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At least 739 records · Page 41Linked to original sources
PubMed2005

The impact of the European Environment and Health Process on UK environment and health policy, plans and practice: what difference has it made?

The European Environment and Health Process (EEHP), led by the World Health Organization (WHO) Regional Office for Europe, aims to support WHO Member States as they plan and implement national and international environment and health policies. An evaluation of the impact of the EEHP in the UK was conducted in preparation for the fourth Ministerial Conference on Environment and Health in Budapest, 2004. The evaluation identified a number of impacts and influences of the EEHP. This concluded that the process had only a marginal direct influence on policy within the UK. However, it was also concluded that the process had resulted in several indirect influences, including better cooperation between government departments, greater awareness of environment and health issues from an international perspective, and a higher political profile of environment and health issues. A few outcomes of the EEHP also appear to have been taken into account in some national and local policy documents. The National Environmental Health Action Plan, which was produced as a direct result of the EEHP, appears to have had little direct impact in the UK, probably because of the lack of an implementation process and indicators, and because it was superseded by other policy initiatives relatively soon after publication. A need for better coordination and promotion of the EEHP amongst stakeholders responsible for environment and health policy areas was also identified.

Delivery of Health Care↗
PubMed2002

Family practice in the United States: position and prospects.

Family practice became the 20th U.S. medical specialty in 1969. It has delivered on its promise to reverse the decline of general practice and care for people with diverse problems in all areas of the country. But many important health care problems remain unsolved, in part because of poor role delineation for family physicians, poor differentiation of family practice from other fields, and insufficient changes in the cultural and political environment. Family practice's problems include confusion about whether it is a reform movement or an incumbent specialty; disagreement about its role in controlling and assuring care; confusion about whether family physicians are generalists or specialists; lack of clarity about family practice as vital for all versus a possible option for some; misunderstanding about the knowledge requirements for family practice; and inadequate business models. Family practice's mistakes include expending much effort on justification and less on assuring practical means to accomplish its work; permitting an erosion of public trust; failing to strengthen relationships with interfacing specialties and organizations; and neglecting research. Nonetheless, there are promising opportunities to improve health and health care through strengthening family practice that depend in part on redesigning the family practice setting, defining carefully critical interactions with other elements of the health care system, fostering discovery of family practice, and further differentiating family practice as a scientific and caring field. Another period of adaptation by family practice is already under way; this may be the first time in history that its ambitious aspirations are actually achievable.

Family Practice↗
PubMedDate not supplied

Can academic group practices survive in managed care environments?

Managed care environments have proven difficult for most health care organizations. Academic medical group practices--also called faculty practice plans--in particular have faced enormous challenges in making strategic adaptations to rapidly evolving health care markets. Recent evidence suggests that academic practices have been less than successful in implementing strategies focused on cost leadership and affiliations with primary care physicians. This article asserts that academic group practices cannot succeed by copying strategies implemented by other medical group practices because they have dissimilar missions, organizational capabilities and environmental constraints. The authors use the TOWS matrix--an acronym for threats, opportunities, weaknesses and strengths--a decision analysis framework that integrates both organizational and environmental factors, to assist executives in strategically positioning academic group practices.

Academic Medical Centers↗
PubMedDate not supplied

Neonatal skin care: clinical outcomes of the AWHONN/NANN evidence-based clinical practice guideline. Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses.

OBJECTIVE: To test the effectiveness of an evidence-based clinical practice guideline for neonatal skin care on selected clinical outcomes for newborns in neonatal intensive-care units (NICU), special-care units (SCU), and well-baby nurseries. DESIGN: Prospective evaluation of the collaborative neonatal skin care research-based practice project of the Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses. SETTING: NICU and well-baby units in 51 hospitals located throughout the United States. PARTICIPANTS: Member site coordinators (N = 51) and the neonates (N= 2,820) observed during both the pre- and postimplementation phases of the project. METHOD: Site coordinators received specialized education in neonatal skin care and implemented an evidence-based clinical practice guideline addressing 10 aspects of neonatal skin care. Baseline observations of skin condition, care practices, and environment of newly admitted neonates were collected by site coordinators. Postimplementation observations were then completed. MAIN OUTCOME MEASURES: Skin condition was assessed with the Neonatal Skin Condition Score (NSCS), which ranges from a score of three (best condition) to a score of nine (worst condition), based on dryness, erythema, and skin breakdown. Changes in frequency of selected skin care practices were used to assess the effectiveness and feasibility of using the practice guideline in everyday clinical practice. Aspects of the care environment with potential effect on skin integrity were monitored to determine risk factors. RESULTS: Fifty-one site coordinators made 11,468 systematic assessments of 2,464 NICU and SCU newborns and 356 well newborns. Baseline skin scores were better in well newborns compared with premature newborns. After implementation of the guideline, skin condition was improved, as reflected by less visible dryness, redness, and skin breakdown in both the NICU/SCU and well newborns. The guideline was integrated into care, as evidenced by increased use of emollients, particularly with premature infants, and decreased frequency of bathing. A relationship was shown between selected aspects of the environment and alterations in skin integrity. CONCLUSIONS: Use of the AWHONN/NANN Neonatal Skin Care Research-Based Clinical Practice Guideline was successfully implemented at 51 sites, and effectiveness was demonstrated by changed care practices and improved skin condition in premature and full-term newborns. The results of this project support a wider dissemination of the project's practice guideline for neonatal skin care.

Clinical Nursing Research↗
PubMed1988

The future of family practice. Implications of the changing environment of medicine. Council on Long Range Planning and Development in cooperation with the American Academy of Family Physicians.

The Council on Long Range Planning and Development of the American Medical Association has identified trends in the environment of medicine and the implications of these trends for specific medical specialties. This report considers the evolution of family practice as a specialty and its role in the future of health care delivery. As a specialty established less than 20 years ago, family practice has successfully surmounted several obstacles to achieve recognition within the medical community and among the public. However, the Council has identified new challenges and opportunities facing this specialty. In particular, the areas of graduate medical education, reimbursement, professional liability, and several health-related societal and ethical issues will pose challenges for and place constraints on family physicians. Family practice will encounter a number of opportunities in the evolving environment of medicine, due in part to demographic trends in the population and the growth in managed care. The Council concludes that, despite the challenges, the increasing demand for the services of family physicians has positive implications for the future of this specialty.

Education, Medical, Graduate↗
PubMed2000

[Is scuba diving allowed in diabetic patients treated with insulin?].

Scuba diving is usually prohibited in diabetic patients at risk of hypoglycemic attacks (i.e. IDDM and NIDDM treated with sulfonylureas) due to the particular severity of these episodes in a hostile environment. In fact, diabetic subjects can perform this popular leisure activity without extra-risk, provided strict requisites in aptitude, practice and environment are enforced. These limitations lead to the establishment of practical guidelines, as proposed in this paper.

Diabetes Mellitus, Type 1↗
PubMed2005

Predicting the adoption of electronic health records by physicians: when will health care be paperless?

OBJECTIVES: The purpose of this study was threefold. First, we gathered and synthesized the historic literature regarding electronic health record (EHR) adoption rates among physicians in small practices (ten or fewer members). Next, we constructed models to project estimated future EHR adoption trends and timelines. We then determined the likelihood of achieving universal EHR adoption in the near future and articulate how barriers can be overcome in the small and solo practice medical environment. DESIGN: This study used EHR adoption data from six previous surveys of small practices to estimate historic market penetration rates. Applying technology diffusion theory, three future adoption scenarios, optimistic, best estimate, and conservative, are empirically derived. MEASUREMENT: EHR adoption parameters, external and internal coefficients of influence, are estimated using Bass diffusion models. RESULTS: All three EHR scenarios display the characteristic diffusion S curve that is indicative that the technology is likely to achieve significant market penetration, given enough time. Under current conditions, EHR adoption will reach its maximum market share in 2024 in the small practice setting. CONCLUSION: The promise of improved care quality and cost control has prompted a call for universal EHR adoption by 2014. The EHR products now available are unlikely to achieve full diffusion in a critical market segment within the time frame being targeted by policy makers.

Attitude of Health Personnel↗
PubMed1997

Advanced practice psychiatric-mental health nursing in a community-based nurse-managed primary care program.

In the evolving health care environment, advanced practice opportunities for psychiatric-mental health nurses may lie in managed care models of community oriented primary health care. As providers, care managers, health promoters and educators, and client advocates with family systems expertise, psychiatric-mental health advanced practice specialists are a necessary component of all primary health care. This article describes the development of a community-based primary care practice that integrates physical and mental health care on the same site.

Adult↗
PubMed1998

Human rights of psychiatrically disturbed persons in the tropical Pacific.

The management of acutely disturbed patients in smaller Pacific island communities presents many clinical challenges as well as ethical and human rights questions. The aggressive, excited, sexually inappropriate, and possibly violent disturbed person frequently will need physical restraint and possible seclusion in a secure environment. In practical terms, on many Pacific islands the only physically secure room is a jail cell. This environment will protect others and possibly protect the out-of-control person from themselves. After protection, the next requirements are adequate information about the person and clinically informed individuals who can make a diagnosis and commence treatment in the jail environment. Adequately trained people who can diagnose and suggest initial treatment are few and widely dispersed in Pacific island communities. Two representative case vignettes from the author's experience as a World Health Organization short-term consultant in Tonga and the Commonwealth of the Northern Mariana islands illustrate the tension between a disturbed person's right to adequate treatment and the right of a citizen/patient to be free of coercion.

Adult↗
PubMed1991

The state of general practice computing in Scotland and the characteristics of computerised practices: a survey of 948 practices.

A survey of 1,179 Scottish practices produced an 81% response rate and gathered data about practice size, environment, state of computerisation as well as future plans for the use of computers in the practice. Results show that the majority of practices are already computerised and that over 90% will be computerised soon. A computer in the practice correlates especially with the presence of a practice manager, a practice nurse and training or teaching status. Scotland is unique in having a national software program (GPASS) for general practice administration. We estimate that by mid 1991 over 750 practices will be using GPASS.

Computers↗
PubMedDate not supplied

Preserving midwifery practice in a managed care environment.

Since 1925 when nurse-midwifery emerged as a new health profession in the United States, and over the past 30 years under the auspices of the American College of Nurse-Midwives (ACNM), national standards for education, certification, and practice have enabled nurse-midwives to provide the quality of care that is highly valued by policy-makers and consumers. This paper describes the education and practice of over 7,000 midwives who have received national certification through mechanisms developed by the ACNM, describes the strengths of the profession, and reviews the impact of managed care on the practice of midwifery. Also highlighted is ACNM's development of a partnership, with the Maternal and Child Health Bureau, to study the impact of changes in the health care environment on pregnant women and ACNM certified midwives. This partnership is presented as an example of how the ACNM has evolved into an organization that is well-positioned to preserve midwifery in a managed care environment.

Certification↗
PubMed1999

Nursing scholarship: role of faculty practice.

As nursing education has moved into the academic setting, nursing faculty have focused on the traditional components of scholarship in the faculty role: research and publication, teaching, and service. However, dramatic changes have occurred in higher education and health care forcing nursing faculty to reexamine their roles in both systems. A survey was conducted to explore the views held by deans and faculty of colleges of nursing on scholarship and to describe ways in which these views on scholarship reflect faculty practice. Principal findings of this study indicated that nursing deans and faculty view scholarship as the generation, dissemination, application, and advancement of nursing knowledge. The components of scholarship in the nursing faculty role were described as research and publication, teaching, service, faculty practice, and presentations. The strongest theme to emerge from the study was the role conflict and fragmentation experienced by faculty as they tried to balance all the components of scholarship. The topic of faculty practice was considered to be an important issue in nursing, with the majority of nursing faculty involved in faculty practice in environments where it is not accommodated, mandated, or formally expected. The findings of this study suggest that faculty practice roles could be considered a component of scholarship as long as scholarly outcomes are demonstrated.

Attitude of Health Personnel↗
PubMedDate not supplied

Clarifying outcomes in clinical practice.

The word 'outcome' is very much in vogue within today's healthcare system, yet its meaning varies between different levels of service, occupational groups and care environments. Using practical examples, this article aims to clarify the concept of outcome, and to explore some of the issues surrounding its use.

Humans↗
PubMedDate not supplied

Baccalaureate educator use of environment-based strategies to teach diagnostic patterns.

Baccalaureate nurse educators reported that their use of 10 environment-based strategies in the classroom or clinical setting may foster recognition of diagnostic patterns likely to be encountered in clinical practice. Environment-based strategies are verbal or print materials that draw attention to a particular aspect of what is being taught and that draw attention to important information. A national sample of 255 full-time baccalaureate educators (56 per cent return rate) from 28 randomly selected programs completed a questionnaire. The reliability estimate related to the 10 items was 0.70. Most respondents reported use of all 10 environment-based strategies with a minimum reported use of 60 per cent for each strategy on at least a "sometimes" basis. The most frequently reported use of a strategy on a "greater than sometimes" basis was the transparency (75 per cent). Color and print differences were the most infrequently used at 40 per cent and 37 per cent, respectively. The results of this study show that faculty, either consciously or unconsciously, use the environment-based strategies to facilitate student selection of key diagnostic indicators. Increasing educators' awareness of such benefits to students may stimulate further research in this area. Methods to help students decipher significant health status indicators from associated ones are clearly needed so that timely intervention can be used to prevent harm to patients.

Attention↗