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At least 775 records · Page 43Linked to original sources

PubMed2006

End-stage heart disease, high-risk research, and competence to consent: the case of the AbioCor artificial heart.

Some commentators believe that persons facing imminent death are incapable of making autonomous, informed decisions about whether to enter high-risk, end-of-life research trials. Using the AbioCor artificial heart trial as an example, this essay argues to the contrary. Although some people are incapacitated, many are capable of making such decisions. To forbid dying people to make a decision about whether to enter a clinical trial may insult deeply held personal values at a time when honoring those values may be most important. Moreover, to deny dying persons entry into high-risk clinical trials leaves ethically worse alternatives: using healthier people, requiring surrogates to decide even when the patient is competent, or simply forgoing all research featuring high-risk, potentially life-saving interventions. Once we agree that it is at least sometimes acceptable to permit dying persons to choose high-risk research, a number of practical safeguards can be implemented to ameliorate the challenges that can hinder decision making in this difficult area.

Attitude to Death↗

PubMedDate not supplied

Public reporting on quality in the United States and the United Kingdom.

The public reporting of comparative information about health care quality is becoming an accepted way of improving accountability and quality. Quality report cards have been prominent in the United States for more than a decade and are a central feature of British health system reform. In this paper we examine the common challenges and differences in implementation of the policy in the two countries. We use this information to explore some key questions relating to the content, target audience, and use of published information. We end by making specific recommendations for maximizing the effectiveness of public reporting.

Community Participation↗

PubMed2000

Computer decision support systems.

Computer decision support systems are computer applications designed to aid clinicians in making diagnostic and therapeutic decisions in patient care. They can simplify access to data needed to make decisions, provide reminders and prompts at the time of a patient encounter, assist in establishing a diagnosis and in entering appropriate orders, and alert clinicians when new patterns in patient data are recognized. Decision support systems that present patient-specific recommendations in a form that can save clinicians time have been shown to be highly effective, sustainable tools for changing clinician behavior. Designing and implementing such systems is challenging because of the computing infrastructure required, the need for patient data in a machine-processible form, and the changes to existing workflow that may result. Despite these difficulties, there is substantial evidence from trials in a wide range of clinical settings that computer decision support systems help clinicians do a better job caring for patients. As computer-based records and order-entry systems become more common, automated decision support systems will be used more broadly.

Computer Systems↗

PubMed2005

Molecular engineering approaches for DNA sequencing and analysis.

High-throughput DNA sequencing development for mutation screening and identification is essential to realize the goal of pharmacogenomics and personalized medicine, which will lead to a new era in clinical medicine and healthcare. Molecular engineering approaches to modify the building blocks of DNA by introducing functional groups for purification and detection has led to the development of high-throughput genetic analysis technologies. This review is focused on the following two DNA sequencing approaches. The first approach is based on the use of molecular affinity and mass spectrometry to perform quick and highly accurate mutation screening, heterozygote identification and insertion/deletion detection. The second approach is based on a sequencing-by-synthesis platform that has the potential for generating DNA sequencing data in a massive, parallel manner. The basic principles, fundamental challenges and methods of implementation of these exciting new technologies will be discussed.

Animals↗

PubMedDate not supplied

[The patient-physician relationship: towards humanization of medical practice].

Based on a literature review, this article discusses the physician-patient relationship by presenting anthropological and communicational approaches, physicians' experiences as patients, key concepts showing the need for humanization of the patient-physician relationship, and some theoretical-philosophical reflections relating primarily to hermeneutics. Based on this framework, one can already identify a series of possibilities for implementing humanizing proposals. The challenge now is to classify, publish, and evaluate these proposals.

Anthropology↗

PubMed2006

Drug therapies in the secondary prevention of cardiovascular diseases: Successes, shortcomings and future directions.

Cardiovascular diseases are the major cause of death and a significant cause of disability in the Western world and more recently threaten to pose an increasing health burden on developing nations. People with pre-existent vascular disease are those at highest risk for adverse cardiovascular outcomes and require aggressive secondary preventive therapies. Large strides have been made in the development of pharmacologic agents that intervene on various pathways implicated in atherogenesis, thus offering the ability to greatly impact on disease progression and to prevent events. Compelling data derived primarily from randomized controlled trials have shown the benefits of aspirin (or antiplatelet agents) and angiotensin converting enzyme (ACE) inhibitors (A), beta-blockers and blood pressure (B) and cholesterol-lowering drugs (C), particularly statins, in preventing recurrent events and improving survival. Taken together these data are the foundation for the simple, but important advice for secondary prevention - the ABCs. In addition, the evidence for the central role of lifestyle factors as determinants of risk has lead to increased efforts towards developing interventions aimed at modifying lifestyle patterns. Today, the biggest challenge remains in the implementation of proven effective therapies. Our focus should turn to educating physicians and patients alike regarding available therapies and their indications. In addition systematic, sustainable and globally applicable approaches to the secondary prevention of cardiovascular diseases need to be developed to truly realize the vast potential benefits of existing therapies.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

Evaluation of a geriatric mental health training program for nursing personnel in rural long-term care facilities.

Although mental illness among elderly living in nursing homes is a substantial and growing concern, the behavioral problems associated with mental illness or threats to mental health are not well understood, tolerated, or effectively managed by nursing home staff. As a result, resident care and quality of life, and staff morale often suffer. The need for geriatric mental health training in long-term care settings has become increasingly apparent. Psychiatric/mental health nurses are in an advantageous position to address this current need and future challenge through the development, implementation, and evaluation of geriatric mental health education and training programs in long-term care settings. This article describes one such innovative training effort, designed to improve the quality of psychosocial care provided by nursing personnel in rural long-term care settings, and highlights evaluation outcomes related to participant satisfaction, staff knowledge, and attitudes.

Aged↗

PubMedDate not supplied

Putting population-based care into practice: real option or rhetoric?

BACKGROUND: Efforts to improve care have focused on population-based approaches, though little practical information exists about implementation. METHODS: This report reviews relevant literature on teamwork in the context of a time-series evaluation of a demonstration project to reorganize care of a single panel of patients in a managed care setting. The proportion of the study panel achieving recommended levels for breast and colon cancer screening, warfarin control, and diabetic eye care was compared with the surrounding practice panels and the managed care population as a whole. Using unconditional logistic regression, we compared changes within populations between March 1993 and March 1995, and the rate of change between populations during the same period. RESULTS: A model of team care was successfully implemented. Colon (occult blood in the stool) and breast (mammography) screening increased more rapidly in the study population than in the surrounding practices or plan as a whole (P < 0.05 for all comparisons). There was no significant improvement in warfarin control or diabetic eye examinations, though absolute increases occurred. CONCLUSION: This work shows that a team approach to population-based care is a real option. Such an approach, however, will not generalize to other settings or all conditions, and its implementation involves some major challenges.

Adult↗

PubMed2006

Faculty development: principles and practices.

Instructors in the health professions today must acquire knowledge and competencies that go beyond disciplinary expertise. It is now generally accepted that educational training as a teacher is essential to a faculty member's effectiveness as an educator. The educational challenges across the health professions share many similarities. In this article, we draw on the medical education literature and focus on faculty development designed to enhance teaching effectiveness. We first address commonly included faculty development topics, including instructional improvement, organizational development, the development of professional academic skills, and the teaching of specific content areas. We then review a variety of educational approaches and formats that are described in the literature. Included in this discussion are commonly used workshops, seminars, short courses, and fellowships, as well as longitudinal programs, peer coaching, mentorship, self-directed learning, and computer-aided instruction. We also briefly explore learning at work and in communities of practice, and we discuss several frequently encountered challenges in designing and implementing faculty development activities, including motivating colleagues and assessing program effectiveness. We conclude the discussion by presenting a set of guidelines for the design of effective faculty development programs.

Education, Veterinary↗

PubMed1989

The urgency of substance abuse education in schools of nursing.

The abuse of alcohol and drugs has become a major health and social problem in the United States. Nurses comprise the largest segment of health-care professionals, yet report their educational experiences offer little to prepare them to develop substance abuse prevention and intervention programs. This article identifies factors that contribute to this educational gap, discusses challenges in planning and implementing substance abuse curricula, and offers specific guidelines for improving educational experiences.

Curriculum↗

PubMed2004

Hospital management of diabetes: beyond the sliding scale.

A growing body of evidence suggests that there is a close correlation between good glucose control and improved clinical outcomes in hospitalized diabetic patients. Until recently, however, no established standards have existed for caring for people with diabetes in the hospital. At a recent consensus conference, experts from around the world studied the evidence and recommended new glycemic targets for hospitalized patients (Endocr Pract 2004; 10:77-82). The challenge now is to implement these targets.

Algorithms↗

PubMed2005

Making evidence based practice a reality for mental health nursing.

In recent years, efforts have been directed towards making mental health nursing more evidence-based. Making evidence based practice (EBP) a reality in modern health services requires due attention to service planning and management. It is acknowledged that there are many challenges and barriers to implementing EBP as outlined in this article. However, by using an example from our mental health service and drawing upon the literature, we show that a variety of techniques can be used to incorporate EBP into everyday practice. A combination of approaches is recommended, including education and training, leadership programs, research units, dissemination of research findings and structural changes to draw upon the expertise of key clinical, education, management and research staff.

Australia↗

PubMedDate not supplied

Work-based learning: making a difference in practice.

Nurses play an increasingly crucial role in ensuring that patients receive the best possible care, and strive to lead innovations in health care. Changing practice is not easy and many nurses do not have the leadership skills or confidence to push for change. Therefore, they need to know that they are supported and encouraged to bring about change in nursing practice. Primary care trusts in the west of Berkshire and a university based in Reading have worked together to respond to this challenge by developing and implementing a flexible, accredited, work-based educational programme. The programme ensures that patients remain at the heart of learning by enabling nurses to lead and influence practice.

Accreditation↗

PubMed1999

[Management of DNA banks: ethical concerns].

With the creation of DNA banks, short and long-term studies can be conducted on the DNA of many individuals using stored cells and tissues. These studies allow an analysis of the pathophysiological impact of genetics and help define individual markers predictive of risk. Genome analysis is thus an important advance in medical science, providing essential information for establishing appropriate measures to slow disease development, limit severity or improve safe recovery. The use of genetic results may however have an adverse effect in certain situations if the genetic information collected were deviated from its purely medical purpose under the influence of social, occupational or economic factors. The aim of our study was to analyse the ethical challenges linked to the implementation of DNA banks in France, particularly to see how to maintain the concept of individual protection in biomedical research within the patient-physician relationship in the current context of legal and administrative regulations in France. In this study, we discuss a set of criteria which should be systematically evaluated in information collection and consent procedures prior to blood or tissue procurement for DNA bank purposes.

Biological Specimen Banks↗

PubMed1994

ERNIE: Emory's record number integrity effort.

Learn how three large, affiliated healthcare facilities in Atlanta accepted the challenge of developing and implementing an electronic medical record system. The main obstacle--dealing with multiple patient identifiers--is outlined and practical and proven solutions are detailed.

Georgia↗

PubMed1995

Public health nursing within core public health functions: "back to the future".

This article defines the role of public health nursing within the core public health functions and health care reform. It discusses the process used in Washington State to define the core public health functions and the development of the Public Health Improvement Plan. It further articulates how the core functions work was built upon to develop a futuristic public health nursing model that incorporates population-based services. The article concludes by discussing some of the challenges and barriers to implementation of the model, yet assuring that public health nursing has a role in public health practice well into the 21st century.

Health Care Reform↗

PubMed1999

A bloodborne pathogen program in civilian aircraft accident investigation.

The Occupational Safety and Health Administration (OSHA) amended 29 CFR Part 1910 in 1991 to include regulations addressing occupational exposure to bloodborne pathogens (BBP). The rule affects all employees that have the potential for occupational exposure to these pathogens. The National Transportation Safety Board (NTSB) and Federal Aviation Administration (FAA) are the primary organizations involved in aircraft accident investigation in the United States. No other organizations in this country have a similar scope or mandate of responsibility. An accident scene presents significant challenges in terms of implementing a program which was primarily envisioned to affect personnel in "traditional" healthcare delivery facilities; the OSHA requirements now had to be met in the chaotic, inhospitable, and logistically difficult environment of an aircraft accident site. Unanticipated issues such as heat-related conditions, performance of physically demanding work in cumbersome gear, biohazard trash disposal from remote sites, and a host of other problems had to be dealt with. The FAA, in close cooperation with other Federal agencies, developed a training and administrative program to meet the requirements of the OSHA BBP rule as it relates to the unique environment of an aircraft accident site. The program has been implemented and successfully tested under actual field conditions at several major aviation accidents that have occurred recently. This article provides observations on the FAA's program and lessons learned from its implementation.

Accidents, Aviation↗

PubMed1985

Office management: increasing productivity in the workplace.

Healthcare managers are seeking new ways to increase productivity in the workplace. New technologies, such as word processing, electronic mail, electronic conferencing, calendar management, data base management systems, artificial intelligence, decision support systems, and local area networks, are being developed to help the healthcare manager make the workplace more productive. The challenge therefore is to implement these systems smoothly and address the organizational issues associated with implementation.

Decision Making↗