132 research outputs found
S.N. Eisenstadt, L. Roniger, A. Seligman, eds—Centre Formation, Protest Movements, and Class Structure in Europe and the United States. | ...
David Montgomery - Citizen Worker: The Experience of Workers in the United States with Democracy and the Free Market During the Nineteenth Century
The City and Community: The Impact of Urban Forces on Working Class Behavior
http://deepblue.lib.umich.edu/bitstream/2027.42/50918/1/143.pd
Development of a post-fall multidisciplinary checklist to evaluate the in-patient fall
Background: Falls suffered by hospitalized patients are an important reportable event. Approximately 4 - 6 % of inpatient falls result in serious injury. Recurrent falls or delayed recognition of injury can harm patients and represents a medico-legal risk. In 2010, our tertiary-care academic medical center reviewed current practice regarding falls prevention and assessment to develop a comprehensive falls prevention program. The committee found that there was no consistent practice in the assessment by nurses or physicians of inpatients who had fallen, either for injury or for conditions which might have led to the fall. A new systematic checklist for evaluation of the hospital faller was developed by a team consisting of nursing, hospitalists, and a medical unit director. Purpose: To develop an evidence-based multi-disciplinary checklist to facilitate evaluation, implementation of secondary prevention interventions and documentation following a hospital fall. Description: The hospitalist and the general medical unit director reviewed relevant literature, consulted national experts, and drafted a multidisciplinary checklist, the UNMH Post-Fall/Huddle Tool, to be used by nurses and physicians in post-fall patient evaluation. The checklist was reviewed and revised with further input from key stakeholders including hospitalists, housestaff, and the adult Medical/Surgical Shared Governance Committee. It was implemented as part of a comprehensive falls prevention program 3 month pilot. The checklist prompts a three step process: (1) an initial 7-item assessment by nursing staff to determine factors which would necessitate immediate evaluation by cross-covering physicians versus deferring evaluation to the primary team; (2) a 5-item focused physical examination to be performed by a physician to assess the likelihood of injury and suggested diagnostic tests based on this examination; and (3) an interdisciplinary face-to-face meeting between the evaluating physician and nurse to review 7 specific possible precipitating events and implement potential interventions. The UNMH Post-Fall/Huddle Tool will be adapted into the electronic health record after pilot completion and evaluation. An educational presentation about falls and how to use the checklist was developed for residents and hospitalists. Use of the checklist was implemented in November, 2010. To date, nurses and residents report that the checklist is easy to use and that it facilitates a timely, multidisciplinary evaluation of patients who have fallen in the hospital. Conclusion: A multi-disciplinary post-fall checklist facilitates a consistent and evidence-based evaluation and treatment of patients who have fallen in the hospital
Junior faculty exchange program assists mid-career clinician-educators increase scholarly activity and meet promotion requirements
Project: Our institution requires peer-review scholarly products and an extramural reputation for promotion of clinician-educators to Associate Professor. Given a lack of robust research skill training during residency and a paucity of research mentors in our Division of Hospital Medicine, meeting these two promotion requirements has been especially challenging for many of our hospitalist faculty. We established a junior faculty exchange with other institutions in order to assist individual faculty members to gain a reputation outside of their home institutions, to develop external mentorship and career advice relationships with early career faculty, and to enhance networking and project collaborations. Methods: Participants were mid-career faculty who would gain the maximal career benefit from delivering an invited visit to an external institution and who have sufficient track record to deliver effective mentoring advice to early career hospitalists. Faculty at the late Assistant Professor level or recently promoted Associate Professors were selected by their Divisions leadership to spend one day at a hosting institution, deliver an invited grand rounds or similar didactic presentation, meet with senior leadership, and provide career advice to junior faculty. The program was reciprocal with one faculty member visiting an institution in exchange for that institution hosting a faculty member for a similar invited visit. Each institution covered the cost of travel and hotel accommodations. No honoraria were paid. Results: Over the first two years, four junior academic hospitalists were exchanged between three institutions. There was a high degree of satisfaction among surveyed visiting and visited junior faculty. Two on-going collaborative relationships and one jointly authored paper have resulted to date. Conclusion: A junior faculty exchange program assisted mid-career academic hospitalists establish extramural collaborations and meet promotion requirements that have been problematic at our institution. Implication: This relatively inexpensive faculty development program is easily adaptable by other institutions and may help generalist faculty increase scholarly activity, develop extra-institutional relationships, and achieve promotion.\u2
From Common Lands to Second Nature: The Scholarship of Richard W. Judd and the Future of Eastern Environmental History
Renowned environmental historian, Richard Judd, retired from teaching at the University of Maine, May 2018. Professor Judd was one of the UMaine History Department’s most prolific scholars and helped build numerous connections between the sciences and the humanities at UMaine in addition to being a significant force within the interdisciplinary field of environmental history itself for the past three decades.
Professor Judd authored dozens of books and articles related to conservation; environmental thought; and the traditional farming, hunting, fishing, and logging cultures of Maine and northern New England. He also served as an editor for a number of projects—most notably among them, the Historical Atlas of Maine—as well as the Journal of Forest History and Maine History.
To celebrate and discuss the significance of Professor Judd’s career, some of his current and former students organized a panel discussion featuring five forward-thinking scholars within eastern environmental history. Brian Payne, a former student of Judd’s and a professor of history at Bridgewater State discusses how Judd influenced him as a mentor and introduced him to the field of environmental history. Kate Viens, director of research at the Massachusetts Historical Society, expands on Payne’s comments about Judd’s influence as an educator, discussing the implications of his work to the field of public history in addition to her own graduate research. Matthew McKenzie, professor of history at University of Connecticut and New England Fisheries Management Council appointee, discusses the way in which Judd’s environmental history work intersects with both the sciences and social history and brings new insights to the environmental recovery within many areas of New England over the last several decades. John Cumbler, professor emeritus of history at the University of Louisville and current history faculty at Suffolk University explores, in greater depth, Judd’s contributions to a social-environmental history hybrid field and his work as indicative of environmental history’s emergence from labor and social history. Brian Donahue, chair of the environmental studies program at Brandeis University and director of the Working Landscapes program at Harvard Forest, discusses the ways in which Judd broke new ground within the field of environmental history by highlighting through his research the conservation efforts of ordinary rural people
Impact of a tailored program on the implementation of evidence-based recommendations for multimorbid patients with polypharmacy in primary care practices — results of a cluster-randomized controlled trial
Background: Multimorbid patients receiving polypharmacy represent a growing population at high risk for negative health outcomes. Tailoring is an approach of systematic intervention development taking account of previously identified determinants of practice. The aim of this study was to assess the effect of a tailored program to improve the implementation of three important processes of care for this patient group: (a) structured medication counseling including brown bag reviews, (b) the use of medication lists, and (c) structured medication reviews to reduce potentially inappropriate medication. Methods: We conducted a cluster-randomized controlled trial with a follow-up time of 9 months. Participants were general practitioners (GPs) organized in quality circles and participating in a GP-centered care contract of a German health insurance. Patients aged >50 years, suffering from at least 3 chronic diseases, receiving more than 4 drugs, and being at high risk for medication-related events according to the assessment of the treating GP were enrolled. The tailored program consisted of a workshop for GPs and health care assistants, educational materials and reminders for patients, and the elaboration of implementation action plans. The primary outcome was the change in the degree of implementation between baseline and follow-up, measured by a summary score of 10 indicators. The indicators were based on structured surveys with patients and GPs. Results: We analyzed the data of 21 GPs (10 - intervention group, 11 - control group) and 273 patients (130 - intervention group, 143 - control group). The increase in the degree of implementation was 4.2 percentage points (95% confidence interval: −0.3, 8.6) higher in the intervention group compared to the control group (p = 0.1). Two of the 10 indicators were significantly improved in the intervention group: medication counseling (p = 0.017) and brown bag review (p = 0.012). Secondary outcomes showed an effect on patients’ self-reported use of medication lists when buying drugs in the pharmacy (p = 0.03). Conclusions: The tailored program may improve implementation of medication counseling and brown bag review whereas the use of medication lists and medication reviews did not improve. No effect of the tailored program on the combined primary outcome could be substantiated. Due to limitations of the study, results have to be interpreted carefully. The factors facilitating and hindering successful implementation will be examined in a comprehensive process evaluation. Trial registration number ISRCTN34664024, assigned 14/08/201
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