Teams in a community setting: the AUHS experience.

The Pennsylvania Local Interdisciplinary Team was created to develop and implement an innovative model for the education of students from multiple disciplines and institutions in the theory and practice of quality improvement. The lead poisoning prevention project is presented as an example of the work of an interdisciplinary student team in a community setting in Philadelphia.

Vascular gene therapy.

Gene therapy is an exciting frontier in medicine today. Radiologists will be involved in tracking the effects of these new therapies through imaging. Vascular and interventional radiology techniques also are ideally suited for minimally invasive, readily monitored gene delivery. Gene therapy is accomplished through gene augmentation or gene blocking. The latter is accomplished through antisense oligonucleotides or transcription factor decoys. Vectors are agents that facilitate gene delivery and expression and can be viral or nonviral. The vascular wall is an ideal target for gene therapy because of its central role in many biologic processes and its ready accessibility. Recombinant genes can be delivered ex vivo and in vivo, with the latter approaches involving open surgical, percutaneous injection, and endovascular catheter-based methods. Perforated, hydrogel-coated, and double balloon catheters have been used with varying success. Optimal catheter systems for gene transfer will enable delivery of the vector to the precise anatomic location with transfection limited to the cells of interest and will minimize shedding of the vector to distal sites, systemic effects of the therapeutic agent, and morbidity from the delivery method. Radiologists must become familiar with the basic rationale, strategies, and mechanisms of gene therapy and involved in its clinical trials to ensure an active role in this field.

Taking aim at interdisciplinary education for continuous improvement in health care.

Over the last 30 years, nursing faculty have achieved varying levels of success in their efforts to engage in interdisciplinary education. To sharpen the focus, the Institute for Healthcare Improvement sponsored a national demonstration project in which nursing faculty from four universities participated.

Assessment preparation for nurse practitioners.

Faced with primary care graduate students who were not adequately prepared to meet the demands of their clinical courses, faculty at the University of Pennsylvania conducted a three-year study to determine the effectiveness of physical assessment prerequisites. They concluded that graduate level assessment preparation was well worth the time and effort such courses require.

The awareness of primary physicians of the psychosocial adjustment of children with a chronic illness.

This study compared primary care physicians' ratings of psychosocial adjustment of their chronically ill pediatric patients with parents' and children's reports. A series of measures of psychosocial adjustment were administered to 63 children with either a seizure disorder or a visible orthopedic condition, and their parents. Each child's physician was asked to rate the presence and severity of psychological adjustment problems in the child, as well as to rate six specific psychosocial domains. Forty-one physicians responded, and relationships between their ratings and child and parent psychosocial measures were determined using Pearson product-moment correlation coefficients. Ratings by physicians correlated with children's reports and parents' judgments about the children, but not with mothers' self-concept or the impact that the illness had on the family. However, physicians' ratings were interdependent. When congruence of physician ratings with child or parent reports was examined for each disease group, we found significant results for the seizure disorder group; however, congruence among ratings for the orthopedically handicapped group was poor. Student's t-tests revealed no statistically significant differences between the two disease groups in any of the demographic variables of the children or physicians, nor in their scores on the criterion measures. Hierarchical multiple regression analysis identified factors that contributed to physicians' significantly different congruence with parents regarding the adjustment of children in the two subsamples. The findings of this study suggested that primary care physicians were moderately aware of the presence and severity of psychosocial adjustment problems in some categories of their pediatric patients with chronic illness.(ABSTRACT TRUNCATED AT 250 WORDS)

Patterns of practice: Master's prepared nurse practitioners.

Graduates of the Primary Care-Family Nurse Clinician Program at the University of Pennsylvania School of Nursing were surveyed as part of an overall, ongoing evaluation of graduate level primary care education in the school. The main focus of the survey was to discover the scope of practice characteristic of the program graduates. The survey revealed that the majority of graduates were providing direct patient care, while some were teaching primary care or embarking on related forms of practice. The graduates were found to be involved in assessment, education and counseling, and were working with physicians and others to provide comprehensive patient care.

Development of children with a chronic illness.

About 5 to 10 per cent of all children have sometime during childhood a moderately to severely handicapping long-term illness or disability. These children are at risk, not only medically, but for complex social, educational, and emotional difficulties. The potential interferences with normal development imposed by a chronic illness are varied but pervasive, and depend on the specific characteristics of the illness, the child, and the child's family. There are known psychological effects of illness on a child, which can best be understood within a developmental framework such as that outlined above. Optimal health care of these children and families depends on a knowledge of the risks to normal development that are regularly faced by these children at each stage of their development. Physicians, nurses, and other health care providers have the opportunity to be powerful advocates for children with a chronic illness. We thus have a responsibility to facilitate these children's negotiation of the challenges and crises of childhood, so they may enter their adult years with strength and security. Such guidance requires an understanding of children's development and the impact of illness on that process, and effective communication with both children and families.

There's a demon in your belly: children's understanding of illness.

Knowledge of how children come to understand the processes of causation, prevention, and treatment of illness is needed to help health professionals and educators in their work with children. Healthy children attending kindergarten through eighth grade were asked a series of standardized questions about illness, and their responses were scored on a scale corresponding to Piaget's theoretical framework of cognitive development. Children's responses varied widely at all ages, but there was a consistent systematic progression in their understanding of illness-related concepts with age. Kindergarten children typically understand illness causation as quite magical, and/or as the consequence of their transgression of rules. At fourth grade, children believe all illness to be caused by germs whose very presence is sufficient to make a child sick. The complexity of the mechanisms that must interrelate to cause illness is not understood until eighth grade at the earliest. At approximately 12 or 13 year of age children begin to understand that there are multiple causes of illness, that the body may respond variably to any or a combination of agents, and that host factors interact with the agent to cause and cure illness. This sequence in the development of understanding about illness parallels conceptual development in other content areas such as physical causality, although it seems to lag a bit. The delineation of the concepts typical of children at each developmental stage, as provided in this paper, will help to guide educational efforts and future research.