Using the Clinical Prevention and Population Health Curriculum Framework to encourage curricular change.

The Healthy People Curriculum Task Force was established in 2002 to encourage implementation of Healthy People 2010 Objective 1.7: "To increase the proportion of schools of medicine, schools of nursing and health professional training schools whose basic curriculum for healthcare providers includes the core competencies in health promotion and disease prevention." In 2004, the Task Force published a Clinical Prevention and Population Health Curriculum Framework ("Framework") to help each profession assess and develop more robust approaches to this content in their training. During the 6 years since the publication of the Framework, the Task Force members introduced and disseminated it to constituents, facilitated its implementation at member schools, integrated it into initiatives that would influence training across schools, and adapted and applied the Framework to meet the data needs of the Healthy People 2010 Objective 1.7. The Framework has been incorporated into initiatives that help promote curricular change, such as accreditation standards and national board examination content, and efforts to disseminate the experiences of peers, expert recommendations, and activities to monitor and update curricular content. The publication of the revised Framework and the release of Healthy People 2020 (and the associated Education for Health Framework) provide an opportunity to review the efforts of the health professions groups to advance the kind of curricular change recommended in Healthy People 2010 and Healthy People 2020 and to appreciate the many strategies required to influence health professions curricula.

The roles of healthcare professionals in implementing clinical prevention and population health.

Across the health disciplines, clinical prevention and population health activities increasingly are recognized as integral to the practice of their professions. Most of the major clinical health professions organizations have begun incorporating clinical prevention and population health activities and services into educational curricula, the accreditation process, and training to affect clinical practice. Students in each health profession need to understand the roles played by those in other health professions. This understanding is a prerequisite for better communication and collaboration among the professions and for accomplishing the educational objectives included in Healthy People 2020 and organized using the Education for Health framework. To help accomplish these goals, this article summarizes each health profession's contributions to the field of prevention and population health, explains how the profession contributes to interprofessional education or practice, reviews specific challenges faced in the provision of these types of services, and highlights future opportunities to expand the provision of these services. Several general themes emerge from a review of the different health professions' contributions to this area. First, having well-trained prevention and population health professionals outside of the traditional public health field is important because prevention and population health activities occur in almost all healthcare settings. Second, because health professionals work in interprofessional teams in the clinical setting, training and educating all health professionals within interprofessional models would be prudent. Third, in order to expand services, reimbursement for health promotion counseling, preventive medicine, and disease management assistance needs to be appropriate for each of the professions.

A systematic assessment of strategies to address the nursing faculty shortage, U.S.

This article provides an assessment of strategies implemented nationwide to counter the nursing faculty shortage, highlights those indicating most promise, and proposes a basis for evaluating outcomes. The deficit of educators is a key impediment to filling the growing demand for nurses generated by an aging population and a weak supply of new graduates, which has left up to 13% of hospital RN positions vacant. Educational institutions have adopted various approaches to expand faculty resources with the goal of increasing nursing student enrollment. After conducting a systematic review of the literature from 2000 onward, we analyzed and coded these initiatives using techniques of content analysis and constant comparison. We induced 4 large domains from the data: advocacy, educational partnerships, academic innovation, and external funding. For each domain we identified an exemplar that is substantial, sustainable and replicable. We then proposed a basis for evaluating the impact of these strategies to facilitate replication.

Maryland's agenda: moving the faculty shortage to the forefront.

As the United States faces an ever-increasing nursing and faculty shortage, Maryland has become a leader in finding innovative ways to address the faculty shortage crisis in an effort to increase the number of bedside nurses. Three years of diligent advocacy involving multiple stakeholders has finally garnered results. In December 2005, the Maryland Heath Care Cost Review Commission and Maryland's Higher Education Commission, with the support of the state government's executive and legislative branches, launched an unprecedented 10-year, $8.8 million annual initiative to address the faculty shortage in the state. This article discusses the process that led to Maryland becoming a national leader in addressing the nurse faculty shortage.

Clinical Prevention and Population Health Curriculum Framework: the nursing perspective.

The Clinical Prevention and Population Health Curriculum Framework (Curriculum Framework) was developed by the Healthy People Curriculum Task Force comprised of representatives from allopathic and osteopathic medicine, dentistry, nursing and nurse practitioners, pharmacy and physicians assistants. This multidiscipline Task Force was covened to address the Healthy People 2010 objective of increasing the health promotion/prevention content in health professional education. A focus on clinical prevention and population health activities is central to the goal of improving the health status of the nation and offers the greatest potential to reduce many leading causes of death and improve quality of life across diverse populations. The Curriculum Framework provides a set of 4 components (evidence base for practice, clinical preventive services, health systems/health policy and community aspects of practice) and 19 domains for organizing and implementing the curriculum. The title "Clinical Prevention and Population Health" includes both individual and population focused health promotion and prevention efforts. The role of nursing in developing the Curriculum Framework, and the tailoring and implementation of the Curriculum Framework for undergraduate and graduate programs in nursing is discussed.

Screening for postmenopausal osteoporosis: a review of the evidence for the U.S. Preventive Services Task Force.

BACKGROUND: Although osteoporotic fractures present an enormous health burden, it is not clear whether screening to identify high-risk persons is appropriate. PURPOSE: To examine evidence on the benefits and harms of screening postmenopausal women for osteoporosis. DATA SOURCES: MEDLINE (1966 to May 2001), HealthSTAR (1975 to May 2001), and Cochrane databases; reference lists; and experts. STUDY SELECTION: English-language abstracts that included original data about postmenopausal women and osteoporosis and addressed the effectiveness of risk factor assessment, bone density tests, or treatment were included. DATA EXTRACTION: Selected information about patient population, interventions, clinical end points, and study design were extracted, and a set of criteria was applied to evaluate study quality. DATA SYNTHESIS: No trials of the effectiveness of screening have been published. Instruments developed to assess clinical risk factors for low bone density or fractures have moderate to high sensitivity and low specificity. Among different bone density tests measured at various sites, bone density measured at the femoral neck by dual-energy x-ray absorptiometry is the best predictor of hip fracture. Women with low bone density have approximately a 40% to 50% reduction in fracture risk when treated with bisphosphonates. CONCLUSIONS: Population screening would be based on evidence that the risk for osteoporosis and fractures increases with age, that the short-term risk for fracture can be estimated by bone density tests and risk factors, and that fracture risk can be reduced with treatment. The role of risk factor assessment and different bone density techniques, frequency of screening, and identification of subgroups for which screening is most effective remain unclear.

Postmenopausal hormone replacement therapy: scientific review.

CONTEXT: Although postmenopausal hormone replacement therapy (HRT) is widely used in the United States, new evidence about its benefits and harms requires reconsideration of its use for the primary prevention of chronic conditions. OBJECTIVE: To assess the benefits and harms of HRT for the primary prevention of cardiovascular disease, thromboembolism, osteoporosis, cancer, dementia, and cholecystitis by reviewing the literature, conducting meta-analyses, and calculating outcome rates. DATA SOURCES: All relevant English-language studies were identified in MEDLINE (1966-2001), HealthSTAR (1975-2001), Cochrane Library databases, and reference lists of key articles. Recent results of the Women's Health Initiative (WHI) and the Heart and Estrogen/progestin Replacement Study (HERS) are included for reported outcomes. STUDY SELECTION AND DATA EXTRACTION: We used all published studies of HRT if they contained a comparison group of HRT nonusers and reported data relating to HRT use and clinical outcomes of interest. Studies were excluded if the population was selected according to prior events or presence of conditions associated with higher risks for targeted outcomes. DATA SYNTHESIS: Meta-analyses of observational studies indicated summary relative risks (RRs) for coronary heart disease (CHD) incidence and mortality that were significantly reduced among current HRT users only, although risk for incidence was not reduced when only studies that controlled for socioeconomic status were included. The WHI reported increased CHD events (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.02-1.63). Stroke incidence but not mortality was significantly increased among HRT users in the meta-analysis and the WHI. The meta-analysis indicated that risk was significantly elevated for thromboembolic stroke (RR, 1.20; 95% CI, 1.01-1.40) but not subarachnoid or intracerebral stroke. Risk of venous thromboembolism among current HRT users was increased overall (RR, 2.14; 95% CI, 1.64-2.81) and was highest during the first year of use (RR, 3.49; 95% CI, 2.33-5.59) according to a meta-analysis of 12 studies. Protection against osteoporotic fractures is supported by a meta-analysis of 22 estrogen trials, cohort studies, results of the WHI, and trials with bone density outcomes. Current estrogen users have an increased risk of breast cancer that increases with duration of use. Endometrial cancer incidence, but not mortality, is increased with unopposed estrogen use but not with estrogen with progestin. A meta-analysis of 18 observational studies showed a 20% reduction in colon cancer incidence among women who had ever used HRT (RR, 0.80; 95% CI, 0.74-0.86), a finding supported by the WHI. Women symptomatic from menopause had improvement in certain aspects of cognition. Current studies of estrogen and dementia are not definitive. In a cohort study, current HRT users had an age-adjusted RR for cholecystitis of 1.8 (95% CI, 1.6-2.0), increasing to 2.5 (95% CI, 2.0-2.9) after 5 years of use. CONCLUSIONS: Benefits of HRT include prevention of osteoporotic fractures and colorectal cancer, while prevention of dementia is uncertain. Harms include CHD, stroke, thromboembolic events, breast cancer with 5 or more years of use, and cholecystitis.

Evaluation of Selected Behavior Change Theoretical Models Used in Weight Management Interventions.

Purpose: This paper evaluates selected behavior change theoretical models used in weight reduction interventions and presents recommendations for the use of theory in weight reduction research. Overweight and obesity are complex problems, requiring long-term behavioral change. Behavioral treatments for overweight and obesity are as varied as the elements of behavior, and the long-term efficacy of most approaches is poor. Because of the complexity of both the problem and its treatment, investigations must target the development of cause-effect explanations. CONCLUSIONS: Many of the behavioral change intervention studies reviewed lacked external validity, primarily due to the failure to consider salient moderators. The theoretical models reviewed in this paper were primarily tested on white, employed populations. These and other data suggest that extant theoretical approaches may not be salient in certain groups. IMPLICATIONS: Practice implications include: 1) assess indicators for readiness to engage in weight reduction efforts; 2) base interventions on multiple theories; and 3) develop context-based interventions. Future research should include a focus on innovative methods in theory development, development of theory acknowledging mediator/moderator interactions, development of theory in context, and development of theory reflecting cultural meaning and diversity.