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At least 757 records · Page 42Linked to original sources

PubMed2004

The effects of a transitional discharge model for psychiatric patients.

This pilot randomized control trial was motivated by the discovery that many individuals with mental health problems are re-hospitalized within a year, with many being unable to fully adjust to community living. A solution was proposed in the form of an intervention called transitional discharge. The transitional discharge model included: (1) peer support, which is assistance from former patients who provide friendship, understanding and encouragement; and (2) overlap of inpatient and community staff in which the inpatient staff continue to work with the discharged patient until a working relationship is established with a community care provider. The overall aim of this study was to test the discharge model designed to assist patients discharged from acute admission wards to adjust to community living. This aim was tested through a number of related hypotheses, which suggest that, 5 months following discharge from an acute admission ward of a psychiatric hospital, individuals participating in a transitional discharge model: (1) report fewer symptoms; (2) report better levels of functioning; (3) have better quality of life; (4) are less likely to have been re-admitted to hospital. The study used a randomized experimental design with two conditions: experimental and usual treatment. In general, both the control and the experimental group demonstrated significant improvements in symptom severity and functional ability after 5 months. Usual treatment subjects in the control group were more than twice as likely to be re-admitted to hospital. This study needs to be replicated in Scotland with a larger sample and with a modified variation of the intervention called the Transitional Care Intervention.

Acute Disease↗

PubMed1982

[Coordination of public health education as a specialty with educational institutions for other related professions].

The authors believe that public health is a specific discipline with its own characteristics and precise objectives which, although it makes use of other subjects, must be distinguished and differentiated from others for teaching and practical purposes. Starting from this conceptual framework, they point out that public health teaching should encourage skills and impart knowledge on planning, organization and coordination of the services in order to provide the community with the greatest degree of health possible. They point out that public health should be taught in coordination with other teaching institutions and with the health services institutions. This will make for better use of available resources and additionally, will coordinate efforts in joint action. They further propose that the teaching cannot be limited to inherent aspects of statistics, administration, epidemiology, etc., but must also cover humanistic factors of motivation to undertake such a large task as providing health for all. It is therefore essential to select health workers properly, and to choose public health teachers well: they must have a positive, optimistic and determined attitude, if they are to be able to transmit the proper knowledge, attitudes and skills.

Attitude to Health↗

PubMed2000

What role for the general practitioner in child protection?

BACKGROUND: New government guidance on cooperation in child protection confirms the importance of the general practitioner (GP) contribution. While research highlights the concerns of others about their role in the multi-agency process, relatively little is known about the views and experiences of GPs themselves. AIM: To examine the understanding that each of the key professional groups had of its own and each other's roles in child protection to identify those factors seen to enhance or inhibit the effective performance of these roles. METHOD: The research formed part of a larger investigation of the role of health professionals in child protection, which combined case study investigations of child protection networks in three health authority sites with a regional survey of Area Child Protection Committee members. RESULTS: A lack of correspondence was identified between GPs' perception and performance of their role in child protection and the expectations placed upon them by other child protection professionals and government guidance. CONCLUSION: The study identifies the need for more explicit discussion of the nature and extent of the GP role in local interagency child protection networks.

Child↗

PubMedDate not supplied

[Breastfeeding promotion and support services in local community health centers].

This study had a two-fold goal. First, to document services relating to breastfeeding promotion and support in CLSCs and, second, to examine the links between the delivery of such services and certain organizational and environmental factors. The data were collected in 1999 by means of a self-administered questionnaire sent to all CLSCs in Quebec. The responses indicated that breastfeeding is most often systematically addressed at prenatal meetings and through integrated perinatal programs. CLSCs belonging to a multipurpose establishment are more apt to integrate the issue of breastfeeding into perinatal activities; in addition, many of them offer breastfeeding activities considered innovative, although the average for this kind of activities is fairly low (33%). In addition, CLSCs that collaborate more closely with community organizations and those that spend more on perinatal programs are the ones that most often offer "innovative" breastfeeding activities.

Breast Feeding↗

PubMedDate not supplied

Vaginal or cesarean birth? Application of an advocacy organization-driven research translation model.

BACKGROUND: Research translation models are needed to demonstrate a process for identifying and communicating high-quality scientific evidence that enables informed involvement of relevant stakeholders, including informed consumer participation in healthcare decision making. PURPOSE: To describe the rationale for, and elements of, a research translation model, as it is being applied to inform and support diverse end users with respect to decisions relating to vaginal versus cesarean birth. METHODS: The Maternity Center Association (MCA), the oldest national United States organization advocating on behalf of mothers and babies, identified the need to clarify and translate into practice best evidence about relative harms of cesarean and vaginal birth. MCA developed a model that included engaging leading stakeholder groups, conducting a systematic review to fill research gaps, and initiating an education and advocacy campaign to reach consumers, health professionals, and the general public with review results and related information and guidance. International standards for systematic reviews and evidence about effective professional practice, use of decision aids, and risk communication were used. RESULTS: Dozens of harms that differ by mode of delivery, with nearly all favoring vaginal birth, were found during review. Without clear, compelling, and well-supported justification for cesarean section, vaginal birth is the safest way for women to give birth and babies to be born. Despite modest resource expenditure, the implemented model is bringing review results to many individuals and organizations, incorporating elements that have been shown to be effective. The next step is to formally evaluate the decision aid in clinical settings. DISCUSSION: Advocacy organizations are uniquely positioned to carry out research translation. Given the importance of research translation and the challenges of carrying out this work, programs and policies should be established to support and evaluate advocacy organizations in this role.

Cesarean Section↗

PubMed1995

Care frames: interactive units of health-care delivery.

Describes a way of characterizing the progress of a patient into and out of acute care. Presents a model of the process which resulted from a study of the interface between tertiary care and resettlement in the home community in a single health district. After discussion of the problems relating to patient discharge as described in the literature, briefly describes the origins of and setting for the study. The method of data collection (through documentary analysis, individual and group interview and case study) involved over 100 staff and patients on both sides of the interface. Does not present the substantive findings in detail, as these remain confidential to the organizations involved. However, outlines the process whereby the data gave rise to a model of patient progress and discusses in detail the essential feature of that model--the care frame--both as a theoretical entity and as a basis for practical action. Concludes with a demonstration of how the care-frame model can be used to manage the interface between successive phases in the provision of care and, especially, how it helps to define and manage the interface between acute care and care in the home community.

Continuity of Patient Care↗

PubMed2005

Integrated medical-psychiatric care of a dying borderline patient: a case of dynamically informed "practical psychotherapy".

Combined training in family practice and psychiatry is relatively new and consists of equal proportions of each specialty intermixed throughout a 5-year period. This blending of two distinct skill sets and patient populations creates opportunities to provide unique patient care. An understanding of psychodynamic principles is vital to treating patients with comorbid medical and psychiatric illnesses in a primary care setting. The patient presented in this article had several medical and psychiatric problems and was treated by a combined family practice-psychiatry resident who cared for her medically and psychiatrically until the time of her death from cancer. Complex patients such as this defy the use of purely applied school-specific psychotherapies. Rather, they require the creative application of integrated psychotherapeutic strategies. Integrated approaches to psychotherapy have been increasingly advocated in recent years. In keeping with terminology used by Carl Jung, this approach may be thought of simply as practical psychotherapy.

Attitude to Death↗

PubMed1993

Nurse managers' perceptions of contracting for education, Part 1: Contracting and pre-registration education.

The introduction of the 'purchaser/provider' split into nurse education alters the relationship between service units (or the education purchasers) and colleges of health studies (the education providers). The aim of this study was to identify how education purchasers view the new contracting arrangements, with regard to the provision of pre-registration and post-registration nurse education. In the first of two papers, findings are reported in relation to purchasers' views of pre-registration education. 24 people from one region, comprising senior nurses, and some non-nurse executives involved in the Working Paper 10 initiative, were interviewed. The findings indicate that most of the respondents want a close working relationship with an education provider. They hope that this relationship will be responsive to, and understanding of the needs of the service, and that it will be enhanced by the contracting process. The majority see the need to formally monitor the quality of the output of the college, to ensure that their educational needs are being met by their provider, but they are unsure as to how this can be done. Finally, although it is understood that if service units become dissatisfied with their local college, they can contract with alternative colleges for pre-registration education, the majority of these respondents believe that this will not be desirable or feasible.

Attitude of Health Personnel↗

PubMed1995

A comparison study of day hospital and day centre attenders.

There has been much recent debate on the appropriateness and relative roles of the two main forms of day care available for dementia sufferers (day hospitals and day centres). The characteristics of day care attenders are an important aspect of this debate and have been examined in this study. The area surveyed (North Edinburgh) is unusual not only in respect of the relatively high number of day centre places but also in respect of the close working relationship between day centre and day hospital staff. Current data indicates that many of the attenders at day hospitals and day centres have similar characteristics suggesting that much of the work currently done in day hospitals could be done in day centres, and that even in North Edinburgh there is room for a further expansion in day centre places. Such expansion should not be wholly at the expense of day hospital services as not only are they providing, almost exclusively, a service for the most severely affected, but there is evidence that a small number of day centre attenders would benefit from a multi-disciplinary assessment such as the day hospital provides. For the two services to work effectively close liasion between workers, such as already exists in North Edinburgh, is a prerequisite.

Aged↗

PubMed1991

Nonprogramming relational database primer: a case study--pharmacist intervention audits.

Using a database product has never been easier. The above example may appear to be complicated, but the Alpha Four software program guides you at every step. You have to decide what you wish to accomplish, then set up the program to handle the task. Alpha Four (or any other nonprogrammable relational database) can also be used for formulary management, investigational drug accounting, personnel management, inventory, purchase order requisitions, etc. Some drug distribution systems provide access to the patient records and clinical information. If you learn how to operate a database manager, you can create reports that may not be available from the vendor. Computers have reduced the workload required for drug distribution. The future of pharmacy practice is headed toward a highly automated setting. New roles for the pharmacist may include the provision of information from the point of admission to discharge and possibly continued follow-up. This will all be an automated process with the pharmacist as a key resource person. If you do not learn how to control the computer systems you work with, they will eventually control you. You do not have to be an expert to learn how to use a database application. If computer applications are not already part of your professional responsibilities, they soon will be.

Clinical Pharmacy Information Systems↗

PubMedDate not supplied

Application of international standards to disasters: summary and action plan.

INTRODUCTION: The need for the application of international standards has been evolving over the last decade. Consistency is needed not just in how we respond, but in when we respond. The discussions in this theme reflected on the progress of standard setting both at the local level and internationally. METHODS: Details of the methods used are provided in the introductory paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The chairs then presided over a workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates. RESULTS: Main points developed during the presentations and discussion included: (1) requirement of standards of care for ALL disasters and core parameters, (2) process and procedure is best when there is interagency collaboration and coordination, (3) problems in disasters are management-related, not skill-related, and (4) standards of care must encompass evolving emergencies (e.g., emerging diseases, landmines). DISCUSSION: The action plans for Theme 5 included: (1) develop positions of standards for management, health and public health, education and training, research, psychosocial aspects, and disaster plans; (2) advocate for actions and task forces to deal with evolving and emerging disasters, terrorism, landmines, and emerging infections; (3) proactively work to advocate and facilitate the multidisciplinary and multiorganizational requirements for disaster management; and (4) develop a resource list of interdisciplinary institutions and activities organized by country and topic including the design and maintenance of a website. CONCLUSIONS: There is a clear need for international standards for the management of disasters. Positions and advocacy for these positions are required to define and implement such standards.

Disaster Planning↗

PubMed2002

[Relations between military health services and humanitarian organizations--the point of view of the International Red Cross].

The classic definition of humanitarian action is any operation conducted for the purpose of helping to reduce human suffering. This concept can be expanded to include a notion of prevention. This expanded definition has opened a wide range of applications for humanitarian assistance. Military personnel are frequently involved in relief operations after natural disasters. Military logistic support is a key factor for coping with the massive needs of victims. However military intervention in humanitarian operations during wartime poses complex problems. The ICRC intervenes during military conflict and has, for several years, expressed its concern over the growing involvement of military forces in humanitarian operations. These considerations provide the backdrop for analysis of the relationship between Military Health Corps Services and the ICRC. The purpose of this article is to evaluate the need to make a clear-cut distinction between political and humanitarian objectives and thus between the actors associated with these goals. In this regard, the role of Military Health Corps Services will be presented in function of the principles underlying any humanitarian program. This article will also discuss areas of agreement and cooperation between the ICRC and Military Health Corps Services.

Altruism↗

PubMed1997

For debate. Local government and the National Health Service: the new agenda.

There are some interesting paradoxes in the relationship between local government and the National Health Service (NHS). Local government is responsible for a range of major services, many of which relate to health broadly defined. The NHS provides many services which are often popularly thought to be part of local government (and, indeed, in many countries are). Local government prides itself on its 'localness'; the NHS, with its services delivered in a very local fashion for the most part, cannot quite decide whether it is a national service or a local one. Yet these two major agencies of governance and public service provision often seem unable to work very well together. In the interests of good government, both agencies need to work together where their interests coincide or abut one another. Differences of perspective, priority, culture and style need to be recognized but resolved. Opportunities for joint working need to be grasped and the experience built on. The paper looks at a series of issues and opportunities which bring local government and the NHS together. They create an incentive to improve working relationships; at the same time they suggest an agenda of future possibilities.

Humans↗

PubMed2003

PROCORAD's international intercomparisons highlight the evolution of techniques used to determine uranium in urine.

Inter-laboratory tests are a means of assessing the analytical coherence of medical laboratories. In radiotoxicology, this kind of exercise makes it possible to keep up with laboratory know-how and with the evolution and relative performances of analytical techniques. The intercomparison exercises organised by PROCORAD (Association for the Promotion of Quality Controls in Radiotoxicological Bioassays) provide an opportunity to compare and contrast radiochemistry and metrology for the in vitro analysis of urine and faeces. For uranium compounds, the development of new techniques such as inductively coupled plasma-mass spectrometry (ICP-MS), alpha spectrometry, and laser spectrofluorimetry makes it possible to compare the effectiveness of these protocols with respect to radiation protection monitoring, both in routine and special situations. Detection limits, flexibility, repeatability, reproducibility and isotopic quantification are the criteria considered in this study. The authors present the evolution of performances for the analysis of uranium in urine over the years. However, the goal of the laboratories taking part in these annual exercises is not only to check the accuracy of their results but also to have analytical discussions and the opportunity to exchange experiences that will enrich the group's general competence.

France↗

PubMed2006

Student and community outcomes in service-learning: part 1--student perceptions.

Service-learning has a long and distinguished history of providing valuable experiences to students across all academic levels. Professional disciplines are well situated to provide students with opportunities related to service-learning while also providing needed health care services to communities. This article and Part 2 on pages 516-518 of this issue describe a service-learning initiative implemented in a bachelor of science in nursing program. Part 1 details students' perceptions of outcomes realized from the program, and Part 2 describes community outcomes. The purposes of the program were to enhance students' skills in history-taking, blood pressure and heart rate assessment skills, and beginning counseling skills, as well as provide the university community with blood pressure screening and counseling in a convenient and accessible location. Data on students' perceptions were collected for each semester of the program and for 1 year after students' participation in the program. Students perceived gains in blood pressure and heart rate skill performance, beginning counseling skills, their understanding of tailored client action plans, and their professional commitment to the health of the community.

Community Health Services↗

PubMed1996

Physicians' attitudes toward clinical trials and their relationship to patient accrual in a Nordic multicenter study on myeloma.

Ninety-nine physicians participating in a Nordic multicenter trial on myeloma in 1990-1994 were surveyed, by means of a mailed questionnaire, with respect to their attitudes toward clinical trials and their opinions regarding the importance of certain factors influencing patient accrual. The inclusion rate of each participating clinic was recorded. Questions related to attitudes of presumed importance for patient accrual were analyzed for associations between the response distribution and the inclusion rate for the corresponding clinics. Ninety-three of the surveyed physicians responded to the questionnaire. The survey indicated that the physicians considered the scientific purpose of a trial to be the most important factor for patient accrual, followed by the simplicity of study protocol, the rightness of ethical aspects, the quality of communication with the study organization, and the degree of participation in investigators' meetings. A positive correlation to patient accrual was found for several attitudes held by the participating physicians, including their perception of the importance of a quality-of-life study in the protocol, their conception of the simplicity of the study protocol, their frequency of participation in investigators' meetings, and their awareness of cost and reimbursement levels for entered patients.

Attitude of Health Personnel↗

PubMed2004

Workplace monitoring for exposures to radon and to other natural sources in Europe: integration of monitoring for internal and external exposures.

Part of the action of the EURADOS working group (European Radiation Dosimetry Group) on "Harmonisation of Individual Monitoring in Europe" was to investigate how the results from personal dosemeters for external radiation, from monitoring for internal exposure and from workplace monitoring, can be combined into a complete and consistent system of individual monitoring. To facilitate this work, the "EURADOS questionnaire Q3" relating to radon and other natural sources of radiation in the workplace was distributed to relevant institutes across Europe. A total of 24 countries replied to the questionnaire. This study offers an important overview on actual regulations, national standards and reference levels for protection of employees from radon and other natural sources in different workplace scenarios. Information was also collected on individual monitoring and area monitoring to determine individual doses in workplaces with elevated levels of natural radiation. The article discusses in detail the results obtained showing by country the reference level in workplaces for radon gas and other natural sources. In both instances, exposures in mines, other underground workplaces, industry workplaces/waterworks, offices, schools and day-care homes were considered. The resultant data clearly indicate that there is a need for harmonisation among countries, not least in the areas of regulation and use of reference levels in the workplace.

Background Radiation↗

PubMed2004

The business of emergency medicine: a model for success.

Today's EPOs and their physicians face an array of daunting challenges. Falling reimbursement, rising malpractice costs. ED and hospital crowding,and demands for improving ED efficiency and patient satisfaction all contribute to the challenging and sometimes threatening environment of EM practice. The EP involved in a busy and often hectic ED shift may feel unduly and unnecessarily distracted when required to continuously acknowledge and address the business aspect of the practice. Nevertheless,regardless of the size and structure, fiscal viability ultimately determines the EPO's ability to continue to offer access to care. This article contends that a comprehensive business strategy drives superior financial performance and supports the organization's mission. The business strategy must identify financial and non-financial determinants of the EPO's success and provide a mechanism for understanding how the organization's resources are converted to value for customers. The section offers a framework for developing this strategy, for identifying possible gaps or deficiencies, and for measuring and monitoring progress in achieving strategic objectives and ultimately, the EPO's mission. The importance of the mission and the dynamic EM environment require that the strategy development process be more than an annual exercise for the leadership of the organization. Though key leaders in any size EPO--set the course for the organization, the entire organization must be aware and understand the strategy before they commit themselves and adopt actions and behaviors that promote it. The model presented here provides a graphic display that lends itself well to consistent communication of a comprehensive strategy in a concise way throughout the organization.Furthermore, the balance of the model, across four perspectives, recognizes the value of balanced organizational objectives and lends itself well to the creation of a measurement system that supports cause and effect relation-ships through leading and lagging indicators. This can prevent the imposition of unproven, arbitrary metrics and expectations.EPOs that expend the time and resources required to develop and implement a comprehensive, well balanced strategy make a long-term investment in their patients and themselves. EPOs that go on to develop credible, efficient measurement systems are not only able to drive more commitment and accountability in the organization, they also have a competitive advantage. They can demonstrate performance history and targeted future performance to differentiate themselves from competitors and to stem efforts to impose unbalanced metrics that do not serve well the hospital, the EPO, and ultimately, patients. The power of such measurement systems, internal and external to the organization, strongly point to the need for consistently defined measures across the industry. Ultimately when faced with changes in the environment,the entire industry will be better equipped to respond in specific ways and to communicate its progress to communities or government authorities.

Commerce↗