College crisis intervention: an initiative to develop regional campus Critical Incident Stress Management teams

This article presents a statewide initiative that was undertaken to develop regional Critical Incident Stress Management (CISM) teams among colleges and universities within a northeastern state. In light of the unique needs and culture of institutions of higher education, this initiative was intended to improve each member college or university's capacity to respond comprehensively and effectively to critical incidents that affect its community. A step-by-step description of the implementation of the initiative is presented as well as discussion of what was learned through the process and future directions.

Employee perceptions of diabetes education needs: a focus group study

The purpose of this descriptive non-experimental research was to assess employee perceptions of desired diabetes education through focus groups. Thirteen employees of a southern university in three focus groups identified many standard and some emerging educational topics of interest including healthier food choices when eating out, increasing activity, deciding whether highly advertised "special" products for diabetes were necessary, and recognizing the importance of obesity among children. The employees were willing to attend group meetings related to diabetes, but not to pay for them. The information will be used to plan an intervention to promote diabetes prevention and self-management in a worksite environment where diabetes costs are rising rapidly, and to support the need for a university wellness program. Occupational health nurses can address both employees' needs and employers' costs through such a program.

Anti-smoking campaign in Multan, Pakistan

Smoking is a serious public health concern, particularly among young people. This communication describes an anti-smoking campaign targeted at the students of Nishtar Medical College and Bahauddin Zakariya University in Multan. The aim was to promote sports and discourage smoking though community participation and mobilization. A mixed media strategy was adopted and information and education materials were developed. A seminar was held giving information on smoking, its hazards, quitting strategies and experiences. This was followed by a cricket match played between the students at which further brochures were distributed and slogans displayed. The activity was very successful and succeeded in mobilizing the community and putting over the anti-smoking message. Such events could be used to promote other issues related to lifestyle.

Radiosurgery in the Treatment of Malignant Gliomas: The University of Florida Experience

OBJECTIVE:

To review a single-institution's 12-year experience of treating malignant gliomas with linear accelerator-based radiosurgery.

METHODS:

One hundred patients were treated for malignant gliomas at the University of Florida between May 1, 1989, and June 12, 2002. Patient variables were entered into a radiosurgery database in a prospective manner. The endpoint of the study was length of survival from the time of diagnosis. The minimum length of follow-up was 18 months or until death. In an attempt to control for selection bias, we used the Radiation Oncology Therapy Group's (RTOG) recursive partitioning categories to compare survival in our group of radiosurgically boosted patients with the RTOG historical database.

RESULTS:

Recursive partitioning analysis classification was significantly associated with survival. Compared with historical controls, this cohort of patients demonstrated a decreased survival for recursive partitioning analysis Class I and II patients, similar survival for Class III and IV patients, and increased median survival for Class V patients. Other variables demonstrating a statistically significant impact on survival were eloquent location and recurrent disease.

CONCLUSION:

The results of this study and those of RTOG 93-05 suggest that the reported benefit of upfront radiosurgical boost for malignant gliomas is the result of selection bias. The possibility remains that radiosurgical boost is of benefit in recurrent tumors, especially those in RTOG Class V.

College campus smoking policies and programs and students' smoking behaviors

Background

Although tobacco use in the United States has declined over the past 20 years, cigarette use among college students remains high. Additional research is thus needed to determine how university tobacco control policies and preventive education programs affect college students' smoking behaviors.

Methods

Approximately 13,000 undergraduate students at 12 universities or colleges in the state of Texas completed a web-based survey. College smoking policies were obtained from a survey of college administrators and from college websites. Logistic regression analyses were conducted to estimate the effects of individual smoking policies and programs on the odds of cigarette smoking.

Results

Of the individual programs, only having a preventive education program on campus was associated with lower odds of smoking. The existence of smoking cessation programs and designated smoking areas were associated with higher odds of smoking. Policies governing the sale and distribution of cigarettes were insignificantly associated with smoking.

Conclusion

Rather than focusing on policies restricting cigarette sales and use, college administrators should consider implementing or expanding tobacco prevention and education programs to further reduce student smoking rates.

Addressing the needs of lesbian, gay, bisexual, transgendered, queer, and questioning clients within university psychiatric services: reflections and recommendations

Concerns still exist among lesbian-, gay-, bisexual-, transgendered-, and queer-identified individuals (LGBTQ individuals) about their reception and treatment by psychiatric service providers. The Psychiatric Service at the University of Toronto and the Office of LGBTQ Resources and Programs convened a committee to address expanding the capacities of the Service related to the needs of LGBTQ and questioning students. In this paper, we describe the committee's role, initiatives, and successes and discuss challenges encountered in the process. The model of community development drawn from in this work can be adapted for use in other community health settings.

Academic incentives for students can increase participation in and effectiveness of a physical activity program

The authors sought to determine whether a greater academic incentive would improve the effectiveness and student adherence to a 12-week voluntary exercise program designed to decrease students' percentage of body fat. They randomly assigned 210 students to 1 of 2 groups with different academic reward structures. The group with the greater reward structure showed better exercise adherence and lost more body fat than those without the additional incentive. These findings suggest that an academic incentive can increase overall student adherence to a voluntary exercise program and can boost the effectiveness of the program in a university environment. The findings also have potential implications for on-campus promotion of physical activity.

Responses of US college and university student health services to the 2004 influenza vaccine shortage

The United States experienced a shortage of influenza vaccine for the 2004--2005 influenza season. The authors surveyed college health programs to determine whether they had targeted vaccine to priority groups and knew how to reallocate remaining vaccine. They used an electronic message to distribute a Web-based survey to the members of 3 college-affiliated organizations--the Association of American Colleges and Universities, American Association of Community Colleges, American College Health Association--and to subscribers of the Student Health Service Listserv. They received 434 completed surveys. Sixty percent (259) of the respondents stated they had received vaccine and planned to vaccinate their high-risk students, staff, and faculty members; 77% (198) planned to reallocate leftover vaccine. Given the potential for future disruptions of the influenza vaccine supply, the authors recommend that college health programs establish policies to identify members of their high-risk population and also consider providing the live attenuated influenza virus vaccine.

Use of email for patient communication in student health care: a cross-sectional study

BACKGROUND

Citizens increasingly use email in personal communication. It is not however clear to what extent physicians utilize it for patient communication. Our study was designed to examine physicians' activity in using email and to estimate the proportion of email messages missing from documentation in electronic patient records (EPR).

METHODS

All physicians (n = 76; 48 general practitioners and 28 specialists) at the Finnish Student Health Service received a questionnaire by email, and were asked to print it and keep a daily tally of visits, phone calls and email messages over the study period of one working week (5.5.-9.5.2003). The response rate was 70%. The data originating from the questionnaire were compared with statistical data from the EPR during the study period.

RESULTS

The majority (79%, 41/52) of doctors reported using email with patients, averaging 8.6 (range: 0-96) email contacts and a percentage rate of "email / visit" 20% (range: 0-185%) in one working week. Doctors in the capital city region and those doctors who had a positive attitude toward email for patient communication were most active in email use. Up to 73% of email contacts were not documented in the EPR.

CONCLUSION

The activity in using email with patients verified among Finnish physicians is compatible with recent study results elsewhere. The notable proportion of un-recorded email messages establishes the need for an electric communication system built into the EPR to improve the quality of patient care and to limit medico-legal risks.

Alcohol policies on college campuses

State and local alcohol policies can minimize opportunities for people to use alcohol, thereby reducing consumption and alcohol-related problems. Little is known, however, about the prevalence of campus policies aimed at reducing college students' alcohol use and related problems. The authors surveyed school administrators in Minnesota and Wisconsin to assess the frequency of alcohol policies and whether institutional characteristics were likely to predict campus policies. They also compared administrators' responses to policies posted on college Web sites. Most schools prohibited beer kegs and provided alcohol-free housing for students. A minority of schools prohibited all alcohol use on campus or at Greek organizations or banned advertisements in school newspapers for alcohol or off-campus bars. The prevalence of policies varied with school characteristics, and agreement was poor between Web-site policy information and that provided by administrators. Further research on the prevalence of college alcohol policies might be useful for assessing trends and future prevention needs on campuses.

A collaborative approach to nutrition education for college students

It is well established in the literature that college students have poor eating habits and that many barriers exist to achieving optimal nutrition for this busy population. Little is known about students' perceptions of this problem or suggestions for improving their dietary habits. Similarly, college health professionals need innovative approaches to nutritional education. In an effort to develop an online nutrition resource specifically geared to college students, the authors assessed the availability of Internet-based nutritional information for this population and conducted focus groups with students and health professionals to identify relevant nutrition concerns. They used concept-mapping techniques to conduct a systematic analysis of the qualitative information generated from their focus group participants. Their findings emphasize the need for targeted resources for college students and the importance of using students' suggestions in developing nutrition programs.

Mental health services for residents: more important than ever

The mental health of physicians in training is a topic of considerable concern. Recent attention to the issue of patient safety has led to examination of the relationship between residents' stress and compromised clinical performance. Few mental health programs dedicated to residents and formally structured to meet their specific needs are reported in the literature. The authors raise the question of why there are so few programs and why more residents don't take advantage of services that do exist. They then describe the development and utilization of the University of Michigan Health System's House Officer Mental Health Program. The program was structured to overcome barriers to utilization such as lack of funding, concerns about confidentiality, ease of access and residents' financial constraints and to provide comprehensive services for a wide range of diagnoses. Data are presented on the first four years of operation from 1997-01 that show increasing utilization and high levels of satisfaction over this time period by house officers at all levels of training and in all departments of the Health System. As increasing attention is paid to how to deal with medical errors, the establishment of such programs should be considered, not only as a means to address the general mental health of residents but also as an appropriate venue to deal with the stress that can contribute to and be induced by medical mishaps.

University Health Network framework for advanced nursing practice: development of a comprehensive conceptual framework describing the multidimensional contributions of advanced practice nurses

BACKGROUND

The global paradigm shift resulting from radical transformations in knowledge and technology is significantly changing the context of healthcare delivery. In this changing environment, the contributions of health professions are vital in ensuring that the healthcare system adapts to meet the needs of today's patient. Advanced practice nurses (APNs) are clinical scholars and leaders in creating innovative approaches to patient care and organizational and professional leadership.

AIMS

To develop a comprehensive conceptual framework for advanced nursing practice at University Health Network that will enhance role clarity by describing the complexity of these nursing roles and the significant contributions they make to patients and the healthcare system.

METHODS

A critical review of the literature and a consultative process were undertaken to build consensus and develop a comprehensive framework for advanced nursing practice.

RESULTS

The development of the University Health Network Framework for Advanced Nursing Practice (UHN-FANP), which clearly articulates all dimensions of advanced nursing practice roles.

CONCLUSION

As clinical leadership roles in nursing continue to evolve, utilization of a conceptual framework facilitates role clarity, role implementation and role evaluation.

Moving to paperlessness: a case study from a large general practice

This case study reports the reasons why this large, multi-site general practice decided to move towards paperless practice in late 2001, and describes the progress and lessons learned to date. The principal operational reasons for this decision were problems associated with moving paper medical records between surgeries, and the realisation that resources to improve the computerised medical record could only come from redeploying the time spent handling paper records. A comprehensive plan was put in place to shift toward paperlessness. Motivating and changing working practices for clinical and support staff was as a great a challenge as upgrading the technology. The practice upgraded its computer system, and has installed scanning and automated generation of referral and other letters. The support staff skills have evolved from moving records to scanning documents and coding data. All clinical staff now consult on their computer, and code diagnoses and key clinical data. A networked digital dictation system allows typing to be centralised at one location, with the networking allowing printing at any site. Audit and quality improvement activities have increased, as the output from computer searches increasingly represents the quality of care provided. The implications of this case study are that a committed general practice can achieve a largely paperless environment in approximately two years. The practice is now fit to be part of any move towards integration of records within its local health community, and can demonstrate from its computer records that it meets the quality targets for primary care.