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Technology is great, but people make the systems work. This is an example of what can go wrong when the users are not involved in decision making. But working as a team, the transcription and management staffs can create a happy ending!
OBJECTIVE: To conduct a cost-effectiveness analysis of the Edmonton Streetworks needle exchange program, in terms of the additional cost per HIV infection averted. The main outcome measures were needle use with and without Streetworks, HIV cases averted, and program costs. METHODS: We conducted interviews and HIV saliva tests on a sample of street-involved intravenous drug users (IDU) who are regular Streetworks' clients. Outcomes were used in a cost-effectiveness model. RESULTS: It is projected that the program has a cost-effectiveness of $9,500 (Canadian) per HIV infection delayed for one year. CONCLUSIONS: The discounted cost per case averted is less than the cost of a case of AIDS. Continuing the program is a dominant strategy.
It is the objective of guideline controlled quality assurance to transfer the best knowledge (evidence based medicine) into clinical practice. The best approach to make these guidelines effective is to involve the potential users (doctors/nurses) in local guideline development. An own study of benchmarking "laparoscopic gallbladder surgery" in 9 hospitals could demonstrate the enormous potential of increasing effectiveness and efficiency by guideline application, since the hospital costs differed double the price with the same result. Internal guidelines help to improve the results and reduce costs.
When the Canadian Council on Health Services Accreditation adopted the Client-centered Accreditation Program (CCAP), we had to assess our methods and results and encourage the staff at all levels and the users to be involved. A complete change, considerable benefits: improved staff knowledge of the organisation, support and understanding within the teams, improved training through team meetings, more room for the patients and their families. Is accreditation costly? One cannot put a price on the degree of satisfaction experienced by the staff within a team who listens to their opinions and strives to make the daily routine as rewarding as possible.
Joint commissioning and provision of mental health services in Somerset failed to produce significant benefits to users over its first two years. Users considered access to services deteriorated and concerns remain that there is no alternative to hospital admission in crises. Users and carers were included as non-voting members of the commissioning board, but users felt less involved in care planning than previously. The combined health and social care trust does not seem to have delivered anything which has not been achieved elsewhere without the transfer of social care staff to a new employer.
BACKGROUND: Social costs of smoking behaviour are remarkable. Although smoking is an individual choice, it is strongly influenced by a social contest where it is widespread. OBJECTIVES: To induce young non-smoking apprentices to continue as such and smokers to give up smoking. METHODS: During 1999, a specific health education programme on smoking was carried out for a group of 1083 young apprentices, 531 females and 552 males, who came to the occupational health unit in Venice for a check on work fitness. This programme was part of a larger global programme concerning health hazards prevention where apprentices received various information about health and safety at work. Smoking habits were compared to a control group of 312 females and 458 males after a one year follow-up. RESULTS: The females' chance of giving up smoking was three times higher than controls; while the chance of becoming a smoker was 70% lower. The males' chance of giving up smoking was double; while the chance of becoming a smoker was 60% lower. The health education programme decreased the trend of becoming a smoker in cases and increased non-smoking, especially in females. In females, there was also a significant prevalence who reduced cigarette consumption. CONCLUSIONS: This study demonstrates the effectiveness of health education programmes on smoking directed to young people and stresses the role of public health units in the involvement of the users of such services in prevention programmes. An occupational health service has specific prevention objectives here, since promoting healthy attitudes affects motivation of individual behaviour. This is the reason why initiatives on a single specific prevention objective, like smoking, become significant in every context of people's lives. Such attitudes are a significant resource which people can use to protect themselves from hazards, with a resulting safe, aware and active behaviour as regards occupational risks.
Current government policy encourages service users to be involved as equal members of the interprofessional care team. This goal is compromised in the care of people with dementia if they are not informed of their diagnosis. This paper looks at recent research both for and against disclosure, and argues in favour of breaking the news in a supportive way.
It's possible to gauge a hospital's IT functions in one day by hiring a consultant to review three key areas: infrastructure and application performance, execution, and alignment. To do so, the consultant should speak with: The hospital's CIO, Members of the IT department, Three senior members of the leadership team, A small sample of frontline managers, A sample of front-line users who were involved in recent implementations.
The Centers for Disease Control and Prevention (CDC) has available a large number of datasets from previous and current surveillance and research.1 Until now, these datasets have not been catalogued. Metadata would organize these datasets and enhance CDC's ability to efficiently use this data to quickly gain the broader view of the nation's health status to effectively carry out public health activities. This project was to develop metadata for cataloguing CDC datasets and a system that would allow researchers to search at least 95% of databases within CDC based on the most relevant criteria for research. It also explored the need to involve stakeholders and users in the project. The resulting metadata and system are available only to CDC researchers on the CDC intranet.
Contingent valuation method (CVM) can be applied to measure benefits of healthcare services. It is a technique for estimating subjects' willingness to pay (WTP) for a service under the scenario describing a virtual market with a questionnaire. In the present research, we outlined foreign studies and reviewed domestic studies on healthcare contingent valuation. A total of 14 papers from domestic literature (five English and nine Japanese articles) identified with mechanical search engines were verified for the following eight items: the method of the questionnaire; the information included in the virtual scenario; the question form for the willingness to pay; bias problems specific to CVM; validity/reliability, ex post/ex ante valuation, altruistic WTP, and non-health value. The following conclusions were drawn from the domestic studies: (1) several studies were short of sufficient information regarding the virtual scenario; (2) no research proved the existence of bias and the ways of coping with it; (3) tests for reliability were not carried out, although some kind of validity was verified; (4) all involved ex post user based evaluation; (5) neither altruistic WTP nor non-health value was examined. Taken the advantages of CVM into consideration, it should become a useful tool, complementing other economic evaluation techniques. Since its application has just begun in Japan, more emphasis needs to be given to practical issues so that healthcare workers will utilize CVM in a way that domestic studies in health economics will be activated.
Services where the G.P. is the central health professional or "team leader" may satisfactorily provide first-contact medical services. Major problems reported in literature are related to inequity in distribution, and the fee-for-service practice that limits access for those on lower incomes and encourages high throughput. There is a heavy reliance on pharmaceuticals as the main treatment, with health promotion and educative services, and counselling, being generally low. While alternative or complementary therapies may address problems of "failed medicine", these don't answer issues of accessibility, or self-responsibility. Studies on nurse practitioners as the first contact in primary level care demonstrate that technically they can function competently and safely amongst a similar clientele, and that the clients find nurses both satisfactory and acceptable as health care providers. While the quality of care is comparable to that offered by a G.P., the cost is less, both directly to user, or more generally to society. This is related to lower costs of education and remuneration, and that lower costs of pharmaceuticals and diagnostic tests are generated. In addition, the health promotion and educative functions of nurses are overall more prominent, and effective in enhancing peoples self-responsibility in health through improving competence and awareness. User-participation and involvement in health services, and empowerment and self responsibility in health, are therefore more likely to be an outcome of a service in which health promotion and educational activities are central, rather than when medical interventions are the focus. In conclusion, this review of recent literature has raised questions about services currently provided by general practitioners, and as presently funded.(ABSTRACT TRUNCATED AT 250 WORDS)
As of October 1989, there were more than 112,000 documented cases of AIDS and more than 1 million Americans were thought to be infected with HIV. Three primary routes of HIV transmission have been defined: sexual contact, parenteral exposure, and perinatal transmission. Epidemiologic surveillance studies provide important information about trends in HIV infection and AIDS among groups recognized to be at increased risk, various demographic subgroups, and the general population. As of this writing, the majority of reported cases have occurred among homosexual or bisexual men. However, a growing risk category involves intravenous drug users, as well as their sexual partners and their children.
During January-November 1995, a total of 19 laboratory-confirmed cases of wound botulism were reported to the California Department of Health Services (CDHS); of these, 13 had occurred since August. Since 1990, the number of wound botulism cases reported annually in California has increased steadily (one case in 1990, two in 1991, three in 1992, four in 1993, and 11 in 1994). All cases except one since 1991 have occurred in injecting-drug users, and many involved subcutaneous injection or "skin popping" of black tar heroin. This report summarizes the findings of the investigation of two cases.
An analysis of documents provided to eight rural Illinois hospital sites during a GRATEFUL MED outreach project involving end-user searching revealed significant patterns that have implications for collection development and information services in small, underserved hospitals. Document requests were analyzed by user groups making the requests, subject matter, inclusion on the Brandon/Hill lists and in Abridged Index Medicus, and publication date. Of the 359 documents requested, 86% came from health professional groups other than physicians and nurses. Eighty-five percent of all requests came from two sites that had active project-trained intermediaries, with most requests forwarded by the intermediaries. Subject analysis revealed a strong need for administrative and allied health information in addition to clinical information. Fewer than half of the titles on the recommended lists were requested during the project. Most documents requested had been published in the past five years. Introduction of end-user searching is not the complete answer to improved information access at small hospitals; the authors conclude that basic collections and library personnel are still needed locally to respond effectively to health professionals' information needs.
Problems in sampling are considered and the implications of various sampling schemes discussed in terms of the risks involved to the users of the schemes. It is concluded that microbiological testing alone cannot guarantee the "safety" of a product. The reliability of analytical procedures of use in the microbiological examination of water is examined and a method of determining the state of statistical control of the procedure described. Finally control charts available for monitoring a manufacturing process are discussed with particular emphasis on the cumulative sum test and its application to colony counts from water.
Several factors should be considered in planning and implementing a nursing administration Local Area Network (LAN). Initial support from nursing management and your organization's information systems department are key to successful acceptance by hospital administration. Involvement of all users and support staff in the process will assure acceptance and an efficient roll-out. Flexibility is critical as the best-laid plans suffer delays when a large project is initiated. Adequate support will assure a smoother process for implementing and maintaining a nursing LAN.
The rapidly evolving information technology domain continuously offers new opportunities for computer aided education (C.A.E.). In a pilot project at the Department of Medical Informatics, we studied the possibilities and the limitations of multimedia systems for computer aided education in medicine. Different specialists paid attention to the medical, didactic, conceptual and technical points of view. From this teamwork originated the AMUSE-environment: an environment where Active Multimedia Use Stimulates Expertise. The AMUSE-environment describes a didactic framework that focuses on knowledge acquisition and application in complex content domains (the transfer and stimulation of expertise). In the context of advanced learning and random access instruction, the active involvement of the user is mandatory. Multimedia systems enhance communication by integrating different media (e.g., text, pictures, audio, video, ...) in one natural, user-friendly environment. The first application that uses the AMUSE-environment is developed in cooperation with the Haematology Department of the University Hospital Gasthuisberg. The haematologists filled the didactical framework with more than 500 full color illustrations and corresponding text and audio. The application gives a complete overview of the morphology of the blood and bone marrow cells.
OBJECTIVES: We examined risk factors for syphilis infection among injection drug users in 3 Russian Federation cities, focusing particular attention on the potential roles of gender and sex work. METHODS: We conducted a cross-sectional survey of injection drug users in Moscow, Volgograd, and Barnaul, collecting behavioral data and testing for antibodies to Treponema pallidum. Associations between presence of antibodies to T pallidum and covariates were explored. RESULTS: Overall, the prevalence of antibodies to T pallidum was 11% (95% confidence interval=9.7%, 13.1%). Syphilis was associated with involvement in sex work and with gender in Moscow and Barnaul but not in Volgograd. Female injection drug users not involved in sex work were more likely than men to be younger and to have recently begun to inject; female injection drug users involved in sex work were more likely than those not involved in sex work to inject daily. CONCLUSIONS: Syphilis transmission dynamics varied by region. Sex work can increase syphilis risk among injection drug users, potentially feeding the momentum of sexually transmitted HIV and syphilis among noninjectors. Targeted interventions are needed to reduce both sexual and injection risk behaviors among injection drug users.