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D Collins

Publications and source records attributed to D Collins.

158 records · Page 9Linked to original sources
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Hospital autonomy: the experience of Kenyatta National Hospital.

An increasing number of countries are exploring the introduction or expansion of autonomous hospitals as one of the numerous health reforms they are introducing to their health system. Hospital autonomy is one of the forms of decentralization that is focused on a specific institution rather than on a political unit. It has gained much interest because it is an attempt to amalgamate the best elements of the public and private sectors in how a hospital is governed, managed and financed. This paper reviews the key elements of the concept of hospital autonomy, the reasons for its expanded use in many countries and a specific example of making a major teaching hospital autonomous in Kenya. A review of the successful experience of Kenyatta National Hospital and its process of introducing autonomy, with regard to governance, operations and management, and finances, lead to several conclusions on replicability. The legal framework is a critical element for successfully structuring the autonomous hospital. Additionally, success is highly dependent on the extent to which there is adequate funding during the process of attaining autonomy due to the length of the transition period needed. Autonomy must be granted within the context of the national health system and national health objectives and be consistent with those aims and their underlying societal values. Finally, as with decentralization, success is dependent upon the preparation done with the systems and management necessary for the proper governance and operation of autonomous hospitals.

Decision Making, Organizational↗
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Consultation/liaison psychiatry utilization patterns in different cultural groups.

This study examined the effect of cross-cultural factors on psychiatric consultations in a general hospital. Using a retrospective case review, 476 patients receiving a psychiatric consultation were contrasted with 14,620 who did not receive a psychiatric consultation. The rate of psychiatric referral was lower for Hispanics compared with Anglos, blacks, and Asians (p less than 0.001). The reason for requesting psychiatric consultation was also different across the ethnic groups. There were more requests for evaluation of depression and suicide in Hispanics and fewer such requests in blacks. More requests for evaluation of grossly abnormal mental status were found in blacks. The different cultural groups also had differences in psychiatric diagnosis. Hispanics were more frequently diagnosed with an adjustment disorder; blacks were more frequently diagnosed with a primary thought disorder and delirium; and Anglos were more frequently diagnosed with dementia.

Cross-Cultural Comparison↗
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Eagle's syndrome.

Explore the source record for details and available documents.

Adult↗
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Trends in periconceptional folic acid use by relatives in Irish families with neural tube defects.

Close relatives in families who have a child with a neural tube defect (NTD) are at greatly increased risk of having an affected child. Periconceptional folic acid reduces the risk of both occurrence and recurrence of NTDs substantially. Public health authorities currently recommend that the diets of all women between the ages of 15 and 44 who are capable of becoming pregnant be supplemented with folic acid tablets daily. We wondered if relatives in NTD families were more likely to use folic acid. From data obtained by interview with uncles and aunts in Irish NTD families we evaluated folic acid use in 144 of their pregnancies occurring between 1990 and 2000. There was a significant trend towards increasing use of folic acid both before and during pregnancy over the 10 years covered by the study. During the most recent years, 1998-2000, 57.9% of pregnancies reported by aunts were supplemented beforehand and 89.5% during the pregnancy. Pregnancies to smokers were significantly less likely to be supplemented with folic acid. In this study close relatives of an NTD child were more likely to report periconceptional folic acid use than the general public. While these results are encouraging, more remains to be done to ensure in this high risk group to ensure that the full prevention potential of folic acid is realised.

Dietary Supplements↗
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The nurse preceptor: preparation and needs.

This article described a specific experience with a preceptor program. Problems inherent in the preceptor role were presented and appropriate solutions recommended. Each individual preceptor program has factors that are operational, however, many of the concepts and principles of preceptorship are transferable to any setting. By presenting our specific problems and conclusions, other programs may benefit. As professionals, we must continue to disseminate both our successes and difficulties so that professional knowledge can be enhanced.

Education, Nursing, Continuing↗
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General practitioner views of a new specialist Department of Medicine for the Elderly.

The reactions of General Practitioners (GPs) in an area served by a new Department of Medicine for the Elderly (Geriatric Medicine) are described. 89% of GPs thought the new service had brought significant benefits to their patients, The department operated an over 80 admission policy for acute medical admissions. After two years in operation 59% of doctors felt this should be lowered with 4% suggesting it should be raised. Rehabilitation and respite admissions were other features of the new service that had approval ratings of over 70% by the doctors surveyed. It is suggested that a Department of Medicine for the Elderly with a policy of rapid assessment and high turnover is appreciated by GPs. While local circumstances will often dictate policy it is suggested that an age-related admission procedure will minimise difficulty for patient and referring practitioner alike.

Aged↗
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Snow leopard (Panthera uncia) spermatozoa are sensitive to alkaline pH, but motility in vitro is not influenced by protein or energy supplements.

To better understand the biology of snow leopard spermatozoa and to facilitate developing assisted reproduction, a series of studies was conducted to: 1) identify the component(s) of complex culture media responsible for the detrimental effect on sperm survival in vitro, 2) optimize medium for supporting sperm viability, and 3) evaluate sperm capacitation in vitro. Constituents of complex media were added systematically to phosphate-buffered saline (PBS) to isolate the factor(s) influencing snow leopard sperm motility in vitro. Sperm capacitation was also assessed following incubation in PBS with bovine serum albumin (BSA), fetal calf serum (FCS), or heparin. For maintaining sperm motility, there was no benefit (P > or = 0.05) to supplementing PBS with low (5%) or high (20%) concentrations of snow leopard serum (SLS) versus FCS or BSA. Likewise, adding supplemental energy substrates (pyruvate, glucose, lactate, or glutamine) did not enhance or hinder (P > or = 0.05) sperm motility. However, motility rapidly decreased (P < 0.05) with the addition of NaHCO3 to PBS or Ham's F10 nutrient mixture. Surprisingly, Ham's F10 with no buffering component or with both NaHCO3 and N-Z-hydroxyethylpiperazine-N'-2-ethanesulfonic acid (HEPES) maintained sperm motility at levels similar (P > or = 0.05) to PBS. Although sperm motility in all treatments decreased with time, there was a strong inverse relationship (P < 0.01; r = 0.90) between motility and sample pH at 6 hours. Spermatozoa incubated in PBS containing FCS, BSA, or heparin did not undergo the acrosome reaction when exposed to calcium ionophore. In summary, alkaline pH has a profound detrimental effect on snow leopard sperm motility, and capacitation does not occur under conditions that normally promote this event in other felid species. These results clearly demonstrate a high degree of interspecific variation among felids in fundamental sperm function, and they provide evidence for the necessity of basic research when developing assisted reproduction in little-studied nondomestic species.

Acrosome↗