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At least 217 records · Page 12Linked to original sources

PubMedDate not supplied

Ways of assessing practice performance.

Management of a dental practice is challenging. The implementation of a management control system will improve practice performance. This system consists of planning practice goals and objectives, gathering information about the practice activity related to the planned goals and objectives, and taking corrective actions to remedy deviations from the practice plan. Three types of control, preventive, concurrent, and feedback, are presented with an application to the dental practice. Within each type of control a variety of administrative functions are discussed, such as financial analysis, employee supervision, and quality assurance.

Financial Management↗

PubMed2024

The use of next-generation sequencing in personalized medicine.

The revolutionary progress in development of next-generation sequencing (NGS) technologies has made it possible to deliver accurate genomic information in a timely manner. Over the past several years, NGS has transformed biomedical and clinical research and found its application in the field of personalized medicine. Here we discuss the rise of personalized medicine and the history of NGS. We discuss current applications and uses of NGS in medicine, including infectious diseases, oncology, genomic medicine, and dermatology. We provide a brief discussion of selected studies where NGS was used to respond to wide variety of questions in biomedical research and clinical medicine. Finally, we discuss the challenges of implementing NGS into routine clinical use.

High-throughput sequencing↗

PubMed1995

Community mental health care for former hospital in-patients. Predicting costs from needs and diagnoses.

BACKGROUND: In the UK the replacement of long-term in-patient care with community-based support has been part of central government health policy for many years. One of the challenges of implementing such a policy is the prediction of support and service needs in the community and the associated costs. METHOD: Using research data from north London analyses were undertaken to examine the associations between service use and costs in the community and the characteristics of hospital in-patients. RESULTS: Although clinical diagnosis was not a useful predictor of either service utilisation or costs, more than a third of the variation in community care costs could be explained by symptoms, behaviour and personal characteristics at least one year earlier.

Adult↗

PubMedDate not supplied

Building TQM into nursing management.

Total quality management (TQM) is a management philosophy that addresses problems currently faced by health care, specifically reducing costs while improving quality of services. As hospital administrators embrace this new management style, nurse executives and managers will be challenged to implement TQM. Building TQM into nursing management will improve quality and reduce costs while meeting the needs of health care customers.

Health Care Costs↗

PubMed1996

Psychoneuroimmunology and innovative behavioral interventions in patients with leukemia.

PURPOSE/OBJECTIVES: To review current research examining the effects of behavioral interventions on reducing symptom distress and improving quality of life in patients with cancer and to explore the application of behavioral interventions to patients with leukemia who are immunosuppressed by the disease or its treatment. DATA SOURCES: Published books, journal articles, and personal experiences. DATA SYNTHESIS: Interventions such as relaxation training, guided imagery, attentional/cognitive distraction, and therapeutic touch have been found to reduce pain, anxiety, and chemotherapy-related side effects, to elicit the relaxation response, and to improve several aspects of immune function in patients with cancer. CONCLUSIONS: A multicomponent, long-term program of behavioral interventions may provide the greatest and most lasting benefit, but it may be very challenging to implement. However, simple relaxation techniques are not difficult to learn, are not particularly time-consuming or costly to practice, and can be used anywhere. IMPLICATIONS FOR NURSING PRACTICE: Nurses in virtually any setting easily can incorporate behavioral modalities into their practices and help patients with leukemia to reduce their physiologic arousal and symptom distress. Nursing research examining the effects of behavioral interventions on immunocompetence and cancer pain in patients with leukemia is needed.

Arousal↗

PubMedDate not supplied

[Coding, nomenclatures, PMSI, medical records, cards with microprocessors: what coherence?].

Computerization of information on health care delivery is being implemented in France. Within hospitals, the PMSI program aimed at coding and storing medical information on patients and their treatment has started. More recently was launched a program for computerizing outpatient care (coding and storing information on medical acts, pathologies and prescriptions). Patient individual cards with microprocessor have been implemented. The challenge ahead is how to coordinate all these processes to make them compatible, and coherent and to avoid wasteful disorders.

Delivery of Health Care↗

PubMedDate not supplied

Nutrition strategies for adolescents with insulin-dependent diabetes mellitus.

Optimal metabolic control is a primary management objective for adolescents with insulin-dependent diabetes mellitus. Nutrition therapy plays an important role in meeting this challenging treatment goal. This article presents broad nutrition goals, makes macronutrient recommendations, and describes their effect on blood glucose levels. Various meal-planning techniques and other developmentally appropriate approaches to assist adolescents in meeting these nutrition objectives are described. Finally, challenges in implementing nutrition therapy in an adolescent population are discussed.

Adolescent↗

PubMed1997

Clinical chemistry in laboratory medicine in Europe--past, present and future challenges.

European experts in clinical laboratory sciences have different backgrounds, and development of expertise in this field started more than 100 years ago. Specific national activities have created the heterogeneity that now exists amongst the academic professional membership of more than 40 scientific societies in Europe. The recent political changes have in addition contributed to the rapidly changing profile of Clinical Chemistry and related fields. Based on a questionnaire answered by 31 national representatives, the past, present and future aspects of the European Clinical Laboratory are reviewed. Of the more than 30,000 members of national societies, the majority studied medicine (40.1%), chemistry (27.2%) and pharmacy (21.1%) with large national differences in relative percentages. Post-graduate education is provided by two thirds of the national societies. In most European countries the same experts cover not only clinical chemistry but also haematology, haemostaseology, immunology and transfusiology. National quality assurance programmes are said to be established in 25 countries, but mandatory in only 11 of them. Of the future challenges, the implementation of request strategies were named most often, with interpretative reports and preanalytical aspects estimated as similarly important. It was thought that information technology and new scientific developments would make the greatest impact in the coming years, with economic pressure being the major limiting factor. Despite these limitations an increase in the number of tests is anticipated by most representatives, supporting the assumption of an increasing role of the clinical laboratory in future clinical medicine.

Chemistry, Clinical↗

PubMedDate not supplied

What happens now? Oregon and physician-assisted suicide.

With assisted suicide now legally sanctioned, health care professionals in Oregon face the challenge of implementing Oregon's Death with Dignity Act. Physicians, hospice professionals, pharmacists, and other caregivers may find their relationships with patients, families, and fellow professionals changing in unanticipated ways as all learn what it means to make aid in dying openly and compassionately available to patients at the end of life.

Aged↗

PubMed1998

Convincing cases: important component of user acceptance.

This paper is presenting the rational that lead to the organisation of the European workshop on Acceptance of Telematics Applications by Healthcare Professionals "Looking for the convincing cases," that took place in Thesaloniki 12-13 December, 1997. A brief overview is presented of the health telematics sector, the current situation of the usage of some applications, and major challenges towards wide implementation of health telematics applications. It focuses on user acceptance as one of the critical challenges towards wider implementation. It concludes that the support and promotion "Convincing cases" are important components contributing to user acceptance.

Attitude of Health Personnel↗

PubMedDate not supplied

Putting prevention into practice.

One of the three broad goals of Healthy People 2000 is that preventive services will be available to all Americans. Although there is professional agreement on the merits of prevention, there are challenges related to implementing preventive health care. Six of these challenges are confusion in terminology, issues related to nursing autonomy and initiative, differing conceptual frameworks, complexity of coordination within a delivery system that does not reward preventive services, prevalent cultural beliefs, and lack of uniform recommendations regarding prevention. The Put Prevention into Practice (PPIP) program is a national strategy to address those challenges. The American Nurses Association and the American Academy of Nurse Practitioners contributed to the development of the PPIP program. These organizations are actively disseminating the information through train-the-trainer methodology and other educational programs that will prepare nurses to improve the health of the population through the provision of preventive health services.

American Nurses' Association↗

PubMed2001

Implementation of guidelines in primary health care. A challenge for the municipal health centres in Finland.

OBJECTIVE: To assess the implementation of guidelines in Finnish primary health care units. DESIGN: A semi-quantitative analysis of a cross-sectional interview survey. SETTING: All municipal health centres in a selected region in Finland. SUBJECTS: Head physicians and head nurses of the 31 participating units. MAIN OUTCOME MEASURES: Number of guidelines adopted; methods used in the implementation; and the unit's estimated purposefulness in the implementation of guidelines. RESULTS: All health centres had adopted at least one guideline in the defined task areas, but only one-third of the units had implemented several guidelines. The implementation methods utilised were usually directive and passive rather than co-operative and problem-solving. Half of the units used training and methods involving active participation of the personnel, and in one-third a multiprofessional approach was applied. Clients' representatives were hardly ever involved in the adaptation of guidelines. A quarter of the health centres were assessed as purposeful in their policy to implement guidelines, the large units being more goal-oriented than the smaller ones. CONCLUSIONS: A minority of health centres are goal-oriented in the adoption of guidelines and use versatile methods to support the implementation; this presents an important managerial challenge for national health care development in Finland.

Cross-Sectional Studies↗

PubMed1999

Strategies in disability management. Corporate disability management programs implemented at the work site.

Managers are challenged to demonstrate all programs as economically essential to the business, generating an appreciable return on investment. Further challenge exists to blend and integrate clinical and business objectives in program development. Disability management programs must be viewed as economically essential to the financial success of the business to assure management support for clinical interventions and return-to-work strategies essential for a successful program. This paper discusses a disability management program integrating clinical and business goals and objectives in return-to-work strategies to effect positive clinical, social-cultural, and business results. Clinical, educational, social, and economic challenges in the development, implementation, and continued management of a disability program at a large corporation with multiple global work sites are defined. Continued discussion addresses the effective clinical interventions and educational strategies utilized successfully within the workplace environment in response to each defined challenge. A multiple disciplinary team approach, clinical and business outcome measures, and quality assurance indicators are discussed as major program components. This article discusses a successful program approach focusing on business process and methodology. These parameters are used to link resources to strategy, developing a product for implementing and managing a program demonstrating economic value added through effective clinical medical case management.

Accidents, Occupational↗

PubMed1997

Implementation of a patient charting system: challenges encountered and tactics adopted in a burn center.

The rapid movement of information technologies into health care organizations has raised managerial concern regarding the capability of today's institutions to satisfactorily manage their introduction. Indeed, several health care institutions have consumed huge amounts of money and frustrated countless people in wasted information systems implementation efforts. Unfortunately, there are no easy answers as to why so many health informatics projects are not more successful. In this light, the aim of this study is to provide a deeper understanding of how clinical information systems are being implemented by emphasizing research efforts on the dynamic nature of the process, that is, the "how" and "why" of what happened. Using a case study methodology, we examined the implementation of a patient charting system in the Burn Center of a large, not-for-profit, teaching hospital. Based on an in-depth examination of this implementation, several insights are offered to those who have responsibility for managing complex and risky clinical information system implementation projects.

Burn Units↗

PubMedDate not supplied

How effective is the computer-based clinical practice guideline?

CONTEXT: The primary prevention of coronary artery disease in patients with diabetes could have a large impact on health care costs and outcomes. Guidelines for improving diabetic health indices are common, but significant challenges exist in implementing them. GENERAL QUESTION: How does integrating an evidence-based guideline into an electronic medical record affect patient care? SPECIFIC RESEARCH CHALLENGE: How can we implement the new guideline-enhanced medical record in a controlled manner and measure its impact on physician satisfaction, diabetes process measures, and the risk for cardiovascular disease? PROPOSED APPROACH: All patients in the University of Washington system have an electronic Web-based medical record. Patients with diabetes will be randomly assigned to a guideline-enhanced or standard electronic medical record. The electronic medical record allows measurement of most clinical process measures and outcomes. Physician satisfaction will be measured by survey. POTENTIAL DIFFICULTIES: Contamination may occur when guideline recommendations are applied to control patients as physicians gain experience with the guideline-enhanced record.

Coronary Disease↗

PubMedDate not supplied

Challenges and opportunities to the design and implementation of chemoprevention trials for prostate cancer.

Since 1991 and the activation of the Prostate Cancer Prevention Trial as well as similar prevention studies in several other organ sites, the interest in prostate cancer prevention has increased substantially. Despite such interest, the challenges to prevention trials-in design, implementation, prioritization, and allocation of resources-are substantial. Simultaneously, there has been an explosion in new targets and agents that may have an effect in the prevention of this disease. In this manuscript, we discuss these challenges to the study of prostate cancer prevention and provide a blueprint for prioritization of future studies.

Adenocarcinoma↗

PubMed1993

Overcoming the barriers to implementation of TQM/CQI in hospitals: myths and realities.

Many health care organizations are attempting to rapidly implement total quality management (TQM) and continuous quality improvement (CQI) philosophies and concepts. In the case of hospitals, a number of issues resulting from traditional organizational design and management practices as well as the characteristics of health care professionals pose significant challenges to rapid implementation. Recognizing and developing strategies to address these challenges, along with realizing that TQM and CQI represent viable processes for conducting organizational "preventive maintenance," may help in changing the focus of quality assessment and enhancement initiatives from processes that are "broken" to processes that should be "fixed" before they "break." This article discusses strategies for overcoming some of the major barriers and challenges to successful TQM and CQI implementation to the hospital setting.

Hospital Administration↗

PubMed1998

Evaluating the Israeli health care reform: strategy, challenges and lessons.

Evaluating the implementation of health care reform provides important information on its effect, as well as a factual basis for deciding upon mid-course modifications. Although researchers in various countries are addressing the impact of reform, only few governments have initiated a structured, planned evaluation to accompany reform efforts. In Israel, the 1995 National Health Insurance Law earmarked 0.1% of the health care budget for research on the law, coordinated by the National Institute for Health Policy and Health Services Research. This paper describes the evaluation strategy of the JDC-Brookdale Institute which is taking part in the research efforts. Implementation of the evaluation strategy and the challenges of evaluating a major reform of the health system are discussed. The evaluation strategy combines elements of formative and summative evaluation using a 'case study' approach which seeks to integrate in-depth understanding of the changing health system and of health care provider's organizational behavior, with a variety of outcome measures. The Israeli case provides support for the proposition that an integrated approach to evaluating health reform provides a better understanding of the subject under review and thus a better basis for making useful recommendations to policy makers. In addition, such an approach enhances the validity and credibility of the data and thus the probability of making an impact, which is a main objective of formative evaluation. Examination of the Israeli case, provides important insights about evaluation of health system reform, and may benefit researchers in other countries attempting to evaluate health care reform.

Evaluation Studies as Topic↗