A process evaluation of a two-year community cardiovascular risk reduction program: what was done and who knew about it?

This research is based on the importance of supervision and evaluation as part of the program management function. Supervision and evaluation of the program need to be carried out to measure its success and feasibility. The purpose of this study is to find out how the management supervision, and evaluation of the context, input, process and product model in muhadatsah sobahiyah program at Darussalam Gontor for Girls Islamic Boarding School 2. This study uses a qualitative approach with a descriptive type of research. All data is obtained through observation, Semi-structured interviews, and documentation techniques. Triangulation is performed to test the credibility of the data. Participants in this study consisted of 5 language supervisors, three of whom were members of the Language Advisory Council and two were members of the Central Language Improvement. The research results showed that the supervision process was carried out by the deputy caretaker, Language Advisory Council, Central Language Improvement, and the regional language section. Muhadatsah supervision at Gontor for Girls Campus 2 includes internal, repressive, preventive, active and passive supervision as well as formal truth supervision. It was also discovered that supervision of the program was carried out collaboratively. while the evaluation carried out on the program consists of 4 elements, namely context, process input, and product. So far, the muhadatsah program at Islamic Boarding School Darussalam Gontor for Girls Campus 2 has run according to expectations and desired goals. The advice for researchers can then continue research on supervision and evaluation of other learning programs in an institution. In addition, this research can be one of the references for academics in efforts to implement supervision and evaluation of programs, especially the Arabic language education program.

Cardiovascular risk stability: From grade school to high school

The Accreditation Council for Graduate Medical Education's Next Accreditation System requires continuous program improvement as part of program evaluation for residency training institutions and programs. To improve the institutional- and program-level evaluation processes, to operationalize a culture of continuous quality improvement (CQI), and to increase the quality and achievement of action items, the Wayne State University Office of Graduate Medical Education (WSU GME) incorporated CQI elements into its program evaluation process. Across 4 academic years, WSU GME phased the following 4 CQI elements into the evaluation process at the program and institutional levels, including the annual program evaluation (APE) and the annual institutional review: (1) An APE template; (2) SMART (specific, measurable, accountable, realistic, timely) format for program and institutional goals; (3) Dashboard program and institutional metrics; and (4) Plan-do-study-act cycles for each action item. Action item goals improved in adherence to the SMART format. In 2014, 38% (18 of 48) omitted at least 1 field, compared with 0% omitting any fields in 2018. More complete action items took less time to resolve: 1.7 years compared with 2.4 years (t (43.3) = 2.87, P = .003). The implementation of CQI in the APE was well received by program leadership. After leveraging CQI methods, both descriptions of institutional- and program-level goals and the time required for their achievement improved, with overall program director and program coordinator satisfaction.

It is generally recognized that for any evaluation to be successful there needs to be a significant amount of involvement from program staff and other stakeholders who are invested in the program. Ideally, these individuals would be highly engaged in the evaluation process; however, in practice this ideal is rarely met. Two research studies were undertaken to explore different stakeholder motives for involvement in program evaluations and their relative importance in involvement decisions. In Study 1, stakeholder views of their own involvement (or lack thereof) in recent program evaluations were analyzed qualitatively using a thematic analysis approach. The findings revealed diverse stakeholder motives for evaluation involvement that include personal/human factors (e.g., opportunity for personal advancement), evaluation factors (e.g., clarity of evaluation goals) and organizational factors (e.g., funding implications). A second study looked more closely at these motives to determine their relative importance to evaluation involvement decision-making. Using the Q-sort method, three involvement profiles were identified which revealed different pathways to involvement based on individual concerns for program funding, learning opportunities, and evaluation quality. A preliminary model of stakeholder involvement motives is proposed in which the value and relevance of the evaluation are determined by expected outcomes of the evaluation.

The Massachusetts WISEWOMAN Project is a cardiovascular disease (CVD) risk reduction program targeting older uninsured and underinsured women. The cost-effectiveness of providing CVD screening and enhanced lifestyle interventions (EI), compared with providing CVD screening and a minimum intervention (MI), was assessed at five El and six MI healthcare sites. Cost calculations were based on data collected during screenings and intervention activities conducted with 1586 women in 1996. Risk factor data, including cholesterol and blood pressure measures, were used to create a summary effectiveness outcome, the 10-year probability of developing coronary heart disease (CHD). The cost-effectiveness ratio of the EI, compared with the MI, was calculated by dividing the incremental cost of the EI by the incremental effectiveness of the EI. The incremental cost of the EI was $191. During the 1-year study period, the 10-year probability of CHD decreased from 9.4% to 9.2% in the MI group and from 10.3% to 9.8%in the El group. Based on these results, it would cost $637 to achieve a 1 percentage point larger decrease in the 10-year probability of CHD for women enrolled in the El. However, because differences between groups were not statistically significant, we cannot reject the hypothesis that the El results in no greater reductions in CHD risk. Although women enrolled in both the MI and El showed decreases in CHD risk during the study period, future research is needed to assess the impact of lifestyle interventions targeting financially disadvantaged women.

Reduction in Cardiovascular Risk Among Latino Participants in a Community-Based Intervention Linked With Clinical Care

The dissertation describes the results of a two-year school improvement program in which the complete school staffs of six Dutch primary schools were trained to integrate inquiry-based pedagogy into daily school practice. In the last two decades, the Dutch government has promoted the widespread implementation of science and technology (S&T) teaching in primary education. There is increasing consensus in the scientific literature that primary S&T education should be understood as a transdisciplinary form of inquiry-focused teaching and learning linked to all school subject areas and lesson activities. However, descriptions of longitudinal and experimental intervention studies on the (school-wide) implementation of S&T education in primary schools have so far been scarce. The present study aimed to help fill this void in the literature. It mainly concerned the evaluation of the aforementioned school improvement program. In addition, preliminary research indicated a scarcity of research on the nature and dimensions of pupils’ curiosity in the school context. Because the stimulation of pupils’ curiosity was deemed a main objective of primary S&T education, and should therefore be included as an explicit measure for assessing inquiry-focused school improvement in this context, separate theoretical and empirical research was conducted first. Therefore, the first two studies of the dissertation focus on the operationalization and measurement of pupils’ curiosity. The last two studies focus on the evaluation of the school development program. The main findings of the study indicate that a school-wide approach to the implementation of S&T education, coupled with extensive attitude-focused and didactical professional training, can help primary schools integrate inquiry-focused (S&T) teaching practice in their school organization. At the same time, our findings highlight that it is not easy for primary teachers to implement such teaching practice on their own. Foundations should promote research aimed at more clearly defining and developing assessments of relevant pupil qualities, initially for research purposes, and later for summative and formative assessment. Only when pupils’ inquiry is perceived by primary teachers as integral to school learning, no less so than literacy and numeracy, will we likely see significant changes happen in classroom practice.

With increased emphasis on prevention in recent healthcare reform initiatives, more information is needed to validate the effectiveness of programs designed to diagnose and treat individuals at high risk for cardiac events and increased mortality. The purpose of this study was to evaluate early and late outcomes of a community-based cardiovascular risk reduction program (CRRP). Methods: Individuals at high risk for cardiovascular events were referred from community primary care physicians for advanced diagnostic testing and medication management at a hospital-based CRRP. Between March 1, 2005 and August 1, 2007, 182 participants were enrolled and had advanced lipid testing, chemistry panels, stress testing, CT calcium scoring, vascular elasticity studies, and comprehensive assessment of cardiovascular risk factors, family history, diet, activity level and psychological status. Participants had on average 4 visits. Mortality and need for hospitalization were assessed at a mean follow-up time of 45±14 months. Results: On CRRP entry, 84% had elevated lipids, 70% had hypertension, 31% had diabetes, 32% had metabolic syndrome, 10% were current smokers, 17% had an abnormal stress test, 36% had depression, 44% had sleep disturbances, and over 50% were not exercising. Over 30% had conditions that had not been recognized or were left undertreated. By last visit, over 95% of participants were on appropriate medications and had received life-style interventions. Late mortality occurred in 9 (5%) participants and 15 (8%) had at least one hospitalization for cardiac reasons. Those who died were older (67 vs. 56; p=0.007), had significantly higher CT calcium scores (998 vs. 114; p<0.0001) and elevated homocysteine levels (14 vs. 9; p<0.0001). Multivariate analyses showed that homocysteine level was the only independent predictor of mortality. No one with metabolic syndrome died (p=0.038). The only factor related to hospitalization was higher NCEP Framingham Age/Sex-adjusted risk score (18 vs. 12; p=0.037). Conclusions: A comprehensive community-based risk reduction program can provide enhanced evaluation and treatment for individuals who are at high risk for cardiovascular events. Appropriate medications and risk modification may impact late events.

This article reviews the literature of African-American risk and identifies the disparity in cardiovascular health status, particularly hypertension, hypercholesterolemia, and cigarette smoking, and mortality rates between African-Americans and whites. Data on African-Americans' knowledge and attitudes toward preventing hypertension and heart disease are summarized and compared to that of whites. Program implementation details such as communication channels, activities, and health outcomes in cardiovascular risk reduction programs in African-American communities are summarized. Promising approaches to program planning and implementation for cardiovascular risk reduction among African-Americans are recommended.

Let’s get technical: Enhancing program evaluation through the use and integration of internet and mobile technologies

Should Lipoprotein(a) be Measured in Youth?

What is new? Cardiovascular disease (CVD) is the leading cause of mortality in type 2 diabetes (T2D) individuals. Of the major risk factors for CVD, less than 10% of T2D people meet the American Diabetes Association/American Heart Association recommended goals of therapy. The present review examines how much of the absolute cardiovascular (CV) risk in type 2 diabetes patients can be explained by major CV intervention trials. Multiple long-term cardiovascular (CV) intervention trials have examined the effect of specific target-directed therapies on the MACE endpoint. Only one prospective study, STENO-2, has employed a multifactorial intervention comparing intensified versus conventional treatment of modifiable risk factors in T2D patients, and demonstrated a 20% absolute CV risk reduction. If the absolute CV risk reduction in these trials is added to that in the only prospective multifactorial intervention trial (STENO-2), the unexplained CV risk is 44.1%. What are the clinical implications? Potential explanations for the unaccounted-for reduction in absolute CV risk in type 2 diabetes (T2D) patients are discussed. failure to take into account synergistic interactions between major cardiovascular risk factors is responsible for the unexplained CV risk in T2D patients. Simultaneous treatment of all major CV risk factors to recommended AHA/ADA guideline goals is required to achieve the maximum reduction in CV risk.

Evaluation is a controversial and little-understood strategy of public governance, control, and decision making. As early as classical antiquity, scholars were summoned to court to counsel kings. Public policy and program evaluation is a recent addition to the great chain of attempts to use the brainpower of scholars and scientists to further the interests of the state. Evaluation scholars are asked to provide retrospective assessments of the implementation, output, and outcome of government measures in order to effect deeper understanding and well-grounded decisions on the part of those in charge of government operations. Evaluation is the process of distinguishing the worthwhile from the worthless, the precious from the useless; evaluation implies looking backward in order to be able to steer forward better. Written from a political science perspective, Public Policy and Program Evaluation provides an overview of the possibilities and limits of public sector evaluation. Evert Vedung examines evaluation as a mechanism for monitoring, systematizing, and grading government activities and their results so that public officials, in their future-oriented work, will be able to act as responsibly, creatively, and efficiently as possible. Topics discussed include: Evaluation, Rationality, and Theories of Public Management; Models of Evaluation; Internal or External Evaluation; Impact Assessment as Tryout and Social Experimentation; Process Evaluation and Implementation Theory; Eight-Problems Approach to Evaluation; and Uses and Users of Evaluation. All evaluation rests upon the idea that perceptions, opinions, intentions, judgments--in short, everything concerned with the world of human consciousness--play such interesting roles in political and administrative action that their functions are worth investigating. Through experience, humans may learn from past actions. The interventions of the modern state are so extensive, their execution so complicated, and their potential consequences so far-reaching that science and social research are needed to monitor operations and establish impacts. As an excellent Introduction to the field of policy evaluation, Public Policy and Program Evaluation will be a valuable resource for students of public administration, public policy, political science, education, and sociology.

A cost-benefit analysis for the appraisal of social and market prices in the probabilistic seismic risk assessment of building portfolios: A methodology for the evaluation of disaster risk reduction programs

Introduction Cardiovascular disease (CVD) is the leading cause of mortality in people with type 2 diabetes (T2D). CAPTURE, a non-interventional, cross-sectional study conducted across 13 countries in 2019, collected demographic and clinical characteristics in almost 10,000 adults with T2D in primary or secondary care. Less than 25% of patients with established CVD treated with a glucose-lowering agent received an agent with demonstrated benefit in cardiovascular (CV) risk reduction, such as a glucagon-like peptide-1 receptor agonist (GLP-1 RA) or a sodium–glucose co-transporter-2 inhibitor (SGLT-2i).1 It is not known whether this is linked to estimated 10-year and lifetime CV risk. Purpose To estimate the CV risk distribution in the CAPTURE population using the Diabetes Lifetime-perspective prediction (DIAL) model, and to assess treatment patterns by CV risk. Methods The DIAL model is an externally validated competing risk adjusted model for predicting CV risk in patients with T2D, calculating absolute 10-year and lifetime risk of myocardial infarction, stroke or cardiovascular death, and life-expectancy free of a CVD event. Patient-level data from CAPTURE (age, sex, body mass index, smoking status, HbA1c, CVD history, T2D duration, clinical parameters and treatment history) were used in the DIAL model. Missing data were imputed by region using predicted mean matching. High risk was defined as 10-year risk >10%, and lifetime risk >50%. Results Data from 9457 patients with T2D aged 30–85 years were included in the analyses. There was a wide distribution of both 10-year and lifetime risk, with higher risk in patients with a history of CVD (n=2914) than in those without (n=6543). Among patients with a history of CVD, 96% had a 10-year risk of CVD >10% and 81% had a lifetime risk of CVD >50% (Figure). In patients with CVD and a high 10-year risk of recurrent CVD, 81% had a lifetime risk of recurrent CVD >50%. In patients without history of CVD, 14% had a 10-year risk >10% and only 1% had a lifetime risk >50% (Figure). Among patients without previous CVD but with a high 10-year risk of CVD, only 4% had a lifetime risk >50%. Of the patients with CVD, 10% received a GLP-1 RA and 18% received an SGLT-2i. Similarly, of patients with CVD and a high 10-year risk of recurrent CVD, 10% received a GLP-1 RA and 17% received an SGLT-2i. Among patients without CVD, 11% received a GLP-1 RA and 16% received an SGLT-2i, and among patients without current CVD but at a high 10-year risk of CVD, 12% received a GLP-1 RA and 16% received an SGLT-2i. Conclusion There is a wide distribution of CVD risk in the CAPTURE population, and only a minority of patients at high risk of CVD received a glucose-lowering agent with demonstrated benefit in CV risk reduction. Discussing with patients the 10-year and lifetime risks, and the CV benefit to be gained from interventions, can enhance shared decision making. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Funded by Novo Nordisk A/S