INTRODUCTION: System level barriers have been associated with inadequate follow-up of abnormal cervical cytology. OBJECTIVE: The aim of this study was to develop and evaluate an electronic tracking system to improve follow-up of abnormal Pap tests. PROGRAM DESCRIPTION: We implemented an electronic medical record (EMR)-based Pap test tracking system at two clinical practices at an inner-city academic health center. The system generated a providerspecific monthly report of all abnormal Pap results, and provided a patient-specific Pap tracking table embedded in the EMR for each subject. EVALUATION: We compared abnormal Pap test followup rates for the 24 months pre-intervention with rates 12 months following its implementation (post-intervention). The evaluation followed all subjects for 12 months from the date of their abnormal Pap test, looking for diagnostic resolution. RESULTS: Subjects were young women (mean age = 30.5) of primarily white (42%) and African American (37%) descent, who spoke English (88%). Forty-eight percent were insured through publicly subsidized insurance. Controlling for type of abnormality and practice location, the adjusted mean time to resolution decreased significantly from 108 days (confidence interval, CI 105-112 days) in the pre-intervention period to 86 days (CI 81-91 days). CONCLUSION: Our study cannot demonstrate that with follow up, we directly avoided cases of invasive cervical cancer. However, we show that in an at-risk urban population, an automated, EMR-based tracking system reduced the time to resolution, and increased the number of women who achieved diagnostic resolution.
Background: Several cardiovascular disease (CVD) biomarkers sensitive to tobacco exposure have been identified, but how tobacco use cessation impacts them is less clear. We sought to investigate the effects of a smoking cessation program with an exercise intervention on CVD biomarkers in sedentary women. Methods: This is a cohort study on a subsample of a 2 · 2 factorial randomized controlled trial (RCT) (exercise setting: home vs. facility; level of exercise counseling: prescription only vs. prescription and adherence counseling) conducted January 2004 through December 2007. The analyses were completed in October 2010. In the greater Boston area, 130 sedentary female smokers aged 19-55 completed a 15-week program. All participants received nicotine replacement therapy (transdermal patch) and brief behavioral counseling for 12 weeks. They all received an exercise prescription on a moderate intensity level. All exercise interventions lasted for 15 weeks, from 3 weeks precessation until 12 weeks postcessation. Main outcome measures were selected CVD biomarkers hypothesized to be affected by smoking cessation or exercise measured at baseline and 12 weeks postcessation. Results: Independent of tobacco abstinence, improvement was seen in inflammation (white blood cells [WBC]), prothrombotic factor (red blood cells [RBC]), and cardiovascular fitness level (maximum oxygen consumption [Vo 2 max]). This suggests that even if complete abstinence is not achieved, reduction in tobacco exposure and increase in exercise can improve the cardiovascular risk profile. A significant decrease was seen for total cholesterol and the total cholesterol high-density lipoprotein cholesterol (HDL-C): ratio only among the abstainers. The heart rate was reduced among all participants, but this decrease was more profound among abstainers. A significant weight gain and body mass index (BMI) increase were observed among abstainers and those who relapsed. We also found an increase in hemoglobin A1c (Hb A1c), although significant only when the groups were combined. Conclusions: A smoking cessation intervention including exercise reduced tobacco-induced cardiovascular damage selectively within 3 months.
University of California, Berkeley librarians have incorporated the flipped instruction model into information literacy training by focusing on two primary elements: assigning pre-class assignments and increasing active learning techniques. We explore these two elements across five diverse instructional cases, which include one-shot and semester-long classes that were conducted through online or in-person delivery for both graduate and undergraduate students across a range of subject areas (sciences, social sciences, and humanities). We examine the enabling factors and the perceived outcomes of this instructional paradigm. Because students came to class with enhanced library understanding and experience from the pre-class assignment, they were better prepared to engage with the material and articulate additional learning needs. We note students' increased engagement during class and more time available for higher-order learning exercises and discussions. As a result, flipped instruction appears to enable more learning opportunities without increasing classroom time. The challenges of this model are the requisite commitment of time and effort, the need to foster class participation, and the facilitation of active communication within the class. We propose a framework of catalysts, building blocks, and instructional outcomes to help library instructors incorporate flipped instruction elements into their instructional design.
This article presents a qualitative evaluation methodology of academic departments for library organizational learning and library enhancement planning. This evaluation used campus units’ academic program review reports as a data source and employed collaborative content analysis by library liaisons to extract departmental strengths, weaknesses, opportunities, threats, and priorities. We illustrate how a systematic review of internal planning documents facilitates the understanding of programmatic goals, identification of cross-unit synergies, and prioritization of library services. Our evaluation used a mix of technological, methodological, and analytical activities suitable for implementation in other academic library settings.
Academic library instructional services and practices have continually evolved in response to trends within the library, on campus, and in higher education. The introduction of computers, and most notably the Internet, sparked changes in what, how, and where library skills were taught. In this article, Dupuis discusses the adaptation of our instructional programs as we gained experience with the maturing, new technology and as variables in our environment changed. She encourages librarians to refocus on the students, who themselves will be a defining force in the next phase of the evolution of teaching and learning.
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