) patients. A history of cryptorchidism was reported in six (10.7%) patients. Most patients (57.1%) presented late with an advanced stage of cancer. Testicular swelling was the main complaint in 48 (85.7%) patients. The right testis was involved in 67.9% of cases. Lymph node and distant metastases were documented in 10 (17.9%) and 12 (21.4%) patients, respectively. Histologically, 80.4% of patients had germ cell cancers, with seminoma accounting for 62.2% of cases. The most common surgical procedure was inguinal orchidectomy (77.4%). Adjuvant chemotherapy and radiotherapy were used in six (11.1%) and four (7.4%) patients, respectively. Eight (14.3%) patients died. The main predictors of mortality (P < 0.001) were patient's age (>65 years), late presentation (>6 months), stage of disease, and presence of metastasis at time of diagnosis. The mean follow-up period was 22 months. At the end of five years, only 18 (37.5%) patients were available for follow-up and the overall 5-year survival rate was 22.2%. The main predictors of 5-year survival rate (P < 0.001) were patients' age, stage of disease, and presence of lymph node and distant metastases. Conclusions: Testicular cancers, though rare in our setting, still carries a poor prognosis. Late presentation, poverty, paucity of resources and the high cost of newer imaging and treatment modalities are major challenges to management. Better health funding and education regarding testicular self-examination is essential.

Chamorro, A. and S. L. Tighe (2015). "Optimized Maintenance Standards for Unpaved Road Networks Based on Cost-Effectiveness Analysis." Transportation Research Record(2473): 56-65.
	Unpaved roads play a crucial role in the economic and social development of societies, linking rural communities to education, health services, and markets. The asset value of unpaved roads is low compared with national and provincial road networks, because agencies responsible for rural roads management lack the resources to assess and maintain the network properly. Lack of resources is especially critical in developing countries, where the majority of the population lives in rural areas and where few tools are available for sustainable management of the unpaved network. The main objective for this study was to develop and validate cost-effective maintenance standards for unpaved rural roads. The study was directed at improving the management process of unpaved road networks that serve rural populations. The scope was to develop maintenance standards that can be used by agencies in charge of network management, given available resources and technical skills. The developed four-step methodology evaluates an unpaved road network for 4 years, identifies the effects of maintenance treatments on the condition of roads from field data analysis, defines maintenance strategies, and develops optimal maintenance standards. The study was part of a 4-year project conducted at the University of Waterloo, in Ontario, Canada, that resulted in the development of a sustainable management system for rural road networks in developing countries. The proposed standards were applied and successfully validated and were demonstrated to be adaptable to varying climates, budgets, traffic, and road structures.

Chan, A., et al. (2015). "Self-Care for Older People (SCOPE): A cluster randomized controlled trial of self-care training and health outcomes in low-income elderly in Singapore." Contemporary Clinical Trials 41: 313-324.
	Population aging is associated with a higher prevalence of chronic health conditions. Previous studies have shown that older persons, specifically those with chronic conditions, often lack sufficient knowledge about their condition and thus frequently have poor self-care skills. Efforts to increase general health screenings and improve access to chronic condition management resources are hampered by a lack of disease and health awareness. Self-Care for Older People (SCOPE) study, a cluster randomized controlled trial in Singapore, was designed to evaluate the impact of a self-care program for chronic disease awareness and management of specific health measures and quality of life of older people over eighteen months. SCOPE provided self-care education targeted at older people with low income and low education in order to improve health-related knowledge. A total of 378 low-income older people with no or minimal disability, defined as having difficulty in one or more activities of daily living (ADL), were recruited from senior activity centers. The measurements taken included self-reported health conditions, health and disease knowledge questions, and biomarkers (HbA1c, blood pressure, peak expiratory flow, lipid panel, albumin, and creatinine). SCOPE was also designed to provide information for policy makers on chronic disease burden and healthcare facility utilization among community-dwelling older adults. (C) 2015 Elsevier Inc All rights reserved.

Chan, M. F., et al. (2003). "Computerization of clinical practice in Hong Kong: A study of Chinese medicine practitioners." Medical Informatics and the Internet in Medicine 28(1): 43-57.
	Primary objectives: To explore the current level of computerization in clinical practice in the Hong Kong Special Administrative Region through a population-based, Chinese medicine practitioner (CMP). Methods and procedures: A self-completed, one-page two-sided, questionnaire were sent to the sample via mail, and a second mailing was sent to those who had not replied after 14 days. The sample consisted of 3335 listed CMPs registered with the Chinese Medicine Council of Hong Kong in 2002. Main outcomes and results: We received 1036 questionnaires from this mailed survey. After deducting those who had moved (n=60), we calculated a response rate of 31.6%. Male respondents accounted for 81.8% (n=847) of replies, and 279 respondents (26.9%) had used computer in their practices. The present analyses provide evidence that CMPs' current overall level of knowledge and use of computers in clinical practice is far from optimal. At best, only about 6.5% and 8.4% of CMPs in the study sample had computerized 4-8 clinical and 3-6 administrative functions, respectively. Conclusions: In Hong Kong primary health care systems place much emphasis on quality outcomes and cost reduction. In order to achieve these goals, apparatus that allows greater accountability represents a means by which healthcare providers and policy makers can exercise greater control over healthcare services. Thus, implementation of computer systems in clinical practice can be seen as a prominent part of this overall philosophy. The present study has systematically documented the extent of clinical computer use in HK, identified areas for improvement, as well as specific groups of CMPs who might benefit from targeted efforts to promote computerization in practice for CMPs.

Chan, M. H., et al. (2015). "Challenges and opportunities to advance pediatric neuro-oncology care in the developing world." Childs Nervous System 31(8): 1227-1237.
	As the morbidity and mortality associated with communicable diseases continue to decrease in the developing world, the medical burden of childhood cancer continues to expand. Although international aid and relief groups such as the World Health Organization recognize the importance of childhood cancer, their main emphasis is on the more easily treated malignancies, such as leukemias and lymphomas, and not pediatric brain tumors, which are the second most common malignancy in children and the leading cause of cancer-related deaths in the pediatric population. Addressing the needs of these children is a growing concern of several professional neuro-oncology-related societies. Thus, the goal of this review is to describe the current state of pediatric neuro-oncology care in the developing world, address the current and future needs of the field, and help guide professional societies' efforts to contribute in a more holistic and multidisciplinary manner. We reviewed the literature to compare the availability of neuro-oncology care in various regions of the developing world with that in higher income nations, to describe examples of successful initiatives, and to present opportunities to improve care. The current challenges, previous successes, and future opportunities to improve neuro-oncology care are presented. The multidisciplinary nature of neuro-oncology depends on large teams of highly specialized individuals, including neuro-oncologists, neurosurgeons, neurologists, radiologists, radiation oncologists, pathologists, palliative care specialists, oncology nurses, physical therapists, occupational therapists, speech therapists, pediatric intensivists, and social workers, among others. Pediatric neuro-oncology is one of the most complex types of medical care to deliver, as it relies on numerous specialists, subspecialists, support staff, and physical resources and infrastructure. However, with increasing collaboration and advancing technologies, developed nations can help substantially improve neuro-oncology care for children in developing nations.

Chan, M. J., et al. (2016). "Compliance with risk management plan recommendations on laboratory monitoring of antitumor necrosis factor-alpha therapy in clinical practice." Journal of the Formosan Medical Association 115(2): 83-93.
	Background/Purpose: A risk management plan (RMP) was introduced to monitor the association between initiation of antitumor necrosis factor-alpha (anti-TNF-alpha) therapy and tuberculosis (TB) and viral hepatitis infections. The aim of this study was to assess adherence and predictors of laboratory-testing rates among patients treated with anti-TNF-alpha therapy. Methods: Data on patients receiving anti-TNF-alpha therapy between January 1, 2005, and November 31, 2013, were retrieved from a large medical organization in Taiwan. Newly-treated patients were categorized into pre- and post-RMP groups. Laboratory testing for TB and hepatitis B and C was ascertained and the proportion of new users receiving the test was compared between the pre- and post-RMP groups. Patient characteristics and concomitant medications used were investigated using multivariate logistic regression to determine the impact of each factor on laboratory testing. Results: Among 1128 new users, the initial testing rate of chest X-ray (CXR) for latent TB infection increased from 60.26% before RMP to 76.38% after RMP implementation; hepatitis B surface antigen (HBsAg) increased from 31.13% to 51.42%; and hepatitis C virus antibody (HCVAb) increased from 32.2% to 54.10%. CXR was significantly associated with age >60 years, higher Quan-Charlson comorbidity index score, psoriasis, and use of prednisolone (>= 7.5 mg/d). Patients aged 40-60 years and with prednisolone doses of >= 7.5 mg/d and history of cancer were more likely to receive HBsAg or HCVAb tests than their counterparts. Conclusion: The rate of laboratory test monitoring for anti-TNF-alpha therapy increased after RMP implementation. A strategy that integrates efforts from patient's education, health profession, and regulatory agencies is needed to improve safety screening and access to laboratory resources for the at-risk group of patients. Copyright (C) 2015, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.

Chan, T., et al. (2015). "Studying with the cloud: the use of online Web-based resources to augment a traditional study group format." Canadian Journal of Emergency Medicine 17(2): 192-195.
	Cloud-based applications such as Google Docs, Skype, Dropbox, and SugarSync are revolutionizing the way that we interact with the world. Members of the millennial generation (those born after 1980) are now becoming senior residents and junior attending physicians. We describe a novel technique combining Internet- and cloud-based methods to digitally augment the classic study group used by final-year residents studying for the Royal College of Physicians and Surgeons of Canada examination. This material was developed by residents and improved over the course of 18 months. This is an innovation report about a process for enhanced communication and collaboration as there has been little research to date regarding the augmentation of learner-driven initiatives with virtual resources.

Chan, T. M., et al. (2016). "Derivation of Two Critical Appraisal Scores for Trainees to Evaluate Online Educational Resources: A METRIQ Study." Western Journal of Emergency Medicine 17(5): 574-584.
	Introduction: Online education resources (OERs), like blogs and podcasts, increasingly augment or replace traditional medical education resources such as textbooks and lectures. Trainees' ability to evaluate these resources is poor, and few quality assessment aids have been developed to assist them. This study aimed to derive a quality evaluation instrument for this purpose. Methods: We used a three-phase methodology. In Phase 1, a previously derived list of 151 OER quality indicators was reduced to 13 items using data from published consensus-building studies (of medical educators, expert podcasters, and expert bloggers) and subsequent evaluation by our team. In Phase 2, these 13 items were converted to seven-point Likert scales used by trainee raters (n=40) to evaluate 39 OERs. The reliability and usability of these 13 rating items was determined using responses from trainee raters, and top items were used to create two OER quality evaluation instruments. In Phase 3, these instruments were compared to an external certification process (the ALiEM AIR certification) and the gestalt evaluation of the same 39 blog posts by 20 faculty educators. Results: Two quality-evaluation instruments were derived with fair inter-rater reliability: the METRIQ-8 Score (Inter class correlation coefficient [ICC]=0.30, p<0.001) and the METRIQ-5 Score (ICC=0.22, p<0.001). Both scores, when calculated using the derivation data, correlated with educator gestalt (Pearson's r=0.35, p=0.03 and r=0.41, p<0.01, respectively) and were related to increased odds of receiving an ALiEM AIR certification (odds ratio=1.28, p=0.03; OR=1.5, p=0.004, respectively). Conclusion: Two novel scoring instruments with adequate psychometric properties were derived to assist trainees in evaluating OER quality and correlated favourably with gestalt ratings of online educational resources by faculty educators. Further testing is needed to ensure these instruments are accurate when applied by trainees.

Chandra-Mouli, V., et al. (2015). "Programa Geração Biz, Mozambique: How did this adolescent health initiative grow from a pilot to a national programme, and what did it achieve? Adolescent Health." Reproductive Health 12(1).
	Adolescent sexual and reproductive health gained particular traction in Mozambique following the 1994 International Conference on Population and Development leading to the inception of Programa Geração Biz (PGB), a multi-sectoral initiative that was piloted starting in 1999 and fully scaled-up to all provinces by 2007. We conducted a systematic review of the literature to gather information on PGB and analyzed how it planned and managed the scale-up effort using the WHO-ExpandNet framework. PGB's activities comprised a clear and credible innovation. Appropriate resource and user organizations further facilitated national scale-up. Challenges relating to the complex nature of the multi-sectoral approach and resistance due to norms about adolescent sexual and reproductive health hindered scaling-up in some geographic areas. The national government exhibited commitment and ownership to PGB through budgetary support and integration into multiple policies. This study adds to the documentation of successful scaling-up strategies that can provide guidance for policy makers and programme managers. © 2015 Chandra-Mouli et al.; licensee BioMed Central.

Chandrasekhar, C. P. and J. Ghosh (2001). "Information and communication technologies and health in low income countries: the potential and the constraints." Bulletin of the World Health Organization 79(9): 850-855.
	This paper outlines the potential offered by technological progress in the information and communication technologies (ICTs) industries for the health sector in developing countries, presents some examples of positive experiences in India, and considers the difficulties in achieving this potential. The development of ICTs can bring about improvements in health in developing countries in at least three ways: as an instrument for continuing education they enable health workers to be informed of and trained in advances in knowledge; they can improve the delivery of health and disaster management services to poor and remote locations; and they can increase the transparency and efficiency of governance, which should, in turn, improve the availability and delivery of publicly provided health services. These potential benefits of ICTs do not necessarily require all the final beneficiaries to be reached directly, thus the cost of a given quantum of effect is reduced. Some current experiments in India, such as the use of Personal Digital Assistants by rural health workers in Rajasthan, the disaster management project in Maharashtra and the computerized village offices in Andhra Pradesh and Pondicherry, suggest creative ways of using ICTs to improve the health conditions of local people. However, the basic difficulties encountered in using ICTs for such purposes are: an inadequate physical infrastructure; insufficient access by the majority of the population to the hardware; and a lack of the requisite skills for using them. We highlight the substantial cost involved in providing wider access, and the problem of resource allocation in poor countries where basic infrastructure for health and education is still lacking. Educating health professionals in the possible uses of ICTs, and providing them with access and "connectivity", would in turn spread the benefits to a much wider set of final beneficiaries and might help reduce the digital divide.

Chandrashekhar, Y., et al. (2016). "Implementing Multimodality Imaging in the Future." Jacc: Cardiovascular Imaging 9(2): 91-98.
	
Chang, A., et al. (2014). "Complexity in Graduate Medical Education: A Collaborative Education Agenda for Internal Medicine and Geriatric Medicine." Journal of General Internal Medicine 29(6): 940-946.
	Internal medicine residents today face significant challenges in caring for an increasingly complex patient population within ever-changing education and health care environments. As a result, medical educators, health care system leaders, payers, and patients are demanding change and accountability in graduate medical education (GME). A 2012 Society of General Internal Medicine (SGIM) retreat identified medical education as an area for collaboration between internal medicine and geriatric medicine. The authors first determined a short-term research agenda for resident education by mapping selected internal medicine reporting milestones to geriatrics competencies, and listing available sample learner assessment tools. Next, the authors proposed a strategy for long-term collaboration in three priority areas in clinical medicine that are challenging for residents today: (1) team-based care, (2) transitions and readmissions, and (3) multi-morbidity. The short-term agenda focuses on learner assessment, while the long-term agenda allows for program evaluation and improvement. This model of collaboration in medical education combines the resources and expertise of internal medicine and geriatric medicine educators with the goal of increasing innovation and improving outcomes in GME targeting the needs of our residents and their patients. (C) Society of General Internal Medicine 2014

Chang, J., et al. (2014). "Evidence-based practice in the health and social services in china: Developments, strategies, and challenges." International Journal of Evidence-Based Healthcare 12(1): 17-24.
	For the past decade, healthcare professionals and decision makers in China have made efforts to promote the development of evidence-based practice (EBP) in medicine and health services. In recent years, attention has been given to the use of EBP among other nonmedical fields, such as social work and education. The purpose of this article is to explore the current and the future development of EBP in health and social services in China. We first presented a brief account of EBP development in the Chinese context. Then, based on a literature search, we explored empirical foundations that may support the development and advancement of EBP in China. We also elaborated on some barriers that inhibit the development of EBP, and proposed strategies that are in place to overcome these barriers. This article concludes with a discussion of perceived challenges to the development of EBP in health and social services in China. © 2014 University of Adelaide, Joanna Briggs Institute.

Chang, L. C. and C. H. Liu (2008). "Employee empowerment, innovative behavior and job productivity of public health nurses: a cross-sectional questionnaire survey." International Journal of Nursing Studies 45(10): 1442-1448.
	BACKGROUND: Employee empowerment is an important organizational issue. Empowered employees with new ideas and innovative attributes may increase their ability to respond more effectively to face extensive changes in current public health care work environments. OBJECTIVES: The objective of this study was to investigate the relationships between employee empowerment, innovative behaviors and job productivity of public health nurses (PHNs). DESIGN: This study conducted a cross-sectional research design. SETTINGS AND PARTICIPANTS: Purposive sampling was conducted from six health bureaus in northern Taiwan. 670 PHNs were approached and 576 valid questionnaires were collected, with a response rate of 85.9%. METHODS: Structured questionnaires were used to collect data by post. RESULTS: Meaning and competence subscales of psychological empowerment, information and opportunity subscales of organizational empowerment, and innovative behaviors were the predictors of job productivity, only accounting for 16.4% of the variance. The competence subscale of psychological empowerment made the most contribution to job productivity (beta = 0.31). Meaning subscale of psychological empowerment has a negative impact on job productivity. CONCLUSIONS: Employee empowerment and innovative behavior of PHNs have little influence on job productivity. Employees with greater competence for delivering public health showed higher self-evaluated job productivity. The negative influences on job productivity possibly caused by conflict meaning on public health among PHNs in current public health policy. It should be an issue in further researches. Public health department should strengthen continuing education to foster competence of psychological sense of empowerment and innovative behavior to increase job productivity

Chang, L. W., et al. (2012). "Information and communication technology and community-based health sciences training in Uganda: perceptions and experiences of educators and students." Informatics for Health & Social Care 37(1): 1-11.
	Information and communication technology (ICT) has been advocated as a powerful tool for improving health education in low-resource settings. However, few evaluations have been performed of ICT perceptions and user experiences in low-resource settings. During late 2009, an internet-based survey on ICT was administered to students, tutors, and faculty members associated with a Community-Based Education and Service (COBES) program in Uganda. 255 surveys were completed. Response rates varied (students, 188/684, 27.5%; tutors, 14/27, 51.9%; faculty, 53/335, 15.8%). Most respondents owned mobile phones (98%). Students were less likely (p < 0.001) to own laptops (25%) compared to tutors (71%) and faculty (85%). Internet access at rural sites was uncommon; mobile phone coverage was almost universally present. Laptop ownership and internet and mobile phone access was not associated with high valuation of students' COBES experiences. Free text responses found that respondents valued ICT access for research, learning, and communication purposes. In summary, ICT penetration in this population is primarily manifest by extensive mobile phone ownership. Internet access in rural educational sites is still lacking, but students and educators appear eager to utilize this resource if availability improves. ICT may offer a unique opportunity to improve the quality of teaching and learning for COBES participants.

Chang, V. W. and D. S. Lauderdale (2009). "Fundamental Cause Theory, Technological Innovation, and Health Disparities: The Case of Cholesterol in the Era of Statins." Journal of Health and Social Behavior 50(3): 245-260.
	Although fundamental cause theory has been highly influential in shaping the research literature on health disparities, there have been few empirical demonstrations of the theory, particularly in dynamic perspective. In this study, we examine how income disparities in cholesterol levels have changed with the emergence of statins, an expensive and potent new drug technology. Using nationally representative data from 1976 to 2004, we find that income gradients for cholesterol were initially positive, but then reversed and became negative in the era of statin use. While the advantaged were previously more likely to have high levels of cholesterol, they are now less likely. We consider our case study against a broader theoretical framework outlining the relationship between technology innovation and health disparities. We find that the influence of technologies on socioeconomic disparities is subject to two important modifiers: (1) the nature of the technological change and (2) the extent of its diffusion and adoption.

Chapin, R. K., et al. (2013). "Reclaiming Joy: Pilot Evaluation of a Mental Health Peer Support Program for Older Adults Who Receive Medicaid." Gerontologist 53(2): 345-352.
	Purpose: Stigma and lack of access to providers create barriers to mental health treatment for older adults living in the community. In order to address these barriers, we developed and evaluated a peer support intervention for older adults receiving Medicaid services. Design and Methods: Reclaiming Joy is a mental health intervention that pairs an older adult volunteer with a participant (older adult who receives peer support). Volunteers receive training on the strengths-based approach, mental health and aging, goal setting and attainment, community resources, and safety. Participantvolunteer pairs meet once a week for 10 weeks. Participants establish and work toward goals (e.g., better self-care, social engagement) that they feel would improve their mental health and well-being. Aging services agencies provide a part time person to manage the program, match volunteers and participants, and provide ongoing support. Outcomes evaluation for this pilot study included pre/postintervention assessments of participants. Results: Thirty-two participants completed the intervention. Pre/postassessment group means showed statistically significant improvement for depression but not for symptoms of anxiety. Quality-of-life indicators for health and functioning also improved for participants with symptoms of both depression and anxiety. Implications: The Reclaiming Joy peer support intervention has potential for reducing depression and increasing quality of life in low-income older adults who have physical health conditions. It is feasible to administer and sustain the intervention through collaborative efforts with minimal program resources and a small amount of technical assistance.

Chapman, C., et al. (2015). "Improving nutritional care: Innovation and good practice." Journal of Advanced Nursing 71(4): 881-894.
	Aims: This paper presents examples of good practice in nutritional screening and care and identifies methods used to overcome contextual constraints and discusses the implications for nursing practice in hospitals. Background: Nutritional screening is an important step in identifying those at risk of malnutrition, but does not produce improved nutritional care unless it results in a care plan that is acted on. The importance of nutrition and implications for clinical care make it imperative to improve practice. Design: Qualitative investigation. Methods: Between January 2011-February 2012, focus groups were held using a semi-structured discussion guide with nine groups of health professionals (n = 80) from one hospital: four with nurses, three with doctors and two with dietitians. Discussions were audio-recorded, transcribed and coded into themes and sub-themes, which were then depicted in a thematic map and illustrated with verbatim quotes. Findings: Three strategies for sustaining effective nutritional practice emerged: establishing routines to ensure screening was undertaken; re-organizing aspects of care to promote good practice; developing innovative approaches. Issues to be addressed were the perceived disconnection between mandatory screening and the delivery of effective care, a requirement for nutrition education, organizational constraints of a large university hospital and the complexities of multidisciplinary working. Conclusion: Professionals seeking to improve nutritional care in hospitals need to understand the interaction of system and person to facilitate change. Nursing staff need to be able to exercise autonomy and the hospital system must offer enough flexibility to allow wards to organize nutritional screening and care in a way that meets the needs of individual patients. © 2014 John Wiley & Sons Ltd.

Chapman, M., et al. (2004). "Innovations in technology for critical care medicine." Critical Care (London, England) 8(2): 74-76.
	This new section in Critical Care presents a selection of clinically important examples of advances in critical care health technology. This article is divided into two main areas: diagnostics and monitoring. Attention is given to how bedside echocardiography can alter the cardiovascular physical examination, and to novel imaging techniques such as virtual bronchoscopy. The monitoring section discusses recent claims of improved efficiency with telemedicine for intensive care units.

Charles, C., et al. (2011). "The evidence-based medicine model of clinical practice: Scientific teaching or belief-based preaching?" Journal of Evaluation in Clinical Practice 17(4): 597-605.
	Rationale Evidence-based medicine (EBM) is commonly advocated as a 'gold standard' of clinical practice. A prominent definition of EBM is: the integration of best research evidence with clinical expertise and patient values. Over time, various versions of a conceptual model or framework for implementing EBM (i.e. how to practice EBM) have been developed. Aims and objectives This paper (i) traces the evolution of the different versions of the conceptual model; (ii) tries to make explicit the underlying goals, assumptions and logic of the various versions by exploring the definitions and meaning of the components identified in each model, and the methods suggested for integrating these into clinical practice; and (iii) offers an analytic critique of the various model iterations. Methods A literature review was undertaken to identify, summarize, and compare the content of articles and books discussing EBM as a conceptual model to guide physicians in clinical practice. Results Our findings suggest that the EBM model of clinical practice, as it has evolved over time, is largely belief-based, because it is lacking in empirical evidence and theoretical support. The model is not well developed and articulated in terms of defining model components, justifying their inclusion and suggesting ways to integrate these in clinical practice. Conclusion These findings are significant because without a model that clearly defines what constitutes an EBM approach to clinical practice we cannot (i) consistently teach clinicians how to do it and (ii) evaluate whether it is being done. © 2010 Blackwell Publishing Ltd.

Charlton, R. (2000). "Innovations in medical education." Medical Education 34(1): 77.
	
Chatterjee, R., et al. (2015). "Oral Screening for Pre-cancerous Lesions Among Arses-nut Chewing Population from Rural India." Oral Health & Preventive Dentistry 13(6): 509-514.
	Purpose: To detect early oral premalignant lesions (OPLs) in a rural population chewing tobacco-free areca nut preparations, determine their awareness level of oral cancer and educate them about maintaining good oral health. Materials and Methods: A total of 2175 18- to 65-year-old areca nut chewers (male:female ratio 2.5:1), without a history of consuming tobacco in any form, from the villages of two districts of the West Bengal state of India were screened clinically through oral examination for suspected OPLs. A pre-designed questionnaire was employed to record demographic data, information on tobacco-free areca-nut chewing habit and knowledge about oral diseases. Education on oral health was provided through distribution of printed leaflets, display of banner/posters and a public-announcement system. Results: Chewing areca nut in the form of betel quid was more popular (90.7%) than chewing areca nut alone (9%) or tobacco-free packaged areca nut preparation sold as 'pan masala' (0.3%). OPLs were detected in 7.3% of the subjects, more among the males. An increasing incidence of OPLs could be observed with an increase in age as well as with duration and frequency of areca-nut chewing, while decreasing incidence was observed with an increase in educational level. Oral submucous fibrosis showed the highest prevalence (2.7%) among the various OPLs detected. Conclusions: Tobacco-free areca-nut chewing is an independent risk factor for the development of OPL and a large rural population still practices such high risk behaviour. In rural areas with limited health care resources, screening by visual oral examination involving minimum cost may prove useful to reduce oral cancer mortality.

Chaudhry, H. J. (2010). "The important role of medical licensure in the United States." Academic Medicine 85(11): 1657; author reply 1657-1658.
	
Chauhan, A. and R. P. Saini (2015). "Renewable energy based off-grid rural electrification in Uttarakhand state of India: Technology options, modelling method, barriers and recommendations." Renewable & Sustainable Energy Reviews 51: 662-681.
	Energy deficiency is one of the key enigmas impacting the livelihood of millions of poverty stricken people throughout the world. It is quite evident that electrification of rural areas can improve the standard of education, health conditions, living and empowering the youth of the nearby population. Uttarakhand state of India is mainly encompassing southern periphery of Himalayas. Census of India reveals that about 123 numbers of villages and 1966 numbers of village hamlets are still unelectrified in the state. Electrification of these villages/hamlets of remote hills using renewable energy resources in off -grid mode is a feasible option compared to uneconomical grid extension. State has identified small hydro power potential of 1500 MW, mean annual daily solar radiation of 4.5-5.5 kWh/m(2) with 300 sunny days in a year, enormous forest foliage, crop residue, animal waste and mean annual wind speed of 5-5.5 m/s in some places of the state. The present study comprises the utilization of single technology based system such as small hydro, biomass, biogas, solar and small wind turbines etc. and also aggregated technology, depending on the availability of the resources in the present locality. A methodological framework has been established to avail the demand and resources assessment of the area. Various barriers and issues are finally discussed, which leads to a greater obstacle, in the path of system implementation. In order to address these barriers and issues, suitable solutions are recommended in the present context. (C) 2015 Elsevier Ltd. All rights reserved.

Chavannes, N. H., et al. (2015). "Suggestions for health information technology trials for respiratory disorders in low- and middle-income country settings: what can we learn from trials in high-income country settings?" Npj Primary Care Respiratory Medicine 25: 4.
	Health Information Technology (HIT) is sometimes seen as a silver bullet for human resource, medical and economic challenges facing health systems. The evidence supporting widespread use of HIT is, however, still patchy and inconsistent. In this Perspective piece, we seek to interpret and draw key lessons from a selection of illustrative trials in developed countries with robust health-care settings in respiratory medicine that failed to demonstrate effectiveness, and offer suggestions to maximise the chances of success in subsequent HIT deployments. Particularly low-and middle-income countries, with relatively weak health infrastructures and limited health care, propose considerable room for improvement. Early experiences of studying HIT thus far in high-income country settings suggest that this process should preferably begin with trials of low-cost, well-established technologies in patient groups with a moderate burden of disease while carefully evaluating patient safety.

Chavarri-Guerra, Y., et al. (2012). "Breast cancer in Mexico: a growing challenge to health and the health system." Lancet Oncology 13(8): E335-E343.
	Breast cancer is a major public health issue in low-income and middle-income countries. In Mexico, incidence and mortality of breast cancer have risen in the past few decades. Changes in health-care policies in Mexico have incorporated programmes for access to early diagnosis and treatment of this disease. This Review outlines the status of breast cancer in Mexico, regarding demographics, access to care, and strategies to improve clinical outcomes. We identify factors that contribute to the existing disease burden, such as low mammography coverage, poor quality control, limited access to diagnosis and treatment, and insufficient physical and human resources for clinical care.

Cheesman, S. and L. Horton (2010). "Does simple creativity change your response to the cold, hard facts?" South Carolina Nurse 17(2): 7.
	
Cheever, L. W. (2014). "Transforming the health care workforce through partnerships." Academic Medicine 89(8 Suppl): S8.
	
Chen, C., et al. (2014). "Physician tracking in sub-Saharan Africa: current initiatives and opportunities." Human Resources for Health 12: 6.
	Background: Physician tracking systems are critical for health workforce planning as well as for activities to ensure quality health care - such as physician regulation, education, and emergency response. However, information on current systems for physician tracking in sub-Saharan Africa is limited. The objective of this study is to provide information on the current state of physician tracking systems in the region, highlighting emerging themes and innovative practices. Methods: This study included a review of the literature, an online search for physician licensing systems, and a document review of publicly available physician registration forms for sub-Saharan African countries. Primary data on physician tracking activities was collected as part of the Medical Education Partnership Initiative (MEPI) - through two rounds over two years of annual surveys to 13 medical schools in 12 sub-Saharan countries. Two innovations were identified during two MEPI school site visits in Uganda and Ghana. Results: Out of twelve countries, nine had existing frameworks for physician tracking through licensing requirements. Most countries collected basic demographic information: name, address, date of birth, nationality/citizenship, and training institution. Practice information was less frequently collected. The most frequently collected practice fields were specialty/ degree and current title/position. Location of employment and name and sector of current employer were less frequently collected. Many medical schools are taking steps to implement graduate tracking systems. We also highlight two innovative practices: mobile technology access to physician registries in Uganda and MDNet, a public-private partnership providing free mobile-to-mobile voice and text messages to all doctors registered with the Ghana Medical Association. Conclusion: While physician tracking systems vary widely between countries and a number of challenges remain, there appears to be increasing interest in developing these systems and many innovative developments in the area. Opportunities exist to expand these systems in a more coordinated manner that will ultimately lead to better workforce planning, implementation of the workforce, and better health.

Chen, C., et al. (2012). "A survey of Sub-Saharan African medical schools." Human Resources for Health 10: 23.
	Background: Sub-Saharan Africa suffers a disproportionate share of the world's burden of disease while having some of the world's greatest health care workforce shortages. Doctors are an important component of any high functioning health care system. However, efforts to strengthen the doctor workforce in the region have been limited by a small number of medical schools with limited enrolments, international migration of graduates, poor geographic distribution of doctors, and insufficient data on medical schools. The goal of the Sub-Saharan African Medical Schools Study (SAMSS) is to increase the level of understanding and expand the baseline data on medical schools in the region. Methods: The SAMSS survey is a descriptive survey study of Sub-Saharan African medical schools. The survey instrument included quantitative and qualitative questions focused on institutional characteristics, student profiles, curricula, post-graduate medical education, teaching staff, resources, barriers to capacity expansion, educational innovations, and external relationships with government and non-governmental organizations. Surveys were sent via e-mail to medical school deans or officials designated by the dean. Analysis is both descriptive and multivariable. Results: Surveys were distributed to 146 medical schools in 40 of 48 Sub-Saharan African countries. One hundred and five responses were received (72% response rate). An additional 23 schools were identified after the close of the survey period. Fifty-eight respondents have been founded since 1990, including 22 private schools. Enrolments for medical schools range from 2 to 1800 and graduates range from 4 to 384. Seventy-three percent of respondents (n = 64) increased first year enrolments in the past five years. On average, 26% of respondents' graduates were reported to migrate out of the country within five years of graduation (n = 68). The most significant reported barriers to increasing the number of graduates, and improving quality, related to infrastructure and faculty limitations, respectively. Significant correlations were seen between schools implementing increased faculty salaries and bonuses, and lower percentage loss of faculty over the previous five years (P = 0.018); strengthened institutional research tools (P = 0.00015) and funded faculty research time (P = 0.045) and greater faculty involvement in research; and country compulsory service requirements (P = 0.039), a moderate number (1-5) of post-graduate medical education programs (P = 0.016) and francophone schools (P = 0.016) and greater rural general practice after graduation. Conclusions: The results of the SAMSS survey increases the level of data and understanding of medical schools in Sub-Saharan Africa. This data serves as a baseline for future research, policies and investment in the health care workforce in the region which will be necessary for improving health.

Chen, H. S., et al. (2001). "Review of telemedicine projects in Taiwan." International Journal of Medical Informatics 61(2-3): 117-129.
	Taiwan is a heavily populated country, with a small land area and many mountains and isolated islands. Because medical resources are unequally distributed, high quality accessible medical care is a major problem in rural areas. Medical personnel are unwilling to practice in rural areas because of fear of isolation from peers and lack of continuing medical education (CME) in those areas. Telemedicine provides a timeless and spaceless measure for teleconsultation and education. The development of telemedicine in Taiwan began under the National Information Infrastructure (NII) project, Distance education and teleconsultation were the first experimental projects during the initiation research stage. The cost and effectiveness of the hardware and network bandwidth were evaluated. In the promotion research stage, applications in different medical disciplines were tested to promote multipoint videoconference, electronic journals and VOD. Investigation of user satisfaction put on more emphasis on improving application functions. In 1998, a new Cyber Medical Center (CMC) international collaboration project was begun, integrating technologies of multimedia, networking, database management, and the World Wide Web. The aim of the CMC is to create a multimedia network system for the management of electronic patient records, teleconsultation, online continuing medical education, and information services on the web. A Taiwan mirror site of Virtual Hospital and two international telemedicine trials through Next Generation Internet (NGI) were done at the end of 1998. In the future, telemedicine systems ill Taiwan are expected to combine the Internet and broadband CATV, ADSL, and DBS networking to connect clinics, hospitals, insurance organizations, and public health administrations; and, finally, to extend to every household. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.

Chen, H. S., et al. (1999). "Recent advances in telemedicine." Journal of the Formosan Medical Association 98(11): 767-772.
	With continuing advances in information technology, the applications of computers in medicine are increasing rapidly. Modern information technology not only affects the delivery of health tare, but also significantly influences the doctor-patient relationship. Since the 1990s, technologic developments in high-band width telecommunications systems and digitizing devices have led to a surge of interest in telemedicine. In recent years, the Internet, with its powerful penetration and scalability, has become an increasingly popular medical information resource and a new platform for telemedicine. The impact of modern technology on the advancement of telemedicine in Taiwan started with the 1995 National Information Infrastructure project, which uses networks of different bandwidths for teleconsultation and distance education programs. In 1998, National Taiwan University and Taipei Medical College in Taiwan, and the University of Pittsburgh and the University of Iowa in the USA, began cooperation on a new Cyber Medical Center (CMC) project that integrates the technologies of multimedia, database management, a multiple-site videoconferencing system, and the World Wide Web. The aim of the CMC is to create a multimedia network system for the management of electronic patient records, teleconsultation, online continuing medical education, and information services on the Web. In the future, telemedicine systems in Taiwan are expected to combine the Internet and cable television to connect clinics, hospitals, insurance organizations, and public health administrations; and, finally, to extend health services to every household.

Chen, H. Y. and L. C. Chen (2010). "Implementation of Innovative Pharmacogenetic Tests into Practice in Taiwan: An Institutional Perspective." Drug Development Research 71(8): 502-506.
	Pharmacogenetic tests are proposed as a means of targeting therapy to patients such that ineffective medicine prescription and adverse events are reduced and overall benefit in terms of improved health outcomes is maximized. However, the true impact of introducing pharmacogenetic tests into clinical practice remains to be confirmed. This commentary presents some of the key requirements in developing a pharmacogenetic clinical practice model in a hospital setting. The analysis considers the need to select carefully which pharmacogenetic tests are best offered, while balancing the cost to the institution given the potential benefits to the patient population base. Drawing on our experience in Taiwan, we recommend that developing a hospital task force for pharmacogenetic testing is a recommended approach to: (1) set quality standards on how best to conduct the test, (2) provide a pro forma for interpreting results, (3) prescribe treatment appropriately according to results, and (4) design an educational program for all relevant health care team members. To further support the implementation of pharmacogenetic testing in the hospital setting, it is necessary to promote audit of clinical practice by building hospital-based registries to facilitate the collection of health care resource use and outcome data that records the clinical uptake of testing. We suggest that well-conducted economic evaluations, relevant to local practice, are essential pieces of information to guide institutional decision making on how best to develop the appropriate use of pharmacogenetic tests in clinical practice. Drug Dev Res 71:502-506, 2010. (C) 2010 Wiley-Liss, Inc.

Chen, J., et al. (2016). "Comparison of traditional Chinese medicine education between mainland China and Australia-a case study." Journal of Integrative Medicine-Jim 14(4): 291-296.
	OBJECTIVE: To analyze and compare the curriculum and delivery of a Chinese and Australian university-level Chinese medicine program. METHODS: A review of PubMed and the Chinese National Knowledge Infrastructure for relevant educational papers was undertaken. Online and paper documents available at the University of Technology Sydney (UTS) and the Chengdu University of Traditional Chinese Medicine (CDUTCM) were read and analyzed. In addition, in-depth interviews with academics from the two universities were conducted during 2014 to 2015. RESULTS: The two Chinese medicine programs share the common goal of providing health services to the local community, but differ in some aspects when the curricula are compared. Areas such as student profile, curriculum structure, teaching approaches and education quality assurance were found to be different. The UTS program adopts a "flipped learning" approach with the use of educational technology aiming at improving learning outcomes. On the other hand, the CDUTCM has better clinical facilities and specialist physician resources. CONCLUSION: A better understanding of the different curricula and approaches to Chinese medicine education will facilitate student learning and educational outcomes.

Chen, J., et al. (2014). "Exploring Contextual Factors and Patient Activation: Evidence From a Nationally Representative Sample of Patients With Depression." Health Education & Behavior 41(6): 614-624.
	Patient activation has been considered as a blockbuster drug of the century. Patients with mental disorders are less activated compared to patients with other chronic diseases. Low activation due to mental disorders can affect the efficiency of treatment of other comorbidities. Contextual factors are significantly associated with mental health care access and utilization. However, evidence of their association with patient activation is still lacking. Using data from the Health Tracking Household Survey 2007 and Area Health Resource File 2008, we examine the association between contextual factors and self-reported activation levels among patients with depression. We investigate two types of contextual factors(a) site of usual source of care and (b) community characteristics, measured by mental health care resources availability, population demographics, and socioeconomic characteristics at the county level. Results show significant variation in activation levels by contextual factors. The availability of community mental health centers, lower proportion of foreign-born individuals, and higher income in the local community are associated with higher patient activation. Our results also show that depressed patients having a usual source of care at a physician's office have significantly higher patient activation levels than those with a usual source of care in the emergency department or hospital outpatient clinics. Results suggest that primary care setting is critical to having a sustained relationship between patients and physicians in order to enhance patient engagement in mental health care. Interventions in communities with low income and high immigrant populations are necessary.

Chen, K. Z., et al. (2015). "Resolving Bottlenecks: Converting Three High-Enrollment Nursing Courses to an Online Format." Journal of Nursing Education 54(7): 404-408.
	BACKGROUND: Converting large undergraduate classes from the classroom to online has been an effective way to increase enrollments in high-demand courses in undergraduate education. However, challenges exist to maintaining students' high-quality learning interaction and engagement in large online courses. This article presents a collaborative model between faculty in health sciences and instructional designers to redesign and redevelop three high-enrollment courses to online at Boise State University.
METHOD: Health studies course faculty and eCampus instructional designers conducted this study to reflect the collaborative online course development process at Boise State.
RESULTS: The offering of high-enrollment nursing courses met enrollment demand and maintained student retention. Challenges related to instruction were addressed by using a careful course redesign process and continuous improvement.
CONCLUSION: Implications of this educational innovation for health science educators, instructional designers, and lessons learned are provided.Copyright 2015, SLACK Incorporated.

Chen, L. S. and P. Goodson (2009). "Barriers to adopting genomics into public health education: a mixed methods study." Genetics in Medicine 11(2): 104-110.
	Purpose: To examine public health educators' perceptions of barriers to incorporate genomic content (information, discoveries, technologies) into health promotion. Methods: Mixed methods (qualitative and quantitative approaches)- using a fully mixed sequential dominant status design-were employed. Qualitative data were collected from a convenient sample of 24 public health educators, through personal interviews. Quantitative data, from a nation-wide sample of 1607 professionals (from four professional organizations/groups), were collected through a Web-based survey (adjusted response rate = 23.1%). Content analysis guided the interpretation of the qualitative data; descriptive statistics were used to analyze the survey data and to compare prevalence of themes across the qualitative and survey samples. Results: Specific barriers highlighted by the qualitative and the survey samples included lack of genomic knowledge (basic and applied), having to deal with the lay public's reaction, lack of priority, time and resources, and incompatibility between genomics and public health educators' religious and ethical beliefs. Conclusion: This study suggests that public health educators perceive numerous barriers to incorporating genomics into health promotion. More research is needed to confirm this study's findings, to explore potential sources, and to propose viable strategies to overcome many of these barriers. Genet Med 2009:11(2):104-110.

Chen, L. S., et al. (2008). "US health educators' likelihood of adopting genomic competencies into health promotion." American Journal of Public Health 98(9): 1651-1657.
	Objectives. We examined