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PubMed2001

Intermediates' satisfaction with a loneliness intervention program aimed at older adults: linkage of program plans and users' needs.

Intermediates' satisfaction with linkage of program plans and users' needs in the Dutch loneliness intervention program in good company (IGC) was studied. IGC was aimed at prevention and diminishment of loneliness in older adults, aged 55 years and above. Moreover, the objective was to improve helping and cooperation skills of intermediates, i.e. professional workers and volunteers. Different linkage approaches were used successively in three neighbourhoods, varying from top down instrumental to bottom up democratic linkage strategies. The intermediates' satisfaction with these strategies was measured using postal questionnaires, sent about 20 months after the introduction of the program to the three neighbourhoods. Satisfaction was significantly related to the intermediates' subjective evaluation of the linkage approach. Satisfaction was highest in the neighbourhood where the intermediates were consulted most explicitly and where they had a clear voice in the design and organisation of the intervention, using democratic linkage strategies. Satisfaction was clearly associated with the program's success in meeting targets aimed at intermediates. A relationship with effective prevention of loneliness in older adults was not found. It is concluded that the use of democratic linkage strategies, like needs assessments, local action plans and two-way communication between program designers and users, is essential for successful dissemination of health promotion activities.

Aged↗

PubMed2004

Interprofessional perspectives on transitional mental health services for young people aged 16-19 years.

This qualitative study investigated the need for transitional mental health services for young people aged 16-19 years in a health district, as perceived by professionals from mental health, social, education and non-statutory services. Semi-structured interviews with 39 managers and practitioners who planned or provided services for this age range, from a wide range of agencies, explored issues related to older adolescents' needs, service communication, transfer arrangements, current gaps, and recommendations. Interviews were transcribed verbatim and themes emerged according to grounded theory. The four identified themes, with 21 categories, were: (i) older adolescents have multi-faceted needs, (ii) statutory mental health services are not geared towards this age group, (iii) communication between services is variable, and (iv) there are no formal transfer arrangements from child to adult services. The findings support the need for specialist transitional services, and the adoption of an interprofessional service model incorporating education, social services and non-statutory agencies.

Adolescent↗

PubMed2001

Role of the clinical microbiology laboratory in infection control--a Danish perspective.

Clinical microbiology laboratories in Denmark are located in hospitals and staffed by clinical microbiologists who are clinically trained medical doctors. Each county has its own clinical microbiology unit, serving a population of 0.3-0.6 million. The responsibilities of clinical microbiology unit cover many different aspects of infection control. They include detection of outbreaks of hospital-acquired infections, screening for multi-resistant organisms, advice to clinicians about disinfection, sterilization and isolation procedures, and the rational use of antibiotics. Clinical microbiologists work closely with infection control nurses. Together they form the infection control team, which is the executive part of the local infection control committee. The infection control team is also the main body responsible for the development of guidelines, which are approved by the regional infection control committee. The local microbiology laboratories work in close contact with the National Department of Hospital Hygiene and other reference laboratories at the State Serum Institute. The present structure of infection control was established 25 years ago. The main aim at that time was to decentralize infection control and establish facilities as close to clinicians and patients as practically possible. This has solved most basic problems related to infection control, and compliance by clinicians has been fairly good. However, the present organization will not meet future requirements for standardization and documentation of quality. Currently a national standard for infection control is being prepared. It consists of a main standard defining requirements for the management system and 12 subsidiary standards defining requirements for specific areas of infection control. Adoption of the standard will undoubtedly require additional resources for infection control at a local level, and some organizational changes may also be needed. Infection control should be maintained as an integrated part of clinical microbiology.

Cross Infection↗

PubMed2006

Pouring rights contracts and childhood overweight: a critical theory perspective.

PURPOSE: To examine school environments, and in particular, pouring rights contracts and how they relate to childhood overweight from a critical theory perspective. CONCLUSIONS: Pouring rights contracts provide a profit to powerful mega-corporations at the expense of children's health. There is a need to move beyond a solely individual approach to addressing childhood overweight and involve a social ecology approach. This would involve a push for social change, including removal of soda machines from schools, and changing marketing practices targeted at children. PRACTICE IMPLICATIONS: Nurses are poised in community situations to actively effect social changes to improve health outcomes of our nation's most vulnerable people, but nurses must get involved.

Advertising↗

PubMed2001

School health nursing: framework for the future, Part I.

Society has an emerging respect for the impact that school health nursing programs have on both the health and the education of school-age children. School nurses need to capture current opportunities by building on the richness of the past in order to remain viable, to advance the value of the specialty, and to meet increasing demands for health-related services in schools. Thriving in an increasingly complex and outcome-driven health and educational environment will require a broadening of perspectives, a modifying of paradigms, and an adjustment of attitudes and practices. This will involve building stronger program support, influencing external societal forces, forging new and expanded partnerships, and solidifying program infrastructures while addressing the specialty's professional and practice issues. Such changes will allow school nursing services to remain available and relevant to the needs of the students and communities they serve. This is Part I of a two-part series on the future of school nursing.

Adolescent↗

PubMedDate not supplied

Integrated, collaborative palliative care in heart failure: the St. George Heart Failure Service experience 1999-2002.

BACKGROUND: Chronic heart failure (HF) is the only heart condition increasing in prevalence and is primarily a condition of aging. This condition has outcomes worse than many cancers; however, patients are often denied the benefits of palliative care with its important emphasis on symptom management, spirituality, and emotional health and focus on family issues. AIM: To describe the development of a model of an integrated, consultative, palliative care approach within a comprehensive HF community-focussed disease management program. METHOD: A collaborative model was developed following a systematic needs assessment and documentation of local resources. Principles underpinning this model were based upon fostering of communication, consultancy, and skill development. Within this model a health care system, based upon universal coverage, supported co-management of patients and their families. The place of death, level of social support available at home, and degree of palliative care involvement was documented in 121 consecutive deaths from 1999-2002. FINDINGS: Following a period of skill sharing and program development, only 8.3% of HF patients in the collaborative program required specialized palliative care intervention for complex symptom management, carer support, and issues related to spirituality. Twenty percent of this cohort died in nursing homes underscoring the importance of supporting our nursing colleagues in this setting. CONCLUSIONS: In spite of well-documented difficulties in determining prognosis, it is the St George experience that key principles of a palliative care strategy can be implemented in a HF disease management program with support and consultancy from expert palliative care services.

Community Health Services↗

PubMed1996

Public health approaches to tobacco use prevention and cessation in the U.S.

Tobacco has a long history of use in the U.S., and its serious health effects have been well-documented during the past half century, U.S. efforts to control tobacco use and tobacco-related morbidity and mortality have been reasonably successful over the past 25 years, during which time there has been a 34 percent reduction in adult smoking. Nevertheless, tobacco use remains a significant public health problem in the U.S., with more than 430,000 tobacco-related deaths per year and over one-fourth of the population continuing to smoke. Many organizations are involved in tobacco use control activities, the most broadly focused of which is the National Cancer Institute (NCI). As an example of the type of program needed to address the problem of tobacco use on a national scale, the NCI's public health research plan and activities are described and its emphasis on a data-based decision matrix in its approach to tobacco and cancer control research and applications of research is discussed. Finally, future approaches to tobacco use control in the U.S. are suggested.

Adolescent↗

PubMed2002

Dental schools' relations with organized dentistry and accreditation: the Gies Report reconsidered.

The American Dental Education Association was formed with Gies' help in 1923 from four existing groups to better represent the interests of dental schools. An independent organization of examiners, practitioners, and educators, the Dental Education Council of America, started in 1909 to rate and later accredit schools. Later this group came under the influence of the ADA as the Council on Dental Education. Modern accreditation of dental education began in 1941, under the ADA Council on Dental Education, but has gradually achieved more independence. Gies favored the work of guiding and developing dental education under the hand of a small number of representative experts, and he cautioned against the sway of politics--a warning as valid today as it was three-quarters of a century ago.

Accreditation↗

PubMed2005

CONCOR, an initiative towards a national registry and DNA-bank of patients with congenital heart disease in the Netherlands: rationale, design, and first results.

INTRODUCTION: Survival of patients with congenital heart disease has dramatically improved after surgical repair became available 40 years ago. Instead of a mortality of 85% during childhood following the natural course, over 85% of these infants are now expected to reach adulthood. However, data on long-term outcome is scarce due to the lack of large, national registries. Moreover, little is known about the genetic basis of congenital heart defects. In 2000, the Interuniversity Cardiology Institute of the Netherlands and the Netherlands Heart Foundation have taken the initiative to develop a national registry and DNA-bank of patients with congenital heart disease in the Netherlands named CONCOR. OBJECTIVES: The aims of the CONCOR project are to facilitate investigation of the prevalence and long-term outcome of specific congenital heart defects and their treatment, to develop an efficient organisational structure for the improvement of healthcare for patients with congenital heart disease, and to allow investigation of the molecular basis of congenital heart defects. METHODS: After informed consent, research nurses enter data of participating patients into the CONCOR database using a web application. Data is transferred over the Internet via a secure connection. About 20 ml blood is withdrawn from the patient, and the DNA is isolated and stored. From each participating patient family history on congenital heart disease is obtained. RESULTS: Within two and a half years more than 4200 patients have agreed to participate. More than 99% of the patients that were asked have given their consent to participate in CONCOR. From 60% of these patients DNA has already been obtained. Mean age of the patients included is 34 years; more than 85% of the patients are younger than 45 years. Late complications occur frequently and the incidence increases with advancing age. 18% of the patients are known with supraventricular or ventricular arrhythmias. 2% of the included patients suffered a cerebrovascular accident, 139 (3%) had endocarditis. 6% of the patients has pulmonary hypertension or Eisenmenger syndrome. More than 15% of the patients reported an affected family member with congenital heart disease in the first, second, or third degree. 6% has an affected first-degree relative, and 4% a second-degree relative. Already 10 research projects have started using the CONCOR data and DNA. CONCLUSION: The population of patients with congenital heart disease is young and rapidly growing. Late complications occur frequently and the incidence increases with advances age. The CONCOR registry and DNA-bank facilitates research on prevalence and long-term outcome and allows investigation of the molecular basis of congenital heart disease.

Academies and Institutes↗

PubMed2004

The development of an educational collaborative to address comprehensive pressure ulcer prevention and treatment.

The prevention and treatment of pressure ulcers is a growing public policy concern. Driven by a more informed consumer and the exploding costs of care, policy makers are looking for ways to integrate health-care research and long-term care practices in an effort to improve the quality of care and ultimately reduce costs. This paper presents a case study that demonstrates how training is being integrated at the facility level, utilizing a collaborative. The collaborative was a joint public-private partnership supported through resources from state, federal, and private agencies, with an overarching goal of delivering high-quality, easily accessible geriatric education and training. Direct care providers and other practitioners were recruited to attend a live, interactive videoconference that featured nationally known experts. The content of the educational program was drawn from nationally accepted guidelines that discuss appropriate procedures for wound cleansing, dressings, positioning techniques, proper nutrition and risk assessment protocols. Evaluation of the program indicated that the highest-rated objectives related to the application of training content in the implementation of treatment and prevention procedures important to quality patient care. An examination of publicly available data revealed that an escalating increase in the percentage of facilities in the state cited for deficiencies because of the incidence of pressure ulcers from 1996 to 1999 was reversed in 2000, subsequent to the videoconference. Future programs are planned to sustain the availability of opportunities for practitioners to get critical updates from the experts in the field via live interactive sessions.

Analysis of Variance↗

PubMed2005

A collaborative model of community health nursing practice.

This paper discusses a strategic collaborative partnership between a Western Australian university and a community health service based on a Practice-Research Model. The partnership has involved a senior academic (0.2 FTE) working in the community health setting as a Nurse Research Consultant since 1998. The first section of the paper draws on the nursing literature on collaborative models and describes the broad background to the partnership and development of the Model. The second section presents in detail the results of a recent evaluation that involved a brief survey and follow-up interviews to determine community health nurses' understanding and perceptions of the partnership Model. Three main themes emerged from the interviews: (1) Advancement of learning captured the extent to which the Nurse Research Consultant position helped to educate nurses and promote and develop research and best-practice; (2) Job satisfaction and self-confidence encompassed the extent to which participants felt nursing management were supportive of their professional education and pursuit of best-practice solutions, and (3) Situational opportunity, which reflected the more negative comments expressed by participants and related mostly to the restricted availability of Nurse Research Consultant and a focus on mainstream research priorities. The results suggest that the partnership Model provided the nurses with the opportunity to develop an increased understanding of the role of research in clinical practice and confidence in their own ability to reflect on current nursing practice. This allowed them to identify clinical problems in order to deliver and evaluate best-practice solutions, as evidenced by a change in attitude from the previous evaluation. However, it was also noted that the operational performance of the Model needs continual monitoring to ensure that all nurses have equitable access opportunities.

Adult↗

PubMed2004

Community capacity for adaptation to climate-induced water shortages: linking institutional complexity and local actors.

There is growing concern for the capacity of urban and rural communities to manage current water shortages and to prepare for shortages that may accompany predicted changes in climate. In this paper, concepts relating to the notion of climate adaptation and particularly "capacity building" are used to elucidate several determinants of community-level capacity for water management. These concepts and criteria are then used to interpret empirically derived insights relating to local management of water shortages in Ontario, Canada. General determinants of water-related community capacity relate to upper tier political and institutional arrangements; the characteristics of, and relationships among, pertinent agencies, groups, or individuals involved in water management; and the adequacy of financial, human, information, and technical resources. The case analysis illustrates how general factors play out in local experience. The findings point to geographically specific factors that influence the effectiveness of management. Key factors include collaboration between water managers, clarification of agency roles and responsibilities, integration of water management and land-use planning, and recognition and participation of both urban and rural stakeholders, whose sensitivities to water shortages are spatially and temporally variable.

Climate↗

PubMed1998

Service use patterns in HIV/AIDS case management: a five-year study.

Over the course of the HIV/AIDS epidemic, the profile of the client population has changed. Increasingly, individuals infected with HIV identify injection drug use and heterosexual contact as their risk factors. Additionally, women are increasingly affected by the epidemic. This study examines individuals enrolled in an HIV/AIDS case management program over a 5-year period. Although the number of clients served per year remained relatively stable, the number of clients with injection drug use histories and the percentage of women on the caseload have increased consistently. The percentage of clients requiring services and the amount of services used increased in the areas of attendant care, mental health services, and skilled nursing care. Additionally, the annual mean use of services increased in the areas of in-home supportive services and hours of case management. These data suggest that as individuals receiving HIV/AIDS case management services are found to have complicating social and economic factors, their need and use of services will increase.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Social regulation of healthcare organizations in the United States: developing a framework for evaluation.

Social regulation is ubiquitous in the US healthcare system, and American healthcare organizations claim to be among the most regulated institutions in the world. Yet relatively little is known about the impact of social regulation on these organizations' performance, or about the characteristics or determinants of effective regulatory strategies and approaches. This paper explores the use of social regulation in US healthcare, drawing on the wider literature on regulation in other countries and settings and on the growing body of general regulatory theory. It offers a framework for analysing and comparing regulatory arrangements, presents the findings from an exploratory qualitative study of regulators and regulated organizations, and concludes by developing a framework of the emergent characteristics of effective regulation which might be used in future evaluations of healthcare regulation.

Accreditation↗

PubMed1992

Factors related to the provision of hospital discounts for HMO inpatients.

Using 1986 AHA hospital survey data, we analyzed hospital-HMO contract provisions, hospital operating characteristics, and market conditions for a national sample of 801 hospitals with HMO contracts to determine the factors related to provision of a discount and the magnitude of the discount if present. Seventy-eight percent of the hospitals reported that at least one of their HMO contracts provided a discount for inpatient services. Risk-sharing provisions, the number of hospitals within a five-mile radius, the proportion of the population enrolled in HMOs, and the number of HMOs operating in the metropolitan statistical area (MSA) were directly related to provision of discounts. Public hospitals were less likely than other facilities to provide discounts. For the magnitude of the discounts, risk-sharing provisions and the number of hospitals within a five-mile radius were again related, as was the number of HMOs operating in the MSA--but this time the number-of-HMOs variable had an inverse relationship. The results suggest that increased HMO market activity does result in price competition for hospital services but that hospital discounting strategies are extremely complex and may not follow conventional market theories. Hospitals appear to be using contracts both to stabilize their relationships with HMOs and increase market share, and they are increasingly giving discounts to achieve those ends.

American Hospital Association↗

PubMed1997

Issues in multidisciplinary teamwork for children with disabilities.

This paper presents a review of key issues surrounding multidisciplinary work in relation to the care of children with disabilities and their families. The discussion is based on experience of working in a child development team and research visits to teams around Britain at the beginning of the 1990s. An outstanding feature of child disability services is their organizational diversity. The research found that district interagency planning groups were a rarity, as were multiagency management groups for teams. Thus it was rare for teams to have clear lines of external accountability. Similarly leadership and management structures within the teams had a profound influence on their effectiveness. Issues are highlighted for identifying good practice and for further development of services.

British Columbia↗

PubMed2003

Prospective medicine: the next health care transformation.

The introduction of science into the practice of medicine in the early 20th century was a transforming event for the profession. Now, breakthroughs in science and know how make it possible to transform care once again and to fix the broken U.S. health care system. To realize this potential, new models of prospective health care must be created and validated. Prospective health care would determine the risk for individuals to develop specific diseases, detect the disease's earliest onset, and prevent or intervene early enough to provide maximum benefit. Each individual would have a personalized health plan to accomplish this. Current knowledge is already sufficient to implement this approach, but there are no effective practice models, delivery systems, and appropriate reimbursement mechanisms. The authors describe the mechanisms of managing care prospectively, describe the components of a personalized health plan, and show how prospective care could relate to a community or group of covered individuals. They conclude by stressing that all interested parties, including academic health centers, insurers, and payers, will need to work together to develop innovative applications of new technologies and appropriate delivery models. At their own institution, pilot programs to foster prospective health care have already begun, and another initiative to develop models to use genomic medicine is also underway. Bipartisan political support will also be needed to help achieve rational reimbursement between providers and payers, so that prospective care can fulfill its promise of being the best cost-effective model to improve the nation's health.

Delivery of Health Care↗

PubMed2006

Health services delivery networks: what do we know and where should we be headed?

Networks of collaborating organizations have become critical mechanisms for the effective delivery of healthcare and related human services. Despite their importance, there is much about health networks that is not understood. The article by Huerta, Casebeer and VanderPlaat is an effort to discuss the importance of health services delivery networks and to point out ways in which such networks might best be studied. Their article offers a number of useful and interesting ideas for both practice and research. Many of these ideas are not, however, well organized, integrated or fully developed. This commentary provides a critique of their work, while offering some of our own suggestions about how the study of health delivery networks might be advanced.

Canada↗