Helping struggling teachers improve has become a big concern — and a
big business — across the country, especially as more states, including
New York, introduce more rigorous teacher evaluations. The federal
government gives local districts more than $1 billion annually for
training programs.
New York City schools spent close to $100 million last year just on private consultants.
Yet even as districts increase accountability for teachers, few are
checking on the companies, universities and in-school programs that are
supposed to help them get better.
On-the-job training for teachers, known as professional development,
encompasses everything from day-long seminars, coaching provided by
in-school specialists, courses in subjects like math and reading, and
teachers working with one another to improve their skills. New York City
even offers Yoga and dance classes to its teachers.
Little reliable, independent research exists on what kind of training for teachers actually works, however.
“We know less than we should about professional development,
particularly given the money that is invested in it,” said Pamela
Grossman, an education researcher at Stanford University who specializes
in teacher training.
Instead, in New York, much of the onus of figuring out which kinds of
training make a difference falls on the shoulders of principals.
Officials from the Department of Education say the sheer number of
vendors — about 900 — makes it difficult for the central office to vet
them all.
“We’ve said we’re endorsing none of them,” said Josh Thomases, deputy
chief academic officer. “Sometimes, particularly the for-profits pay
for lunch, and so they’re sitting in the room with me, and people are
watching me while I’m saying, ‘We’re telling you to be very cautious
with your dollars,’ in front of the vendors.”
In New York City, schools spent about $97 million between May 2011
and April 2012 on outside consultants that provide professional
development, according to an analysis of D.O.E. data collected by the
city comptroller’s office. The year before, they spent $90 million.
District officials say the amount spent on consultants doesn’t
include training run internally — such as coaching and workshops — that
is extensive but difficult to quantify.
On a recent afternoon at P.S. 176
in Dyker Heights, Brooklyn, about 15 teachers gathered in the library
to take a class on how to use interactive smart boards. Matthew Thaxter,
from the Long Island-based company TEQ, showed the teachers how to make
words appear on blank screens, something he said would excite and
engage their young students. The teachers have had smart boards for
years, but taking the class made them “certified” in the technology.
Mr. Thaxter said there’s a growing demand for this training now that classrooms rely so much on technology.
“We have about 30 trainers around New York State and New Jersey,” he
said. “We also offer our own conferences for technology; it’s not just
about smart boards.”
P.S. 176 has spent $15,000 on Thaxter’s training this year, and
budgeted more than $100,000 in total on professional development. This
is more than double its district’s average.
The school’s above-average spending is partly because it has a high
number of students in poverty and receives a pot of federal money every
year for professional development. But Principal Elizabeth Culkin also
thinks the training is working for her teachers. Her proof? The school
has received consistent A’s on it progress reports.
But there are plenty of city schools spending large amounts of money
on professional development that receive D’s and F’s, only underscoring
the lack of a system for judging various professional development
programs.
“We have some hunches,” said Michael Garet, a vice president at the American Institutes for Research
and lead author of a major study on teacher training sponsored by the
federal government. Some research shows that it’s more effective to
train teachers in content knowledge, such as math or science, and to
make sure the training is frequent and ongoing.
“But we don’t yet know how to provide professional development reliably at large scale,” he said.
Ms. Culkin conceded it can be difficult to pick providers, but she said she relies on years’ of experience and word of mouth.
New York’s adoption of a new set of more intensive academic
standards, known as the Common Core State Standards, has meant the
number of consultants offering to train teachers in the new system is
likely to multiply, further confusing the picture for principals.
“Every time there’s this kind of policy push, providers come out of the woodwork,” said Sandi Jacobs, vice president of the National Council on Teacher Quality, an advocacy group in Washington, D.C.
Providers say it’s not always fair to judge them based on the performance of schools.
“If you’re a professional development provider and they keep hiring
you but don’t do the things you’re trying to help them do, then you
can’t really be held accountable for their failure to raise student
learning,” said Lauren Resnick, co-director of the Institute for Learning at the University of Pittsburgh, which has provided training to New York City schools in the past.
But Resnick also thinks districts should attempt to gather evidence to help principals make the best choices.
“If teachers are going to have to show results, why would it be okay for the people who teach them not to?” she said.
Biyernes, Hunyo 1, 2012
Hospitals fight drug scarcity, fear patients harmed
WASHINGTON (Reuters) - At the Henry Ford Hospital in Detroit,
pharmacists are using old-fashioned paper spreadsheets to track their
stock of drugs in short supply - a task that takes several hours each
day.
Most of the hospital's medicines - an estimated $100-million supply a year - are tracked by automated systems that allow for quick reorders when the supply runs low. But these automated systems, designed to help the hospital avoid purchases and storage costs of unused pills and vials, do not work if it is uncertain when the next batch of drugs will come in.
A few hundred medicines make the list of drugs in short supply: anesthetics, drugs for nausea and nutrition, infection treatments and diarrhea pills. A separate list has scarce cancer drugs for leukemia or breast cancer.
"Now we have to go through the pharmacy and count those drugs on a daily basis ... to make sure we don't run out," said Ed Szandzik, director of pharmacy services at the hospital for over a decade.
The growing scarcity of sterile, injectable drugs is one of the biggest issues confronting hospitals across the country, and will be a key issue at the annual American Society of Clinical Oncology meeting in Chicago this weekend.
Health officials blame the shortages on industry consolidation that has left only a handful of generic manufacturers of these drugs, even as the number of drugs going off-patent is growing. Some drugmakers have been plagued by manufacturing problems that have shut down multiple plants or production lines, while others have stopped producing a treatment when profit margins erode too far.
Some medicines have been periodically short in the past, doctors and pharmacists say, but the number of drug shortages has escalated in recent years, jumping from 56 in 2006 to 250 last year, according to U.S. Food and Drug Administration figures.
Generic drugmakers like U.S.-based Hospira Inc and Israeli Teva Pharmaceutical Industries say they are building new facilities to prevent future shortages.
But in the meantime, pharmacies around the country are counting pills, begging neighboring hospitals for extra supplies and scouring the Internet for news of additional supply disruptions.
When rumors surface of an impending shortage, some pharmacies rush to buy up more than they need, likely leading to bigger shortages, analysts and other pharmacists said.
All of this requires regular attention from hospitals to manage the crisis. At Children's National Medical Center in Washington, D.C., pharmacists and administrators meet weekly to discuss just how dire the situation is for different medicines.
"Every Wednesday before we have that (meeting), I have a bit of anxiety," said Ursula Tachie-Menson, acting chief of the hospital's pharmacy division. She spends about 30 percent of her time each week addressing shortage-related problems.
"Out of all the (21) years I have been practicing, these drug shortages have been one of the biggest challenges," she said.
EARLY WARNING SYSTEM
The FDA has been acting under an October executive order from President Barack Obama to fill in the gaps. It has had success getting an early warning from drug companies when they foresee a new shortage, allowing the agency to persuade other manufacturers to increase their production or look overseas to guarantee supply.
"I can tell you that there's not a single company I'm aware of out there that isn't talking to the FDA," said David Gaugh, head of regulatory sciences at the Generic Pharmaceutical Association, referring to the trade group's members.
The FDA said early notification has helped prevent 128 shortages in six months. It also estimates the rate of new shortages is slowing, with half the number of new scarce drugs this year compared to last.
But surveys and anecdotes continue to pile up, showing doctors' efforts to find scarce drugs have not gotten easier. This month, a website for U.S. oncologists, MDLinx, surveyed 200 doctors and found more than 90 percent of them have experienced shortages of key cancer drugs.
CANCER, ANESTHESIA, NUTRITION
A clinical nutrition group, the American Society for Parenteral and Enteral Nutrition, found that 70 percent of the 800-member nurses, doctors, and pharmacists who responded to an online survey said they had seen shortages of adult injectable multi-vitamins, used for basic nutrition for patients with intestinal issues.
More than a quarter were not giving their patients multi-vitamins because of the shortages, placing them at risk of severe vitamin deficiencies that can lead to issues like anemia, due to a lack of folate, or scurvy, which happens when people do not get vitamin C.
In extreme cases, a deficiency of a type of B vitamin called thiamine can lead to cardiac arrest or death.
"This is an act of daily living for people now," said Jay Mirtallo, president of the group. "How that can be acceptable, I don't understand."
When a drug is not available, doctors have to seek alternatives, which may not work as well or cost more money. Others have to ration limited supplies of a life-saving treatment to only those who need it most.
Dr. Steven Allen, a specialist in blood cancers at North Shore University Hospital in New York, recently treated a young woman who had suffered several relapses of a life-threatening cancer known as acute lymphoblastic leukemia.
Allen found a combination that involved thiotepa, an older drug his patient had not tried and could tolerate.
"When I ordered it, I was informed that there was none available, and it couldn't be obtained," said Allen, also chair of the committee on practice at the American Society of Hematology. He substituted a similar drug, but one that the woman had already taken. "We tried to make up a dose that was equivalent to thiotepa and hoped for the best. ... But I think it may have compromised her care."
On May 14, the FDA announced it would allow temporary imports of thiotepa made by Italian company Adienne Pharma & Biotech, to relieve manufacturing delays at Bedford, Ohio-based Bedford Laboratories, a unit of the private German company Boehringer Ingelheim that is the only approved manufacturer for the United States. Bedford said in April it does not know when further shipments would be available once its supplies run out.
Imports have not helped anesthesiologists like Jason Soch, who hears about a new shortage nearly every week during his rotations at several surgical centers in Philadelphia. These are often "workhorse" drugs such as fentanyl, midazolam and propofol, used every day during surgery.
"It seems like as soon as one drug is no longer in shortage, we get an email from the hospital pharmacist that they're on their last box of another," he said. Every disruption forces doctors to change dosing, or give new drug combinations they may not be as familiar with.
"I didn't envision this when I went to anesthesia," Soch said. "I'd figured we'd have whatever we needed."
SCRAMBLING FOR A FIX
The problem has inspired some creative solutions, like a drug shortages mobile application called RxShortages that allows medical and pharmacy staff to track new drug shortages posted on websites, including the FDA's. Mick Schroeder, a pharmacy resident who created the app, said it has been downloaded about 25,000 times.
Brooke Bernhardt, an oncology pharmacist at Texas Children's Hospital, said she checks RxShortages at least once a day.
"Unfortunately, at any point we expect a drug to go on back order," she said.
Ed Szandzik, the pharmacy director at Henry Ford Hospital in Detroit, admits he would buy a larger quantity of drugs than usual if it became available.
"If I have to get one or two months' supply, I'll buy it, because our patients need it," he said. "Hoarding is in the eye of the beholder."
Some distributors and manufacturers prevent hoarding by allocating drugs based on historical demand. Other pharmacists say it is natural to want to buy more to ensure supply.
"Why did it ever have to get to this point in the first place?" said Szandzik. "It takes a lot of hours, a lot of labor, a lot of luck to make sure our patients are safe. ... And I don't see it getting better for a while."
Most of the hospital's medicines - an estimated $100-million supply a year - are tracked by automated systems that allow for quick reorders when the supply runs low. But these automated systems, designed to help the hospital avoid purchases and storage costs of unused pills and vials, do not work if it is uncertain when the next batch of drugs will come in.
A few hundred medicines make the list of drugs in short supply: anesthetics, drugs for nausea and nutrition, infection treatments and diarrhea pills. A separate list has scarce cancer drugs for leukemia or breast cancer.
"Now we have to go through the pharmacy and count those drugs on a daily basis ... to make sure we don't run out," said Ed Szandzik, director of pharmacy services at the hospital for over a decade.
The growing scarcity of sterile, injectable drugs is one of the biggest issues confronting hospitals across the country, and will be a key issue at the annual American Society of Clinical Oncology meeting in Chicago this weekend.
Health officials blame the shortages on industry consolidation that has left only a handful of generic manufacturers of these drugs, even as the number of drugs going off-patent is growing. Some drugmakers have been plagued by manufacturing problems that have shut down multiple plants or production lines, while others have stopped producing a treatment when profit margins erode too far.
Some medicines have been periodically short in the past, doctors and pharmacists say, but the number of drug shortages has escalated in recent years, jumping from 56 in 2006 to 250 last year, according to U.S. Food and Drug Administration figures.
Generic drugmakers like U.S.-based Hospira Inc and Israeli Teva Pharmaceutical Industries say they are building new facilities to prevent future shortages.
But in the meantime, pharmacies around the country are counting pills, begging neighboring hospitals for extra supplies and scouring the Internet for news of additional supply disruptions.
When rumors surface of an impending shortage, some pharmacies rush to buy up more than they need, likely leading to bigger shortages, analysts and other pharmacists said.
All of this requires regular attention from hospitals to manage the crisis. At Children's National Medical Center in Washington, D.C., pharmacists and administrators meet weekly to discuss just how dire the situation is for different medicines.
"Every Wednesday before we have that (meeting), I have a bit of anxiety," said Ursula Tachie-Menson, acting chief of the hospital's pharmacy division. She spends about 30 percent of her time each week addressing shortage-related problems.
"Out of all the (21) years I have been practicing, these drug shortages have been one of the biggest challenges," she said.
EARLY WARNING SYSTEM
The FDA has been acting under an October executive order from President Barack Obama to fill in the gaps. It has had success getting an early warning from drug companies when they foresee a new shortage, allowing the agency to persuade other manufacturers to increase their production or look overseas to guarantee supply.
"I can tell you that there's not a single company I'm aware of out there that isn't talking to the FDA," said David Gaugh, head of regulatory sciences at the Generic Pharmaceutical Association, referring to the trade group's members.
The FDA said early notification has helped prevent 128 shortages in six months. It also estimates the rate of new shortages is slowing, with half the number of new scarce drugs this year compared to last.
But surveys and anecdotes continue to pile up, showing doctors' efforts to find scarce drugs have not gotten easier. This month, a website for U.S. oncologists, MDLinx, surveyed 200 doctors and found more than 90 percent of them have experienced shortages of key cancer drugs.
CANCER, ANESTHESIA, NUTRITION
A clinical nutrition group, the American Society for Parenteral and Enteral Nutrition, found that 70 percent of the 800-member nurses, doctors, and pharmacists who responded to an online survey said they had seen shortages of adult injectable multi-vitamins, used for basic nutrition for patients with intestinal issues.
More than a quarter were not giving their patients multi-vitamins because of the shortages, placing them at risk of severe vitamin deficiencies that can lead to issues like anemia, due to a lack of folate, or scurvy, which happens when people do not get vitamin C.
In extreme cases, a deficiency of a type of B vitamin called thiamine can lead to cardiac arrest or death.
"This is an act of daily living for people now," said Jay Mirtallo, president of the group. "How that can be acceptable, I don't understand."
When a drug is not available, doctors have to seek alternatives, which may not work as well or cost more money. Others have to ration limited supplies of a life-saving treatment to only those who need it most.
Dr. Steven Allen, a specialist in blood cancers at North Shore University Hospital in New York, recently treated a young woman who had suffered several relapses of a life-threatening cancer known as acute lymphoblastic leukemia.
Allen found a combination that involved thiotepa, an older drug his patient had not tried and could tolerate.
"When I ordered it, I was informed that there was none available, and it couldn't be obtained," said Allen, also chair of the committee on practice at the American Society of Hematology. He substituted a similar drug, but one that the woman had already taken. "We tried to make up a dose that was equivalent to thiotepa and hoped for the best. ... But I think it may have compromised her care."
On May 14, the FDA announced it would allow temporary imports of thiotepa made by Italian company Adienne Pharma & Biotech, to relieve manufacturing delays at Bedford, Ohio-based Bedford Laboratories, a unit of the private German company Boehringer Ingelheim that is the only approved manufacturer for the United States. Bedford said in April it does not know when further shipments would be available once its supplies run out.
Imports have not helped anesthesiologists like Jason Soch, who hears about a new shortage nearly every week during his rotations at several surgical centers in Philadelphia. These are often "workhorse" drugs such as fentanyl, midazolam and propofol, used every day during surgery.
"It seems like as soon as one drug is no longer in shortage, we get an email from the hospital pharmacist that they're on their last box of another," he said. Every disruption forces doctors to change dosing, or give new drug combinations they may not be as familiar with.
"I didn't envision this when I went to anesthesia," Soch said. "I'd figured we'd have whatever we needed."
SCRAMBLING FOR A FIX
The problem has inspired some creative solutions, like a drug shortages mobile application called RxShortages that allows medical and pharmacy staff to track new drug shortages posted on websites, including the FDA's. Mick Schroeder, a pharmacy resident who created the app, said it has been downloaded about 25,000 times.
Brooke Bernhardt, an oncology pharmacist at Texas Children's Hospital, said she checks RxShortages at least once a day.
"Unfortunately, at any point we expect a drug to go on back order," she said.
Ed Szandzik, the pharmacy director at Henry Ford Hospital in Detroit, admits he would buy a larger quantity of drugs than usual if it became available.
"If I have to get one or two months' supply, I'll buy it, because our patients need it," he said. "Hoarding is in the eye of the beholder."
Some distributors and manufacturers prevent hoarding by allocating drugs based on historical demand. Other pharmacists say it is natural to want to buy more to ensure supply.
"Why did it ever have to get to this point in the first place?" said Szandzik. "It takes a lot of hours, a lot of labor, a lot of luck to make sure our patients are safe. ... And I don't see it getting better for a while."
Clorox to be aggressive in healthcare deals
NEW YORK (Reuters) - Clorox Co Chief Executive Don Knauss plans to be
fairly aggressive in buying assets to expand his company's healthcare
offerings as it looks to triple the size of that business over the next
five years.
The 99-year-old company is best-known for its namesake bleach, but its healthcare business - encompassing products like disinfecting spray, germicidal wipes and hand sanitizer - has been a small growth engine in recent years.
The business has grown to around $100 million in annual revenue from around $2 million over the past five years, Knauss told Reuters in an interview. He hopes to expand it to a $300 million business within five years, with about half that growth coming from acquisitions.
"You can certainly expect more activity," Knauss said, noting that there are dozens of family-owned healthcare companies that focus on disinfection products, or products that prevent the spread of infection - offerings the company is looking to expand.
"Most of these companies that we've looked at are in the $10-to-$50 million range" of annual revenue, Knauss said.
The company spent about $80 million to $90 million to buy two healthcare companies - Aplicare Inc and HealthLink - earlier in 2012.
Internationally, Knauss said Clorox will also look for bolt-on acquisitions for its home care and laundry businesses in countries where it already does business, especially in Latin America.
He said the company was interested in Procter & Gamble Co's bleach business in Central America, for instance.
"We'll continue to knock on their door," he said, noting that the unit probably brings in less than $50 million in revenue annually.
Clorox is trying to reshape its portfolio to align more with the consumer trends of health and wellness, sustainability, multiculturalism and affordability. It has sold its auto care business and acquired various products sold to the healthcare industry as well as Burt's Bees natural personal care products and Soy Vay Enterprises, which makes Asian marinades and dressings.
Still, Knauss said the company was not interested in making any drastic changes through acquisition.
"I think people typically overpay when they start talking about transformational acquisitions," Knauss said.
Clorox shares dipped 4 cents to close at $68.80 on Thursday.
The 99-year-old company is best-known for its namesake bleach, but its healthcare business - encompassing products like disinfecting spray, germicidal wipes and hand sanitizer - has been a small growth engine in recent years.
The business has grown to around $100 million in annual revenue from around $2 million over the past five years, Knauss told Reuters in an interview. He hopes to expand it to a $300 million business within five years, with about half that growth coming from acquisitions.
"You can certainly expect more activity," Knauss said, noting that there are dozens of family-owned healthcare companies that focus on disinfection products, or products that prevent the spread of infection - offerings the company is looking to expand.
"Most of these companies that we've looked at are in the $10-to-$50 million range" of annual revenue, Knauss said.
The company spent about $80 million to $90 million to buy two healthcare companies - Aplicare Inc and HealthLink - earlier in 2012.
Internationally, Knauss said Clorox will also look for bolt-on acquisitions for its home care and laundry businesses in countries where it already does business, especially in Latin America.
He said the company was interested in Procter & Gamble Co's bleach business in Central America, for instance.
"We'll continue to knock on their door," he said, noting that the unit probably brings in less than $50 million in revenue annually.
Clorox is trying to reshape its portfolio to align more with the consumer trends of health and wellness, sustainability, multiculturalism and affordability. It has sold its auto care business and acquired various products sold to the healthcare industry as well as Burt's Bees natural personal care products and Soy Vay Enterprises, which makes Asian marinades and dressings.
Still, Knauss said the company was not interested in making any drastic changes through acquisition.
"I think people typically overpay when they start talking about transformational acquisitions," Knauss said.
Clorox shares dipped 4 cents to close at $68.80 on Thursday.
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