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As healthcare systems become more complex, medical education needs to adapt in many ways. There is a growing need for more formal leadership learning for healthcare providers, including greater attention to health disparities. An important challenge in addressing health disparities is ensuring inclusive excellence in the leadership of healthcare systems and medical education. Women and those who are underrepresented in medicine (URMs) have historically had fewer opportunities for leadership development and are less likely to hold leadership roles and receive promotions. One successful initiative for improved learning of medical leadership-presented as a case example here-is the Academic Career Leadership Academy in Medicine (ACCLAIM) at the University of North Carolina at Chapel Hill School of Medicine. ACCLAIM is uniquely designed for faculty identified as having emerging leadership potential, with an emphasis on women and URMs. Using a leadership learning system approach, annual cohorts of participants (Scholars) interactively participate in a multi-faceted nine-month long learning experience, including group (e.g., guest-speaker weekly presentations and exercises) and individual learning components (e.g., an individual leadership project). Since its initiation in 2012 and through 2021, 111 Scholars have participated in ACCLAIM; included were 57% women and 27% URMs. Two important outcomes described are: short-term impact as illustrated by consistent improvements in quantitively measured leadership knowledge and capabilities; and long-term leadership growth, whereby half of the ACCLAIM graduates have received academic rank promotions and almost two-thirds have achieved new leadership opportunities, with even higher percentages observed for women and URMs; for example, 87% of URMs were either promoted or achieved new leadership positions. Also consistently noted, through qualitative assessments, are broader healthcare system knowledge and shared tactics for addressing common challenges among Scholars. This case example shows that the promotion of leadership equity may jointly enhance professional development while creating opportunities for systems change within academic medical centers. Such an approach can be a potential model for academic medical institutions and other healthcare schools seeking to promote leadership equity and inclusion., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 National Medical Association. Published by Elsevier Inc. All rights reserved.)

This article addresses the critical issue of measuring impact of a distance education Master of Public Health degree program on public health practitioners. It is based on an online survey of the 49 graduates of the Public Health Leadership Program at the School of Public Health of the University of North Carolina at Chapel Hill. The survey was carried out 1-year postgraduation and had a 73% response rate. Results indicated that graduates continued to have a high level of satisfaction with the program; 97% of respondents indicated they would recommend the program to others, and 75% said that their overall opinion about the program had increased since graduation. On a scale of 1 to 10, 79% of respondents rated the program with a score of 8 or higher in terms of the impact of the program on their ability to do their current job. Regarding new opportunities, 75% of respondents reported that they had new professional affiliations or service commitments, and 31% had job promotions since graduating. The methodology and results reported here may be a model for assessing the impact of a distance learning degree program for mid-career professionals. These results support the viability of a distance-education format for providing necessary training at the master's level for the public health workforce.

This article describes the context and examines factors influencing the quality of primary health care delivery and management in Ghana, West Africa. It describes the potential of continuous quality improvement as a management philosophy and tool to improve the quality of primary health care delivery and management in Ghana. It compares the Ghanaian context in which the use of continuous quality improvement in health care is new and untried with the developed country context (mainly the U.S.), where continuous quality improvement has a relatively long history of use in health care and is a requirement for the accreditation of health institutions. Finally, the article discusses the steps that have to be taken to translate continuous quality improvement from a theoretical management concept to improve quality of care to an actual managerial intervention in Ghana. In conclusion, continuous quality improvement is shown to be a potential viable approach to improving quality of care in the Ghanaian context and merits further investigation.

The challenge of quality improvement extends beyond traditional service delivery organizations. This article, the second in a two-part series (see QMHC 7:3, Spring 1999, 7-21 for the first part) focuses on training and empowerment, leadership and statistical process control, and the contribution of these factors to the success of CROs in the pharmaceutical and biotechnology industry. The importance of each is presented along with specific illustrations from operating CROs.

The challenge of quality improvement extends beyond traditional service delivery organizations. This is the first of a two-part series on the application of continuous quality improvement (CQI) to contract research organizations associated with the pharmaceutical and biotechnology industry. The challenges and processes of clinical trials research, and the role of CQI within that process, are presented. The importance of customer focus, which is a key element of CQI, is described here as the foundation of the CQI process among contract research organizations (CROs) and as a major contributing factor to their success in recent years.

These data represent a subset of data from the original 36-week study conducted by Maddin et al., which was in itself a preliminary study of a pulsed electrical stimulation device in male subjects alone. The extension phase of this study, which is summarized here, was undertaken to gather data on longer-term efficacy and safety and to study clinical effects in control subjects who were then switched to active treatment. Thirteen subjects had active treatment for 70 weeks, and 14 subjects were included in the crossover group, which had sham treatment for 36 weeks followed by active treatment for 30 additional weeks. On average, terminal hair counts increased from 82 to 276 in the active treatment group. Among those in the crossover group, a mild increase, from 124 to 160, was observed during the sham treatment period and a more notable increase, from 160 to 249, occurred during the subsequent active treatment period. The results presented here provide evidence of the efficacy and safety of this device during extended use; however, the generalizability of these findings is limited by the small subset of subjects for whom complete data are available.

Pharmacological management of pain for acute and chronic conditions has been guided by a scientific understanding of peripheral and central acting mechanisms for the control of inflammation as well as pain. Oral surgery pain is a reliable model to reference the effectiveness of commonly used analgesics such as ibuprofen and acetaminophen. A total of 706 patients who were experiencing moderate to severe pain received a single dose of ibuprofen, acetaminophen, or placebo. After 6 hours, the degree of pain relief and tolerance was assessed. Ibuprofen has important implications for postoperative pain in clinical practice.

Comparative clinical studies are extensively used as a basis of support for the potential approval of treatments by the Food and Drug Administration and also for other general health policy decisions. The purpose of this paper is to review statistical principles that are relevant to the design, analysis, and interpretation of comparative clinical studies. Three general criteria are emphasized: clarity, comparability, and generalizability. These criteria are discussed in terms of their implications to such considerations as scope of patient population, sample size, randomization, and covariance analysis. Also, an extensive reference list further addressing these topics is presented.

The time-reversed crossover design is a quasi-experimental design which can be applied to evaluate the impact of a change in health policy on a large population. This design makes use of separate sampling and analysis strategies to improve the validity of conclusions drawn from such an evaluation. The properties of the time-reversed crossover design are presented including the use of stratification on outcome in the sampling stage, which is intended to improve external validity. It is demonstrated that, although this feature of the design introduces internal validity threats due to regression toward the mean in extreme-outcome strata, these effects can be measured and eliminated from the test of significance of treatment effects. Methods for within- and across-stratum estimation and hypothesis-testing are presented which are similar to those which have been developed for the traditional two-period crossover design widely used in clinical trials. The procedures are illustrated using data derived from a study conducted by the United Mine Workers of America Health and Retirement Funds to measure the impact of cost-sharing on health care utilization among members of its health plan.

A national model on need for dental treatment, as measured by the HANES survey of the National Center for Health Statistics, is described and applied to determine expenditures required to provide necessary dental services under third-party funding of a national dental program. Services have been divided into five components by type of service and age of the population and expenditures are projected for each year, 1980-84. Total expenditures are projected to increase from 18.98 billion dollars in 1980 to 26.42 billion in 1984. Separate projections are also provided for each component and each service. Expenditures derived from this model are compared to direct projections of trends taking place in the current dental care system. Only minor discrepancies in total expenditures are noted but there are large differences for individual services, notably in the areas of prevention and periodontal diseases. Separate comparisons with demand-based projections derived from the experience of the California Dental Service are also presented. Again, the major differences relate to expenditures for individual services, particularly crowns, for which demand expenditures outstripped need by a three-fold margin.