Board Of Foundation Research Articles

The Times They (May) Be A-Changin’

248 Am J P The appeal of screening for both the public and the medical profession has been a dominant force in prevention for the past 50 years. The general trend toward increased intensity of screening—screening more people with more sensitive tests more often—has continued seemingly unfazed by the occasional objections of some. Until now. Of late, there has been a growing chorus of voices that suggest a coming change in the attitudes of the public and the profession. Although the reasons are not clear, the media regularly discusses “waste” in the healthcare system, that we are testing and treating more than we need. Books for both the public and the profession have discussed overdiagnosis and overtreatment as a result of too much testing and screening. Consumer Reports has teamed up with the American Board of Internal Medicine Foundation to develop a “Choosing Wisely” campaign (consumerhealthchoices.org/campaigns/choosing-wisely/). Journal articles have even started using the term “harm” for the adverse events that come from medical interventions. And the U.S. Preventive Services Task Force (USPSTF), sometimes joined by other professional and advocacy groups, has continued to recommend less screening for breast cancer (every other year rather than annually, starting older and ending younger); colorectal cancer (may use approaches other than colonoscopy, should stop at older ages); prostate cancer (stop screening altogether); and cervical cancer (start at age 21, screen every 3 years, stop at age 65 or after hysterectomy). The new message from all of these sources boils down to this: Screening is not the unqualified good that we have advertised it to be. It has clear potential harms as well as benefits, and these must be carefully weighed before a rational decision about screening can be made.

Overuse of Health Care Services

There is widespread agreement that ‘more’ is not always better in health care. Doing ‘more’ can harm patients, generate excess costs, and defy patient preferences. All are major threats to the delivery of high quality health care. Reflecting this notion, the Institute of Medicine (IOM) National Roundtable on Health Care Quality coined the term ‘overuse’ in 1998,1 adapting the definition of an ‘inappropriate’ service developed for the RAND Appropriateness Method in the 1980s.2 Overuse was defined as “a health care service [that] is provided under circumstances in which its potential for harm exceeds the possible benefit.”1 Initiatives to address overuse of medical services3 will be crucial in reducing total health care spending and iatrogenic harms.4 But recent initiatives also illustrate a potential obstacle – what is meant by overuse may be conceptually vague. In 2008, the National Priorities Partnership identified eliminating overuse as a national priority, describing it as “unscientific,” “redundant,” and “excessive” care.3 The American College of Physicians identified examples of overused screening and diagnostic tests that “clinicians often use in a manner that does not reflect high-value, cost-conscious care and does not adhere to currently available clinical guidelines.”5 The American Board of Internal Medicine Foundation’s Choosing Wisely campaign provides yet another description of overuse and helps to demonstrate the potential consequences of this ambiguity. The campaign is intended to help physicians and patients choose care that is “supported by evidence, not duplicative of other tests or procedures already received, free from harm [to patients], [and] truly necessary.”6 But the diversity of scenarios identified is substantially broader than this description. Three scenarios in Choosing Wisely differ strikingly in their underlying premise of what constitutes overuse: ‘do not repeat colorectal cancer screening for 10 years after a high-quality colonoscopy is negative in average-risk individuals,’ ‘don’t use DEXA screening for osteoporosis in women younger than 65 or men younger than 70 with no risk factors,’ and ‘don’t initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their physicians.’6 For too frequent colorectal cancer screening, potential for harm (e.g., perforation of the colon) outweighs the benefit. Although in theory any health care intervention can cause ‘harm,’ DEXA screening for low-risk groups would not have a measureable effect on quality of life or mortality. Rather, the low likelihood of meaningful benefit is associated with the high costs of DEXA screening (estimated $70 per scan, totaling $527 million per year in the United States for women under age 657). The reasons not to initiate chronic dialysis without shared decision-making are more complex than merely avoiding the initiation of a service expected to do more harm than good. Rather, integrating individual preferences and goals into clinical decisions can help to avoid the provision of undesired care.8 Among these and other examples, no clear conceptual pattern emerges. Rather, the lists are a loose collection of services joined only by the broad notion that they should not be delivered, at least in some contexts. In our view, this lack of conceptual backbone will impede the acceptance of these initiatives by physicians. Absent a clearer conceptual framework, it will be difficult to answer key questions. For example, what types of services should next be included on a list? How should a potential area of overuse be identified a priori? How should a culture that encourages overuse or fails to discourage it be mended? A conceptual framework contemplating different dimensions of overuse might help. The framework we propose has three categories: the tradeoff between benefits and harms, the tradeoff between benefits and costs, and consideration of patient preferences. Examples of overuse can be found in each category. Making the categories explicit can help clarify the reasons to diminish a service’s use, and help those who develop and use the recommendations to make sense of seemingly disjointed issues within and across initiatives.

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Promoting professionalism via a video‐based educational workshop for academic hospitalists and housestaff

Unprofessional behavior can compromise care and detract from the hospital learning environment. Discrepancy between professional behaviors formally taught and what is witnessed has become increasingly evident. With funding from the American Board of Internal Medicine Foundation, a workshop was developed to address unprofessional behaviors related to inpatient care previously identified in a multi-institution survey. The aims were to utilize video-based education to illustrate unprofessional behaviors, how faculty play a role in promoting such behaviors, and facilitate reflection regarding motivation for and prevention of these behaviors. Hospitalists and housestaff at 3 Chicago-area academic hospitals and 1 community teaching affiliate participated. Videos were debriefed, identifying barriers to professional behavior and improvement strategies. A postworkshop survey assessed beliefs on behaviors and intent to change practice. Forty-four (53%) faculty and 244 (68%) residents (postgraduate year 1 and greater) participated. The workshop was well received, with 89% reporting it "useful and effective." Two-thirds expressed intent to change behavior. Most (86%) believed videos were realistic and effective. Those who perceived videos as "very realistic" were more likely to report intent to change behavior (93% vs 53%, P = 0.01). Video-based education is a feasible way to promote reflection and address unprofessional behaviors among providers and may positively impact the learning environment.

Editorial

FigureAs part of the American Board of Internal Medicine Foundation's Choosing Wisely campaign, the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) recently published its list of “Five Things Physicians and Patients Should Question.” The goals of the campaign were to promote awareness of the overuse of tests and treatments and to improve the overall quality of American healthcare. The AAO-HNSF Patient Safety and Quality Improvement Committee was charged with leading an unbiased and equitable process to arrive at five conditions. The committee reviewed 20 initial items for consideration and then refined the list based on the amount of supporting clinical evidence and the frequency of use of the test, procedure, or treatment. Three of the final five items address diseases of the ear. 1. Don't order a computed tomography (CT) scan of the head/brain for sudden hearing loss. The support for this item comes from a recent AAO-HNSF Clinical Practice Guideline (Otolaryngol Head Neck Surg 2012;146[suppl 3]:S1-35).Figure: Michael E. McCormick, MDThe role of imaging in a patient with sudden sensorineural hearing loss (SSNHL) is to identify pathology that may be causing acute symptoms. SSNHL typically results from an abnormality of the cochlea, cochleovestibular nerve (CN VIII), or brainstem. While we are unable to accurately image the inside of the cochlea with current modalities, more central etiologies, such as the CN VIII and brainstem, are best evaluated by magnetic resonance imaging.Figure: Rahul K. Shah, MDTherefore, a routine CT scan of the head/brain adds no diagnostic yield to the workup of these patients in most clinical situations. Furthermore, CT scans expose the patient to potentially harmful radiation and intravenous contrast (Expert Opin Drug Metab Toxicol 2009;5[4]:403-416; Arch Intern Med 2009;169[22]:2078-2086). 2. Don't prescribe oral antibiotics for uncomplicated acute tympanostomy tube otorrhea. Ototopical antibiotic drops are typically 100 to 1,000 times more concentrated than oral preparations and do not need to undergo systemic metabolism and biodistribution (Drugs 1999;58[3]:509-531). As a consequence, topical preparations often can treat bacteria that oral antibiotics cannot. Using antibiotic eardrops instead of oral agents can also help prevent the development and spread of resistant bacteria (Pediatr Infect Dis J 2001;20[1]:102-103) and avoids the systemic side effects associated with oral therapy, such as vomiting, diarrhea, and rash.Figure. David: W. Roberson, MD3. Don't prescribe oral antibiotics for uncomplicated acute external otitis. Similar to the first recommendation, this item is supported by evidence from an AAO-HNSF Clinical Practice Guideline (Otolaryngol Head Neck Surg 2006;134[suppl 4]:S4-S23). The item applies primarily to healthy patients without complications or extension beyond the ear canal. In addition to the benefits of curbing overuse of oral antibiotics, there are multiple nonantibiotic preparations that are efficacious. Awareness of and general adherence to these simple recommendations by our health professional colleagues could potentially save an immeasurable amount of resources while improving the quality and perhaps outcomes of care in the United States.

Community Foundation Strategy

This research provides detailed descriptive information about decision-making behaviors and processes of community foundation boards. Our study responds to Graddy and Morgan’s (2006) call for research that examines how community foundation leadership (board and staff) affects strategic direction. We provide an understanding of how community foundation boards interpret organizational and environmental realities while balancing what has been described in the literature as “competing” mission-related objectives among donors, recipients, and the community. We find decision making to be influenced by three powerful forces; fear, tradition, and serendipity.

From the ground up: strengthening health systems at district level.

This supplement introduces the African Health Initiative (AHI), a research program comprised of five unique district health system-strengthening activities in Ghana, Mozambique, Rwanda, Tanzania, and Zambia that began in 2009 (Figure ​(Figure1).1). This supplement should be of interest to all engaged in improving delivery of district primary health care — whether ministries of health, service providers, funders, or those who evaluate complex interventions. The five AHI projects, known as Population Health Implementation and Training (PHIT) Partnerships, are funded by the Doris Duke Charitable Foundation (DDCF) with a common goal: to produce significant, measureable health improvements in a defined geographic area over a five to seven year grant period. With the partnerships in their fourth year of funding, it is now possible to capture lessons learned in project design and implementation. Evaluation of the African Health Initiative’s impact on population health, including mortality, however, must await the conclusion of the grant period. Figure 1 Population health implementation and training partnership sites Why focus on health systems? The last two decades saw unprecedented growth in the level of assistance available for health in developing countries. Although health expenditure by African governments remains below the Abuja Declaration target (15% of government expenditure) [1], donor support for health more than tripled between 1990 and 2008 [2] , reaching more than $27 billion annual expenditure in 2010 [3]. Much of this support is directed at “big diseases”, notably HIV/AIDS, tuberculosis, and malaria, often under the auspices of new global health initiatives. These laudable, ambitious efforts to target major killers encountered already fragile, under-resourced health systems that limited the capacity of beneficiary countries to absorb new investments. Although there are no simple, fast solutions to strengthening health systems, the World Health Organization [4] and others, notably the Alliance for Health Policy and Systems Research, have been central in promoting a dialogue on how to address this critical issue [5]. In 2006, as global health funding was increasing, the Doris Duke Charitable Foundation Board of Trustees was considering one or two new initiatives, spurred by a desire both to celebrate its upcoming 10th anniversary of grant making and a surge in returns on its endowment. The Foundation’s Medical Research Program supported mainly domestic clinical research. Only a small portion of DDCF’s grant making was directed to research on the treatment and care of AIDS patients in Africa and the construction of the Doris Duke Medical Research Institute in Durban, South Africa. It was these latter activities that brought DDCF staff to several sub-Saharan African countries. On an early visit, staff were struck by the presence of a new HIV clinic — stocked with needed medicines and supplies and staffed by a proud health worker –- while across the street was a district hospital —derelict, no supplies, crumbling infrastructure, few staff, and patients lying on the ground for lack of beds. Further visits confirmed that, as AIDS treatment rolled out, such contrasts were common throughout sub-Saharan Africa. How could it possibly make sense for a woman to attend this new HIV clinic, and then have to contend with a non-functioning community clinic and an under-resourced district hospital for pregnancy care, childhood immunizations, or management of malaria? Not only did it seem logical that health clinics should provide integrated primary care for an entire family, but also that those clinics be part of a health system that could deliver drugs and supplies on time, train workers, and, when required, refer patients for treatment of complicated cases. Although how to define, assess, and measure health systems continues to pose challenges [6], it was these real-world observations, consultation with a range of experts, and the belief that the Foundation should be willing to address critical gaps even if they were ‘hard and high risk,’ that propelled DDCF to invest in health systems strengthening. Staff were heartened by findings of the Tanzanian Essential Health Interventions Project (TEHIP) [7] and the Navrongo Experiment in northern Ghana [8], both of which suggested that health systems interventions could indeed result in meaningful population health gains in a relatively short period of time.

Nonprofit Competitive Advantage in Grant Markets: Implications of Network Embeddedness

This paper empirically addresses the effects that the network embeddedness of nonprofit organizations has on their ability to access philanthropic resources within competitive markets. Implicit in many criticisms of institutional philanthropy is the normative belief that nonprofits that are not ‘in’ the existing networks of foundation boards and staffs will be otherwise excluded from the grants process. We relate this proposition to theory on status signaling and test it in a network of nonprofits linked by grants from common foundations in metropolitan Atlanta during 2000 and 2005. Through this analysis we find that observable characteristics of nonprofits including age, size and their financial operating ratios explain success in grant markets. However, the reputation effects from greater network centrality in previous time periods provide additional advantages in securing resources. Our findings raise questions about the implications of socially constructed entrance barriers that may prevent otherwise competitive organizations from accessing financial resources.

Managerial Distance and Virtual Ownership: The Governance of Industrial Foundations

Industrial foundations are autonomous nonprofit entities that own and control one or more conventional business firms. These foundations are common in Northern Europe, where they own a number of internationally prominent companies. Previous studies have indicated, surprisingly, that companies controlled by industrial foundations are, on average, as profitable as companies with conventional patterns of investor ownership. In this article, we explore the reasons for this performance, not by comparing foundation-owned firms with conventional investor-owned firms, but rather by focusing on differences among the industrial foundations themselves. We work with a rich data set comprising 113 foundation-owned Danish companies over the period 2003-2008.We focus in particular on a composite structural factor that we term “managerial distance.” We propose this as a measure of the extent to which a foundation establishes an identity that is distinct from that of the company it owns. More particularly, we hypothesize that, within limits, greater managerial distance increases the intensity, clarity, and objectivity with which the foundation’s board of directors – which holds ultimate control of a foundation-owned company -- focuses on the company’s profitability. In effect, a substantial degree of distance puts members of the foundation board in the position of “virtual owners,” in the sense that information and decisions are framed for the board in roughly the way they would be framed for profit-seeking outside owners of the company. Consistent with this hypothesis, our empirical analysis shows a positive, significant, and robust association between managerial distance and the economic performance of foundation owned companies. The findings appear to illuminate not just foundation governance, but corporate governance and fiduciary behavior more generally.

Program and AbstractsThirty-third Annual Meeting of the Surgical Infection SocietyLas Vegas, NevadaApril 12–15, 2013

Program and AbstractsThirty-third Annual Meeting of the Surgical Infection SocietyLas Vegas, NevadaApril 12–15, 2013

American Geriatrics Society Identifies Five Things That Healthcare Providers and Patients Should Question

Given the American Geriatrics Society's (AGS) commitment to improving health care for older adults by, among other means, educating older people and their caregivers about their health and healthcare choices, the AGS was delighted when, in late 2011, the American Board of Internal Medicine Foundation invited the Society to join its "Choosing Wisely(®) " campaign. Choosing Wisely is designed to engage patients, healthcare professionals, and family caregivers in discussions about the safety and appropriateness of medical tests, medications, and procedures. Ideally, these discussions should examine whether the tests and procedures are evidence-based, whether any risks they pose might overshadow their potential benefits, whether they are redundant, and whether they are truly necessary. In addition to improving the quality of care, the initiative aims to rein in unneeded healthcare spending. According to a 2008 Congressional Budget Office report, as much as 30% of healthcare spending in the United States may be unnecessary.

“We think of Rome, imperial, imperious, imperative”: A Report on the Seventh James Joyce Graduate Conference, Rome, Italy, 6-7 February 2014

“We think of Rome, imperial, imperious, imperative”:A Report on the Seventh James Joyce Graduate Conference, Rome, Italy, 6-7 February 2014 Georgina Binnie For the latest news about Joyce and the world of Joyce studies, visit the JJQ blog “Raising the Wind” at <http://jjqblog.wordpress.com>. Following James Joyce’s 132th birthday on 2 February 2014, a group of aspiring graduates and scholars gathered in Rome for the VII James Joyce Italian Foundation Graduate Conference. The James Joyce Italian Foundation board members, Franca Ruggieri, the President, Carla Marengo Vaglio, John McCourt, Enrico Terrinoni, Sonia Buttinelli, Ira Torresi, and honorary members Umberto Eco and Fritz Senn, created a welcoming platform for Joyce scholarship to be shared amid Rome’s auspicious settings. The conference was held at the Sala Conferenze “Ignazio Ambrogio,” Università degli Studi, Roma Tre, and began with the University President, Mario Panizza, Department Director, Giuseppe Grilli, and Franca Ruggieri welcoming delegates. With the theme of the conference set as “The Recirculation of Realism,” they highlighted some of the event’s central concerns, such as mimesis and opposition. In her opening plenary, Anne Fogarty gave an analysis of realism and affect in Dubliners. While she noted that the terms “affects” and “feelings” are often confused, she helpfully defined the former as those biochemical intensities that may be social, atmospheric, or of the body and explained how these might become historically coded. By focusing on Dubliners, she demonstrated the way Joyce’s characters sense affects such as discomfort and unease and project these outwards towards one another and the surrounding landscape. The second plenary was delivered by Fritz Senn who explored the difficulties of translation. He demonstrated how sentences might become different linguistic events in other languages using, among many examples, Gretta’s revelation in “The Dead” that “I was great with him” (D 220). By questioning the multiple meanings of Gretta’s words, Fritz demonstrated how the “realism” we might ascribe to Joyce’s work cannot always be wholly accurate. On the second day, Jolanta Wawrzycka provided a fascinating account of nineteenth- and early-twentieth-century optical toys and, taking the magic lantern as her primary [End Page 579] focus, revealed how the device could have influenced the tableau effects and eastern imagery in Dubliners. In the final plenary, Rosa Maria Bosinelli warned of the dangers of over-prescribing a specific reality to Joyce’s work, reminding us of the importance of analyzing internal emotions and the confusion over what is left unsaid. The conference panels were made up of three or four Joyceans at various stages of their academic careers. The first was chaired by Anne Fogarty and consisted of Francesca Caraceni (University of Tuscia), Illaria Aletto (Università Roma Tre), and Victoria Lévêque (Sorbonne Nouvelle, Paris III). Caraceni’s paper considered Joyce and Laurence Sterne’s writing as a challenge to realism and examined the way in which formal literary experimentation can encourage a didactic reader-text relationship. Aletto gave a fascinating account of the wait for the 1993 unabridged, complete Russian translation of Ulysses, revealing that the delay lasted through almost the entire Soviet period! Presenting the audience with a photograph of Auguste Rodin’s “Meditation of the Inner Voice,” Lévêque drew comparisons between the statue and Gerty MacDowell and convincingly argued that the reality of perception in the “Nausicaa” episode prevents Bloom’s and Gerty’s experiences from being entirely satisfactory. She noted that the parallels between “Nausicaa” and Virginia Woolf’s work demonstrate the way these writers challenge the boundaries of the real via their ontological engagement with writing. The second panel was chaired by John McCourt and included Sophie Corser (Goldsmiths College, University of London), Geraldina Colombo (Catholic University of Milan), and Neslihan Ekmekçioglu (Hacettepe University). Corser’s paper reminded us of the importance of the Uncle Charles principle and examined the self-referential nature of the “Eumaeus” episode of Ulysses, and she drew the audience’s attention to Zachary Mason’s The Lost Books of the “Odyssey”: A Novel and questioned how rewriting and authorial intention affect the reality of a text.1 Colombo examined the often-neglected Chamber Music and suggested that the poems should be...

Foundation News

With all of the excitement the glittering lights of Las Vegas brings, attendees of the Foundation's Annual Donor Luncheon, held during SEG's 2012 Annual Meeting, found themselves caught up in the midst of excitement as the Foundation highlighted its 2012 successes and the road traveled since incorporation as a SEG supporting organization in 1987. Tom Smith, chairman of the SEG Foundation Board of Directors, thanked everyone for making possible the important work of the SEG Foundation, and began the event with announcements about major financial donations to key programs. He first revealed that Paradigm Geophysical is the latest company to support the Distinguished Lecture Program, joining others with a five-year commitment of US $250,000 to help bring leading geophysical advances to SEG members around the world. “It is always a great pleasure for us to support our new students and industry training. It's an important cause for us, and we are happy to continue supporting the Foundation,” said Eldad Weiss, chairman and CEO.

Table of Contents

Abstract Creative Raffles The Science of Setting Attendance Numbers Incorporating Creativity Balance Planning and Artistic Inspiration for Tabletop Events Golfing Event Tip Profitable Galas Prep Work Takes Guess Work Out of Event Success Connecting With Patrons Engage People in Your Nonprofit's Life During Events Annual Events Recognize, Respect the Life Cycle of an Annual Event Partnership Opportunity Captaining a Table Offers Partnership Opportunity at Gala Help Outsiders Fit In Promotion Tips For Annual Events Ten Ways to Improve Your Special Event Website Calculate Event Costs Transition From Old to New Centerpieces Send Message Accept Bids for Centerpieces Policies and Procedures Land Mines to Avoid When Serving Alcohol Volunteer Involvement Offering Options Helps Attract, Retain Fundraising Volunteers Securing Sponsors Need Sponsors? Market Your Entire Year's Events in Advance Gender‐specific Events Chicks With Sticks Caters to Female Golfers Auction Rule of Thumb Tree‐themed Events Can Be Enjoyed Year‐round Museum Fundraiser Features Multimedia and Interactive Art Ticket Sales Quality, Variety Are Key to Patron Packages' Success Venue Selection Holding Your Event Onsite Offers Advantages Post‐event Actions Questions to Consider After Your Event Enlisting Can‐do Leaders Hospital Foundation Board Member Spearheads Event Tips on Choosing a Theme Workshop Exercise: People See What They Want to See Display the American Flag Properly in a Parade Picture This Decor Idea Conflict Resolution Analyze How You Give Instructions Reunion Planning MIT Volunteers Utilize Reunion Planning Toolkit Reunion Planning Toolkit Steps Event Vendors One Rental Company or Multiple?

Five Things Physicians and Patients Should Question in Hospice and Palliative Medicine

Overuse or misuse of tests and treatments exposes patients to potential harm. The American Board of Internal Medicine Foundation's Choosing Wisely® campaign is a multiyear effort to encourage physician leadership in reducing harmful or inappropriate resource utilization. Via the campaign, medical societies are asked to identify five tests or procedures commonly used in their field, the routine use of which in specific clinical scenarios should be questioned by both physicians and patients based on the evidence that the test or procedure is ineffective or even harmful. The American Academy of Hospice and Palliative Medicine (AAHPM) was invited, and it agreed to participate in the campaign. The AAHPM Choosing Wisely Task Force, with input from the AAHPM membership, developed the following five recommendations: 1) Don't recommend percutaneous feeding tubes in patients with advanced dementia; instead, offer oral-assisted feeding; 2) Don't delay palliative care for a patient with serious illness who has physical, psychological, social, or spiritual distress because they are pursuing disease-directed treatment; 3) Don't leave an implantable cardioverter-defibrillator activated when it is inconsistent with the patient/family goals of care; 4) Don't recommend more than a single fraction of palliative radiation for an uncomplicated painful bone metastasis; and 5) Don't use topical lorazepam (Ativan®), diphenhydramine (Benadryl®), and haloperidol (Haldol®) (ABH) gel for nausea. These recommendations and their supporting rationale should be considered by physicians, patients, and their caregivers as they collaborate in choosing those treatments that do the most good and avoid the most harm for those living with serious illness.

The American Academy of Neurology's Top Five Choosing Wisely recommendations

To discuss the American Academy of Neurology (AAN)'s Top Five Recommendations in the Choosing Wisely campaign promoting high-value neurologic medicine and physician-patient communication. The AAN published its Top Five Recommendations in February 2013 in collaboration with the American Board of Internal Medicine Foundation and Consumer Reports. A Choosing Wisely Working Group of 10 AAN members was formed to oversee the process and craft the evidence-based recommendations. AAN members were solicited for recommendations, the recommendations were sent out for external review, and the Working Group members (article authors) used a modified Delphi process to select their Top Five Recommendations. The Working Group submitted 5 neurologic recommendations to the AAN Practice Committee and Board of Directors; all 5 were approved by both entities in September 2012. Recommendation 1: Don't perform EEGs for headaches. Recommendation 2: Don't perform imaging of the carotid arteries for simple syncope without other neurologic symptoms. Recommendation 3: Don't use opioids or butalbital for treatment of migraine, except as a last resort. Recommendation 4: Don't prescribe interferon-β or glatiramer acetate to patients with disability from progressive, nonrelapsing forms of multiple sclerosis. Recommendation 5: Don't recommend carotid endarterectomy for asymptomatic carotid stenosis unless the complication rate is low (<3%).

CPNP Announcements

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Endoscopy for Gastroesophageal Reflux Disease: Choose Wisely

In this issue, the ACP Clinical Guidelines Committee provides best practice advice for using endoscopy to help manage GERD and makes it clear that endoscopy often is not needed. The editorialist di...

A LONGITUDINAL EXAMINATION OF THE RELATIONSHIP OF SELECTED INSTITUTIONAL VARIABLES TO COMMUNITY COLLEGE FOUNDATION REVENUE

The primary purpose of this study was to examine the annual revenue received by United States public Community College Foundations from 2008-2009 in relation to selected variables associated in the literature with successful foundation performance. This study also collected longitudinal data by replicating and expanding upon a similar study conducted by Dr. Sharon McEntee Carrier a decade earlier. Linear regression analysis was used to collect descriptive statistics that described the frequencies, central tendencies, and distribution of the data. The researchers used linear regression and analysis of variances (ANOVA) to study the relationship between revenue gained in connection with private giving and college foundation operations for fiscal year 2008-2009, the degree to which the college president, chief resource development officer, and foundation board members were rated as playing a critical role in the foundation’s operation, the degree to which meeting institutional strategic goals was rated as an important factor in evaluating the foundation’s operation, the institution’s geographic location, size (based on FTE enrollment), size of endowment, and organizational structure. The explanatory variables, foundation operations, the Chief Development Officer’s role in the foundation’s operation, location, size, endowment, and the Chief Development Officer’s perception of how fundraising efforts were appreciated by the institutions served were found to be statistically significant. Keywords: chief resource development officer (CDO), college fund raising, college foundations, endowments, community college revenue

Making pharmacists’ patient care services consistent, predictable, measurable

Making pharmacists’ patient care services consistent, predictable, measurable