Effect of an educational program in primary care: the case of lipid control in cardio-cerebrovascular prevention.

Lowering blood cholesterol levels reduces the risk of coronary heart disease. However, the effect of interventions depends on the patients' adherence to treatment. Primary care plays an important role in the detection, treatment and monitoring of disease, therefore different educational programs (EP) have been implemented to improve disease management in general practice. The present study is aimed to assess whether a general practitioner auditing and feedback EP may improve dyslipidaemia management in a primary care setting and to evaluate patients' adherence to prescribed lipid-lowering treatment. The quality of cardiovascular and cerebrovascular disease prevention before and after the implementation of an EP offered to 25 general practitioners (GPs), was evaluated. Clinical and prescription data on patients receiving at least one lipid-lowering treatment was collected. To evaluate the quality of the healthcare service provided, clinical and biochemical outcomes, and drug-utilization, process indicators were set up. Adherence was evaluated before and after the EP as the "Medication Possession Ratio" (MPR). A correlation analysis was carried out to estimate the effect of the MPR in achieving pre-defined clinical end-points. Prescription data for lipid-lowering drugs was collected in a sample of 839 patients. While no differences in the achievement of blood lipid targets were observed, a slight but significant improvement of the MPR was registered after the EP (MPR >0.8=64.2% vs 60.6%, p=0.0426). Moreover, high levels of statin adherence were associated with the achievement of total blood cholesterol target (OR=3.3 for MPR >0.8 vs MPR <0.5, 95% CI:1.7-6.7) or LDL therapeutic goal (OR=3.3 for MPR >0.8 vs MPR <0.5, 95% CI:1.5-7.2). The EP partially improved the defined clinical targets; probably, a more patient-based approach could be more appropriate to achieve the defined target. Further studies are needed to identify how healthcare services can be improved.

Mathematics reform in the education of deaf and hard of hearing students.

In response to increased demand for competent workers who possess skills in problem solving, cooperative work, and technology, education professionals have set out to reform mathematics education. The purpose of the present study was to determine the state of mathematics reform in the education of deaf and hard of hearing students. A national survey was sent to administrators and faculty at schools for the Deaf seeking information on mathematics programs and instruction. Data were analyzed by profession (i.e., administrator, teacher) and grade level (K-4, 5-8, 9-12). Results show that some aspects of reform (e.g., problem solving, use of concrete materials) have been incorporated into the deaf education mathematics curriculum but that many 'traditional' techniques (e.g., drill and practice, rote memorization) remain in use. Data support the need for increased attention to mathematics education reform within deaf education. Recommendations are provided to professionals in the field to better prepare students for the 21st century.

Mathematics preparation and professional development of deaf education teachers.

With the world increasingly dependent on mathematics and problem-solving skills, the poor mathematics performance of deaf and hard of hearing students is cause for concern. The present article focuses on the mathematics competency of teachers of deaf and hard of hearing students as a factor in this poor performance. As part of a larger study (Pagliaro, 1996, 1998a), deaf education teachers provided data on their postsecondary education and their professional development activities related to mathematics. Administrators were also questioned to investigate the schools' contribution to these activities. Results reveal an insufficient level of mathematics preparation among deaf education teachers, especially at the high school level. Few hold degrees in a mathematics-related field, and only a moderate number seek professional development in this discipline. Recommendations for improving the mathematics competencies of deaf education teachers are provided, with the objective of improving student performance.