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At least 289 records · Page 16Linked to original sources
PubMed2006

Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND): process modelling of pilot study.

OBJECTIVE: To determine the effects of a structured education program on illness beliefs, quality of life and physical activity in people newly diagnosed with Type 2 diabetes. METHODS: Individuals attending a diabetes education and self-management for ongoing and newly diagnosed (DESMOND) program in 12 Primary Care Trusts completed questionnaire booklets assessing illness beliefs and quality of life at baseline and 3-month follow-up, metabolic control being assessed through assay of HbA1c. RESULTS: Two hundred and thirty-six individuals attended the structured self-management education sessions, with 97% and 64% completing baseline and 3-month follow-up questionnaires. At 3 months, individuals were more likely to: understand their diabetes; agree it is a chronic illness; agree it is a serious condition, and that they can affect its course. Individuals achieving a greater reduction in HbA1c over the first 3 months were more likely to agree they could control their diabetes at 3 months (r=0.24; p=0.05), and less likely to agree that diabetes would have a major impact on their day to day life (r=0.35; p=0.006). CONCLUSION: Pilot data indicate the DESMOND program for individuals newly diagnosed with Type 2 diabetes changes key illness beliefs and that these changes predict quality of life and metabolic control at 3-month follow-up. PRACTICE IMPLICATIONS: Newly diagnosed individuals are open to attending self-management programs and, if the program is theoretically driven, can successfully engage with the true, serious nature of diabetes.

Activities of Daily Living↗
PubMed2005

The implications of network structure for epidemic dynamics.

It has long been realised that the standard assumptions of mass-action mixing are a crude approximation of the true mechanistic processes that govern the transmission of infection. In particular, many infections can be considered to be spread through a limited network of contacts. Yet, despite the underlying discrepancies, mass-action models continue to be used and provide a remarkably accurate description of epidemic behaviour. Here, the differences between mass-action and network-based models are investigated. This allows us to determine when mass-action models are a reliable tool, and suggest ways in which their behaviour should be refined.

Cluster Analysis↗
PubMed2005

Use of quality index in the evaluation of organ procurement and transplant programs in a University Hospital.

AIM: To evaluate organ procurement efficiency at Hospital Clinic of Barcelona (HCP), a University Hospital, in 2000 and 2003 compared with other Catalan, other Spanish, and American (US) results. METHODS: Efficacy rate of the donor procurement was calculated per million population per year (pmp/y). Efficacy rate in kidney, liver, and heart transplantation was calculated also in pmp/y. We evaluated 1-year graft survival. RESULTS: During this period, the average rate number of donors was 49.1 pmp/y in HCP, 38 in Catalonia, 33.4 in Spain, and 21.7 in the United States. The average rate of kidney transplantation was 74 pmp/y in HCP, 55 in Catalonia, 47 in Spain, and 24.6 in the United States. The average rate of liver transplantation was 44.5, 26.6, 23.2, and 18 pmp/y, respectively. The average rate of heart transplantation was 13.3, 8.5, 7.8, and 6.4 pmp/y, respectively. One-year graft survival in HCP was 90.6% for kidney, 89.5% for liver, and 88.2% for heart transplants. DISCUSSION: The results show that organ procurement and transplantation programs in HCP are efficient. The organizational model is based on a hospital transplant coordinator and efficient, well-trained transplant teams.

Graft Survival↗
PubMed2001

Partnerships identified within primary health care literature.

Primary health care promotes partnership in nursing. The purpose of this study was to delineate defining characteristics of partnerships within primary health care and to identify strategies to facilitate the development of these partnerships. Findings from this integrative review of the literature include the development of a partnership framework that emerged from the meanings inherent in the prefixes of words used to describe "multi", "inter", and "intra" partnerships. Also, the findings revealed characteristics of partner expectations, attributes of active and passive participation, and strategies to foster, and barriers to hinder, active participation. Using the developed partnership framework, implications for practice, education, and research have been discerned.

Attitude of Health Personnel↗
PubMed1998

Organizational considerations for an electronic curriculum. Part II: A multimedia approach to dental education in general and to prosthodontics in particular.

STATEMENT OF PROBLEM: In using multimedia electronic knowledge-transfer as a tool in dental education, an overriding concern has centered on how to devise an organizational model that will accommodate the vast and diverse arrays of information involved, yet be sufficiently simple to provide students with a rational and consistent means of accessing the information they require. PURPOSE: This article presents a model that adopts the Natural History of Dental Diseases as the organizing principle. This article also encourages a mindset in prosthodontics that focuses on the dynamics of energy-dispersal through the supporting structures, in an attempt to provide learners with a deeper cognitive dimension for problem solving and to facilitate their empowerment as life-long learners.

Computer-Assisted Instruction↗
PubMed1998

Organizational considerations for an electronic curriculum. Part I: A rational nosology for concept management in dentistry.

STATEMENT OF PROBLEM: With the use of multimedia electronic knowledge as a tool in dental education, an overriding concern has centered on how to devise an organizational model that will accommodate the vast and diverse arrays of information involved, yet be sufficiently simple enough to provide students with a rational and consistent means of accessing the information they require. By adopting the natural history of the diseases dentists are called on to address as a common organizing principle, it becomes possible to link all concepts that relate to individual problem areas through a technique of retro-mapping. PURPOSE: The purpose of this article is to introduce learners to a cognitive "scaffolding" that will assist them in achieving a deeper cognitive dimension for problem solving.

Curriculum↗
PubMed1994

School-based crisis intervention: a role for pediatricians.

We have presented an overview of issues to consider in school-based crisis intervention using an organizational model for crisis response within the school. A wide range of ways exist in which pediatricians and other pediatric primary care providers can assist in the development, implementation, and functioning of school-based crisis intervention services for children. Those pediatricians with an interest in this area will find such activities personally and professionally rewarding and will come to appreciate the impact that such services can have on the lives of the students within the school, within their pediatric practices, and within their community.

Child↗
PubMed2000

Molecular structure of human TFIIH.

TFIIH is a multiprotein complex required for both transcription and DNA repair. Single particles of human TFIIH were revealed by electron microscopy and image processing at a resolution of 3.8 nm. TFIIH is 16 x 12.5 x 7.5 nm in size and is organized into a ring-like structure from which a large protein domain protrudes out. A subcomplex assembled from five recombinant core subunits also forms a circular architecture that can be superimposed on the ring found in human TFIIH. Immunolabeling experiments localize several subunits: p44, within the ring structure, forms the base of the protruding protein density which includes the cdk7 kinase, cyclin H, and MAT1. Within the ring structure, p44 was flanked on either side by the XPB and XPD helicases. These observations provide us with a quartenary organizational model of TFIIH.

Antibodies, Monoclonal↗
PubMed1992

The development of quality assurance in the German health care system.

Quality assurance efforts in the German health care system have primarily been a responsibility of the medical profession. The Federal and State Physician Chambers coordinated early quality assurance studies, which conformed to the guidelines of voluntary participation by physicians, confidentiality of data, and no imposition of sanctions for poor performance. These guidelines were challenged by the Health Reform Act of 1989, which made the legal regulations for quality assurance the same for hospitals as for out-patient care. Some current draft implementation plans conform to the principle of anonymity, requiring no disclosure of patient-specific, physician-specific, or hospital-specific data to third parties; others allow release of data to individual insurers or their associations. Although no consensus has been reached as to how quality assurance will be performed in the future in Germany, it will clearly become an integral part of the system.

Delivery of Health Care↗
PubMedDate not supplied

The new interventional centre--a multidisciplinary R&D clinic for interventional radiology and minimal access surgery.

The National Hospital wanted to coordinate and promote the development of new minimally invasive procedures by structuring collaboration and communication across traditional speciality boundaries. To achieve this, a new hospital department has been established, a 'neutral ground' for working with such clinical applications in multi-disciplinary teams with surgeons, radiologists, cardiologists etc., individually composed for the type of intervention to be performed. The Interventional Centre also represents a full fusion of a modern radiology department with a state-of-the-art operating department, securing the use of relevant imaging technologies, aseptic conditions and options of converting any 'key-hole' procedure to open, conventional surgery within minutes. The Centre represents a new organizational model for such activities. It is also a technology centre, a common 'tool-box' securing better access and higher quality for the use of advanced radiological and surgical technology in our hospital.

Hospital Departments↗
PubMed2003

[An approach to home care. How does the Catalonian public health system handle home care?].

OBJECTIVE: To describe the organizational model, resources and implementation of the home care program run by the Catalonian public health service, and to note difficulties reported by primary care professionals. DESIGN: Cross-sectional, descriptive study.Setting. Autonomous Community of Catalonia. PARTICIPANTS: 214 primary care centers (PCCs) operating under reformed administrative procedures were surveyed, and responses were obtained from 112 (52.3%). MAIN MEASURES: Semistructured, self-administered questionnaire sent by mail, with variables that identified the center, resources, organization and use of protocols for home care. Questionnaires were collected during July to November, 2000. RESULTS: Home care programs were being used at 90.2% (95% CI, 84.7%-95.7%) of the centers, and had been in effect for a mean of 5.6 years. Nursing services predominated in 64% of the case, with nurses spending a mean of 5.09 h/week on the program, twice as much time as physicians and social workers. The mean rate of computerization of the data was 31.3%, and was highest (P<.05) in Gerona (51%) and in PCCs run privately (70%). Of all participating PCCs, 70% had social workers on the staff, 13% had a home care nurse and 50% operated in coordination with social services. Of all PCCs, 79.5% (95% CI, 72.1%-86.9%) used specific protocols for pressure sores (69.1%), terminal illnesses (43.6%), bedridden patients (41.8%) and pain management (40.9%). Evaluations were done with the Barthel scale (73.2%), the Mini-Mental State Examination (73.2%) and the Norton scale (53.6%). Continuing education (66%) and activities for care providers (>75%) were frequent in home care programs. The main difficulties identified were the burden of care (65.2%), time constraints (51.8%), inadequate social support (43.8%) and lack of coordination with other levels of care (33%). CONCLUSIONS: Noteworthy findings were the dedication of nursing staff to the home care programs, the low level of computerization of the data, the limitations in social service resources, the uniformity of assessment protocols and scales, and the agreement regarding current difficulties.

Aged↗
PubMedDate not supplied

[A personal balance of 25 years of modern health care management in the Spanish Public Health System].

At the beginning of 2002, the transference of authority over public health care services from the Spanish national health System (INSALUD) to all the autonomous communities hitherto lacking this authority closed a period of modern halthcare management in Spain which, nevertheless, had lacked the dynamism and innovative capacity of business management. Despite this, during these 25 years, Spanish healthcare management underwent a spectacular growth. The problems of the Spanish public health system are either linked to the inherent problems of a system of universal coverage, with generous provisions and clear underfinancing, or they are characteristic of an obsolete organizational model in which centers and healthcare professionals lack autonomy, or they are related to users' increased expectations and to the enormous complexity of the medicine of the future. All these questions should be approached from the perspective of a new form of management appropriate to the new century. Despite its serious defects and problems, the public values the Spanish public health system; the main risk is chronic and progressive delegitimization wich causes users to lose faith and trust in the public health system.

Forecasting↗
PubMedDate not supplied

Reforming Dutch substance abuse treatment services.

The Dutch substance abuse treatment system is in the middle of a major reorganization. The goal is to improve outcomes by redesigning all major primary treatment processes and by implementing a system of regular monitoring and feedback of clinical outcome data. The new program includes implementing standardized psychosocial behavior-oriented treatment modalities and a stepped-care patient placement algorithm in a core-shell organizational model. This article outlines the new program and presents its objectives, developmental stages, and current status.

Behavior Therapy↗
PubMed1994

Continuity of care: a challenge for ambulatory oncology nursing.

Continuity of care has many facets and challenges both as a philosophy and in practice. In an abstract sense, it represents an ideal to which health care professionals strive. It is becoming a professional and consumer expectation that each health care professional contribute to continuity of care. Although a variety of organizational models for providing continuity of care have been established in which nursing plays a prominent role, recent research suggests that some frontline nursing personnel may not fully understand their responsibility to continuity of care. There is a need for nursing curricula in both basic and continuing education programs to address continuity of care concepts, models, and methodologies to strengthen awareness of patient care needs across the disease continuum and across care settings. Performance expectations that include professional accountability for continuity of care also encourage greater attention to this issue.

Ambulatory Care↗