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At least 1,801 records · Page 100Linked to original sources
PubMed2004

Whole population secondary prevention of coronary heart disease in Scotland: the HEARTS database.

Implementing the evidence base for the management of chronic disease is as challenging as discovering which interventions are effective. The HEARTS collaboration (Heart disease Evidence-based Audit and Research in Tayside Scotland) is achieving that goal for the secondary prevention of coronary heart disease (CHD by linking national databases to manually validated hospital and family practice electronic patient records. Specific data from the system is fed back to practices in a facilitated educational process and through the NHS intranet. This paper describes some of the key features of this strategic decision support system. All residents of the Tayside region of Scotland (n=484,013 mid year estimate 2002) are covered by the system. 9,828 patients who have suffered a myocardial infarction(MI) or who have undergone angioplasty or bypass surgery are registered on the system. Improvements in clinical status and prescribing of effective therapies are 5-10% greater than elsewhere in Scotland.

Angioplasty, Balloon, Coronary↗
PubMed2002

Telebaby videostreaming of newborns over Internet.

New information technologies are used to fill gaps in our need for communication. Hospitals are now starting to discover the possibilities of multimedia communication for their patients. Telebaby is a project of the University Medical Centre Utrecht that allows parents to view their newborn on the intensive care, high care or medium care unit at home. Standard Internet technology for distributing multimedia allows parents to virtually "visit" their baby more often and give parents the feeling of control. A non-complex technical system like Telebaby is easily adopted by the parents, implementing it in a closed environment like a hospital is the real challenge.

Academic Medical Centers↗
PubMedDate not supplied

Enacting narrative pedagogy. The lived experiences of students and teachers.

Reforming nursing education to meet contemporary challenges in educational and clinical environments is needed through the development and implementation of new pedagogies. Nancy Diekelmann is advancing the science of nursing education by describing a new phenomenological pedagogy, Narrative Pedagogy, identified through interpretive research in nursing education. Narrative Pedagogy is an approach to reforming nursing education that is always site specific and not generalizable from school to school. However, the processes of Narrative Pedagogy are transferable and can be enacted in many contexts. This study describes the common experiences and shared meanings of teachers and students engaging in or enacting Narrative Pedagogy. Diekelmann gathered seven teachers and students in five schools of nursing in four midwestern states to share their experiences. Interpretive phenomenology was used to analyze the group interview. One of the findings identified during this analysis, Enacting Narrative Pedagogy, is explicated, and two themes, Decentering Skill Acquisition and Content and Attending to the Practices of Thinking, are described.

Education, Nursing↗
PubMed2005

Effect of inhaled combination therapy on asthma management.

The growing use of guidelines to manage asthmatic patients prompted us to evaluate their impact on clinical practice. This study was performed in two similar groups of asthmatic patients. A retrospective and prospective review of medical records in an asthmatic population was performed. The patients were followed up for a mean period of 2 years before (group 1 [G1]) and after the publication of the Guideline for Asthma Treatment (group 2 [G2]). After evaluation of objective/clinical measurements we noticed a significant difference between both groups. There were 23 and 40 patients who did not complain of any respiratory symptoms in G1 and G2, respectively. The total number of visits to the emergency department decreased by more than 75%, from 26 (G1) to six (G2). The forced expiratory volume in 1 sec improved by a mean of 4% in G1 and 9% in G2. After application of the guidelines there was a redistribution of the degree of disease severity. In G2, there was a 12% increase in the use of long-acting beta2-stimulating sprays; 40% of the patients were using a combination of a long-acting beta2-stimulating drug and an inhaled steroid. In our experience, the use of the Global Initiative for Asthma (GINA) guidelines leads to better management of asthma patients with different degrees of severity. These findings suggest the need to perform a similar analysis in a broader setting such as a national multicenter survey in order to collect information on the challenges of putting these theoretical difficulties into practice and to compare their implementation in distinct centers.

Administration, Inhalation↗
PubMed2005

The development of the model for recognition of prior learning for nurses in South Africa: development of RPL guidelines by the policy makers and stakeholders of nursing.

The National Qualifications Framework (NQF) was established to address the compartmentalization of education and training, the absence of norms and standards and the need for international recognition. According to the South African Qualifications Authority (1996),this framework was aimed at developing a comprehensive qualifications structure and an integrated approach to education and training in the country (NCHE, 1996:46). Educational institutions, including those for nursing, were challenged with a view to rethink the whole culture of teaching and learning and was counted as knowledge. The major principle of the NQF was the Recognition of Prior Learning (RPL), which had to be persued across all sectors (Musker, 1998: 8). RPL was seen as a means to widen access into learning programs for those who had been historically denied this. The challenge for educational institutions was how to ensure that RPL systems once implemented did not compromise academic standards. Research into methodologies to implement the NF in the absence of mechanisms was then essential. The purpose of the study was to develop and test a RPL model for nurses in South Africa. The study adopted a multi phase decisions-oriented evaluation research design. Stuffelbeam's educational evaluation model was used to guide data collection and analysis. The research questions were incorporated under the different phases of evaluation. The model was development at six levels: level one was at the policy makers level; level two was at the stakeholders; levels three to six were at institutional level where three institutions participated at pilot site for the RPL model development. These levels are presented as tiers in the figure 1. This article present the results of the model development at the first two levels, which according to Stuffelbeam's model is the context evaluation for boundary setting. Part two will present the model development at institutional level, involving the input and process evaluation and depicted as tiers three, and four.

Clinical Competence↗
PubMedDate not supplied

[Education in postgraduate surgical schools: the role of the surgical tutor as supervisor in the operating room].

The Postgraduate Surgical education is in an era of transition, in order to create physicians with skills and attitudes needed by modern health care. Many studies have examined the impact of surgical tutoring in surgical residency programs in USA Medical Schools, while few experiences are reported from European Universities. The new Italian guidelines for post-graduate education require a structured clinical learning with the supervision of a tutor ("attending surgeon" for surgical residency); it is a challenge to describe the role of this teacher and educator, and to implement an effective evaluation of operating room teachers. Confidential survey was administered to 14 surgical residents of the Authors' University. Questions were related to their surgical activity and their perception of educational role of tutors in operating room and tutors' teaching behaviors. Residents pointed out five behaviors they perceive as signs of tutor excellence in clinical and operating room setting. According with studies from other Universities, residents need a tutor with competency but also with good teaching skills and a mature self-perception as educator. Faculty would provide training programs for surgeons in order to improve their teaching skills and behaviors.

Faculty, Medical↗
PubMed2006

Can Croatia join Europe as competitive knowledge-based society by 2010?

The 21st century has brought important changes in the paradigms of economic development, one of them being a shift toward recognizing knowledge and information as the most valuable commodities of today. The European Union (EU) has been working hard to become the most competitive knowledge-based society in the world, and Croatia, an EU candidate country, has been faced with a similar task. To establish itself as one of the best knowledge-based country in the Eastern European region over the next 4 years, Croatia realized it has to create an education and science system correspondent with European standards and sensitive to labor market needs. For that purpose, the Croatian Ministry of Science, Education, and Sports (MSES) has created and started implementing a complex strategy, consisting of the following key components: the reform of education system in accordance with the Bologna Declaration; stimulation of scientific production by supporting national and international research projects; reversing the "brain drain" into "brain gain" and strengthening the links between science and technology; and informatization of the whole education and science system. In this comprehensive report, we describe the implementation of these measures, whose coordination with the EU goals presents a challenge, as well as an opportunity for Croatia to become a knowledge-based society by 2010.

Croatia↗
PubMed1991

Evaluating the role of transrectal ultrasonography and magnetic resonance imaging in prostate carcinoma.

A review of the recent literature on the performance of transrectal ultrasonography and MR imaging in the evaluation of prostate carcinoma demonstrates the typical evolutionary cycle inherent in any technology assessment: increasingly improved methodology has resulted in the tempering of initial enthusiastic reports by more sober observations and realistic expectations. This inevitable and predictable evolution should not be interpreted as a criticism of earlier work; designing and implementing a rigorous study of new and rapidly changing technology is a challenging endeavor. Nevertheless, the most current work has greatly helped to provide a more balanced and convincing perspective that is more useful to the practicing radiologist.

Carcinoma↗
PubMed1990

Quality assurance goals in surgical pathology.

The development, implementation, and evaluation of quality assurance programs for surgical pathology present special challenges, largely because of the subjective and consultative nature of the "test result" (the diagnostic report). The primary objective of quality assurance is the generation of an accurate, timely, and clinically relevant diagnostic report based on the interpretation of optimal technical preparations. This article defines the essential elements of a comprehensive quality assurance program for anatomic pathology, reviews the role of accrediting agencies in evaluating quality assurance, and describes the various contributions of professional organizations that may influence the achievement of our quality assurance goals. The major emphasis is on those activities that affect the quality of the "outcome" (completed diagnostic report) in surgical pathology and assess its contribution to patient management.

Accreditation↗
PubMed1990

[Public policy and elderly women].

Talking about the aging population is talking about aged women. The census data in Puerto Rico reflects a considerable increase in this population sector. This increase represents a challenge to the provision of human services and to the formulation and implementation of public policy to this cohort. The public policy should be guided to end the existing inequality among sexes, recognize and deal adequately with the particular needs of the elderly women. Three areas of the public policy that are essential regarding the elderly women are: economic security, health care, and social services.

Aged↗
PubMedDate not supplied

Chronobiology: a frontier in biology and medicine.

On the occasion of Franz Halberg's 70th birthday, some of his many achievements are reviewed. We provide a historical background to the development of chronobiology; offer insight into the current state of this new science; and sketch the promise of this discipline for health care and cure. As a tribute to Franz Halberg, in an era of fast-growing technology, an attempt is made to describe his perspective of tomorrow's medicine and biology. The many students he trained throughout his productive career face the challenge of deserving the trust he placed in them and of further implementing his vision. A leader in social pediatrics put it aptly: it will take several generations of researchers to study and master his life's work.

Animals↗
PubMed1988

Hostage-takers in health care settings.

No security staff is large enough to provide a safe working environment for health care personnel without the cooperation of the entire staff. Staff members must be able to recognize early in an incident when things are beginning to get out of hand so they can implement appropriate strategies to defuse the situation or call for assistance. The challenge of facing violent incidents in the health care setting will continue to grow. Hostage incidents provide the opportunity for the powerless to be heard. Incidents occur daily. No place is safe. New issues such as abortion, genetic research, and animal research along with the old issues of estrangement, insensitivity to human emotional pain, and vulnerability will ensure that violence in the medical care setting continues. Avoiding the issue will not cause it to go away and can be costly to your facility in terms of money and morale. The key to maintaining the safe environment health care workers have a right to expect lies in planning, training, and commitment. Disturbing trends in which upper level management demands that staff not document recommendations for procedures for handling violence open a pandora's box of negligence issues, not to mention professional ethics. I hope we can confront these problems in a cooperative and open manner without recrimination and fear. Failing to address them will not provide safety or long-term gain.

Health Facilities↗
PubMed1993

Managing the care of patients with irreversible dementia during hospitalization for comorbidities.

Caring for the patient with AD hospitalized with comorbidities is a nursing challenge. By educating staff, using the PLST model, working with families, and implementing patient-focused care, positive outcomes are not only possible but probable. It is important for staff to work with caregivers in all aspects of care of the patient incorporating the patient's personal and medical historical knowledge into the care plan. Nursing facilities and families can provide a wealth of information, and communication before and after hospitalization maximizes positive outcomes for all concerned.

Chronic Disease↗
PubMed1995

Progress towards a fire-safe cigarette.

About 1,000 deaths, 3,000 serious injuries, and several billion dollars in costs of property loss, health care and pain and suffering, result each year in the U.S. from fires started by dropped cigarettes. Efforts to prevent these losses have progressed from admonitory slogans to product-flammability standards to addressing the cigarette itself. Two recent federal studies have: a) concluded that it is technically feasible to produce a cigarette with a reduced likelihood of starting fires, and b) published a broadly validated method by which cigarette brands can be tested for this propensity. The long-term effort of scientists, legislators and public health activists to develop and implement a fire-safe cigarette standard also constitutes a legal liability challenge and a threat to the relative and absolute size of the cigarette market shares held by major U.S. tobacco companies.

Burns↗
PubMed1995

Managed care: is it moral?. Interview by Cheryl Slagle King.

The expansion of managed care has raised a number of ethical and moral issues in the evolving health care marketplace. Health care providers have been highly concerned about the dominant shift from quality to cost in the health care marketplace. As a nation, a fundamental challenge we face is determining what comprehensive health care system can be implemented, enabling us to maximize dollars spent on health care while simultaneously improving quality and access. A parallel to the Hitlerian era is used to dramatically illustrate the importance of remembering lessons learned from the past.

Ethics, Nursing↗
PubMed1998

Rethinking the paradigm for child protection.

Mounting pressures on the nation's system for helping children who are abused and neglected have prompted new efforts to reform the child protective services (CPS) system to better protect children's safety. As this article explains, current reform efforts are focusing on the "front end" of the system, in which reports of abuse and neglect are screened and investigated, and caseworkers recommend whether and when to close a case, provide in-home services, or remove a child from a home. This article discusses the problems of the CPS system that are currently receiving attention, and it closely examines one proposal for reform--the community-based partnership for child protection. This approach emphasizes targeting investigations by CPS toward only high-risk families, building collaborative community networks that can serve lower-risk families, and providing a differentiated response to both high- and low-risk families that is tailored to each family's situation. Early experiences implementing these ideas in Missouri, Florida, and Iowa illustrate the promise and challenges of reform.

Child↗
PubMedDate not supplied

Adaptation of the application of good clinical practice depending on the features of specific research projects.

The conduct of clinical trials falls within a strict regulatory framework. The objective of the round table was to develop reasonable recommendations for the implementation of GCP according to the type of research and taking in account the risks and challenges related to this research. Two types of risks have been identified: those related to the characteristics of the research and those related to the impact of the study results. The group designed an evaluation table of these risks. The round table focused its investigations on 3 main themes: monitoring, the investigational medicinal product and undesirable effects. Three methods of monitoring adaptation were analysed in terms of advantages and disadvantages: the gradual approach, the central monitoring, monitoring on the basis of sampling. Examination of the investigational medicinal product focused on the medicinal product circuit. The group recommends using the following 'basic' decision-making tree, which takes three elements into account: 1) is it an investigational medicinal product?, 2) do the trial objectives and design require packaging specific to the research?, 3) is the risk of use higher than that in standard practice? Finally, adaptation of the implementation of GCP in terms of pharmacovigilance appeared very limited and could possibly be considered for the medicinal product, the subject of the research, which already holds a marketing authorisation, and for which the safety profile is well known; in this case, only simplified collection of non-serious adverse events may be envisaged, which may be implemented by designing and using a standard collection listing. The adaptation of the implementation of GCP is possible. This firstly takes into account the characteristics of the research: which objectives/which risks/which challenges. The options in terms of adaptation must be pre-defined, documented and justified; if necessary, they will also be re-assessed in the course of analysis.

Clinical Trials as Topic↗

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