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PubMed2000

The AMA clinical quality improvement forum on addressing patient safety.

BACKGROUND: More than 200 health care policy makers and researchers, clinicians, quality professionals, and other representatives of health care organizations, government, and academia attended the Division of American Medical Association Clinical Quality Improvement's conference, "Addressing Patient Safety," April 28, 2000, in Chicago--the first national conference to respond to the recent Institute of Medicine (IOM) report, To Err Is Human: Building a Safer Health System. ADDRESSING PATIENT SAFETY--PUBLIC AND PRIVATE PERSPECTIVES: John M. Eisenberg, MD, stated that research on errors is needed to describe the scope and nature of the problem, understand the barriers to and benefits of improvement, and develop and test strategies for improvement. Kenneth W. Kizer, MD, MPH, stated that the National Quality Forum will develop a compendium of best practices and will develop core measures for serious adverse events, and health care organizations and government health programs should act now to make a clear organizational commitment to patient safety, create a nonpunitive health care culture of safety, and implement known safe medication practices. Alan R. Nelson, MD, stated that the IOM report places its emphasis on continuous quality improvement and technology that can be used to mitigate the risks in a complex health system. HOSPITAL AND ACCREDITATION AGENCY ACTIVITIES ON PATIENT SAFETY ISSUES: Donald M. Nielsen, MD, discussed the American Hospital Association's (AHA's) Medication Safety Initiative, which promised to provide its members with successful practices, tools, and resources and to track progress of implementation of the recommended successful practices. Dennis S. O'Leary, MD, stated that when a hospital reports a sentinel event, the hospital is expected to implement improvements to reduce risk and monitor their effectiveness. The National Committee for Quality Assurance is considering changes to its accreditation standards to further address patient safety.

Accreditation↗

PubMed2002

The Safety Case Management Committee: expanding the avenues for addressing patient safety.

BACKGROUND: The greatest gains in patient safety are likely to result from using a multifaceted framework of safety enhancement initiatives. The Safety Case Management Committee, which has been meeting at the VA Ann Arbor Healthcare System since early 1999, is one such initiative; it is directed at broadening organizational involvement in creating a safer clinical environment. The committee's objective is to address fundamental issues related to patient safety and quality of care. The committee aims to develop thematic approaches to improving major systems triggered by unsafe or risky incidents that demonstrate either iatrogenic harm or risk of harm to patients. COMMITTEE STRUCTURE AND FUNCTIONING: Committee members represent top management, middle management, and front-line employees, but membership is weighted toward those in direct patient care roles. The group also includes a consumer representative. Critical issues are addressed through rigorous case discussion, literature review, and expert consultation. RESULTS: In a 3-year period (Feb 1999 through Dec 2001), 85% of the group's 45 recommendations have been implemented. Topics have included reducing medication errors during emergency procedures, enhancing palliative care services, minimizing the risk of missed x-ray findings, optimizing anticoagulation management, reducing the risk of vascular catheter-related infection, and improving pain management. SUMMARY: The Safety Case Management Committee has successfully addressed actual and potential errors and has implemented strategic safety improvements. The dedicated efforts of highly motivated clinicians who serve on such a committee can augment and enhance risk management advances made through other channels.

Case Management↗

PubMed2006

Posttraumatic stress disorder in posttransplant children: creating a clinical program to address their needs.

Posttraumatic stress symptoms have been shown to occur in pediatric and adult solid-organ transplant recipients. The presence of these symptoms is associated with non-adherence to medications, increased distress, and poor outcome. Because posttraumatic stress disorder is treatable and because a transplant operation usually is an "anticipated trauma," it is possible to address posttraumatic stress disorder symptoms in transplant recipients and attempt to prevent their development. Under my direction, the pediatric liver transplant program at Mount Sinai Medical Center in New York City created research and clinical programs to address posttraumatic stress symptoms and their consequences. Specifically, the focus on non-adherence to immunosuppressive medications in transplant recipients who are distressed and their parents. This article begins with a review of the data that led to the decision to start these programs. I then present the basic elements that are in place, in this particular program, to address patients' needs. I end this review with preliminary outcome data that illustrate the potential impact of such an integrated approach to patient care on medical outcomes.

Child↗

PubMed2004

An addressable antibody nanoarray produced on a nanostructured surface.

The ability to address specific nanoscale features is required to produce diverse biological nanoarrays or perform local assembly using biological building blocks and is an important unsolved problem in nanotechnology. In this work, we describe the use of a novel nanofabricated gold surface, with regions of distinct topography and chemical functionalities, to solve this problem. First, nanoarrays of IgG antibodies were produced by selective immobilization in nanoholes on the surface. The smallest feature size was determined by the hole size (fwhm 90 nm) and not surface diffusion. Using holes of 300 nm diameter, we selectively addressed specific features in the array by nanopipet delivery of a functional antibody, anti-IgG. To our knowledge, this is the first example of addressing specific biologically functional features on a surface at the nanoscale.

3-Mercaptopropionic Acid↗

PubMed1997

Discovery of a novel class of substituted pyrrolooctahydroisoquinolines as potent and selective delta opioid agonists, based on an extension of the message-address concept.

This paper describes the design and synthesis of compounds belonging to a novel class of substituted pyrrolooctahydroisoquinolines which are potent and selective delta opioid agonists. Molecular modeling studies performed on known, selective delta ligands such as (+)-3 and the potent delta agonists SNC 80 led to the identification of the carboxamido moiety of the latter as a putative nonaromatic delta address. Insertion of this moiety onto the octahydroisoquinoline opioid message resulted in (+/-)-5b, a potent and selective delta ligand. The active enantiomer, (-)-5b, displayed nanomolar affinity for the delta receptor (Ki = 0.9 nM) with good mu/delta and kappa/delta binding selectivity ratios (140 and 1480, respectively). In addition, (-)-5b behaved as a full delta agonist in the mouse vas deferens bioassay having an IC50 = 25 nM and being antagonised in the presence of 30 nM naltrindole (NTI). These studies, based on the message-address concept, indicated that the nonaromatic (N,N-diethylamino)carbonyl moiety is a viable alternative to the classical benzene ring as a delta opioid address. Preliminary in vivo studies showed that (+/-)-5b produced a dose-related antinociception in the mouse abdominal constriction test after intracerebroventricular administration (ED50 = 1.6 micrograms/mouse).

Animals↗

PubMed2006

Policy strategies to address sustainability of Alaskan boreal forests in response to a directionally changing climate.

Human activities are altering many factors that determine the fundamental properties of ecological and social systems. Is sustainability a realistic goal in a world in which many key process controls are directionally changing? To address this issue, we integrate several disparate sources of theory to address sustainability in directionally changing social-ecological systems, apply this framework to climate-warming impacts in Interior Alaska, and describe a suite of policy strategies that emerge from these analyses. Climate warming in Interior Alaska has profoundly affected factors that influence landscape processes (climate regulation and disturbance spread) and natural hazards, but has only indirectly influenced ecosystem goods such as food, water, and wood that receive most management attention. Warming has reduced cultural services provided by ecosystems, leading to some of the few institutional responses that directly address the causes of climate warming, e.g., indigenous initiatives to the Arctic Council. Four broad policy strategies emerge: (i) enhancing human adaptability through learning and innovation in the context of changes occurring at multiple scales; (ii) increasing resilience by strengthening negative (stabilizing) feedbacks that buffer the system from change and increasing options for adaptation through biological, cultural, and economic diversity; (iii) reducing vulnerability by strengthening institutions that link the high-latitude impacts of climate warming to their low-latitude causes; and (iv) facilitating transformation to new, potentially more beneficial states by taking advantage of opportunities created by crisis. Each strategy provides societal benefits, and we suggest that all of them be pursued simultaneously.

Acclimatization↗

PubMed2004

Distinct domains control the addressing and the insertion of Bax into mitochondria.

The translocation of Bax from the cytosol into the mitochondrial outer membrane is a central event during apoptosis. We report that beyond the addressing step, which involves its first alpha-helix (halpha1), the helices alpha5 and alpha6 (halpha5alpha6) are responsible for the insertion of Bax into mitochondrial outer membrane bilayer. The translocation of Bax to mitochondria is associated with specific changes in the conformation of the protein that are under the control of two prolines: Pro-13, which controls the unfolding of halpha1, and Pro-168, a proline located immediately before the hydrophobic carboxyl-terminal end (i.e. helix alpha9, halpha9), which controls the disclosure of halpha5alpha6. An additional step, the disruption of an electrostatic bond formed between Asp-33 (halpha1) and Lys-64 (BH3), allows the mitochondria addressing of Bax. We conclude that, although the intramolecular interactions of halpha1 with the BH3 region control the addressing of Bax to mitochondria, the Pro-168 is involved in the control of its membrane insertion through halpha5alpha6.

Amino Acid Sequence↗

PubMed2005

Defining and addressing the nutritional needs of populations.

OBJECTIVE: To examine the present methods used to define nutritional needs, and to analyse the intrinsic limitations of the reductionist chemical, biological and medical approaches to assess requirements. To establish the necessity to incorporate the complexities emerging from a broader understanding of the biological sciences as well as to include environmental and social dimensions in addressing nutritional needs. METHOD: Examples of the limitations of current approaches and the implications of these in defining potential solutions and policy options to address present nutritional problems are presented and discussed. CONCLUSION: The chemical and biological sciences have provided a strong base for nutrition and have been essential in establishing nutrition as a science with public health relevance. However, these approaches are clearly insufficient to address the main challenges that confront nutrition science now in the twenty-first century. There is a pressing need to include the social, economic and human rights aspects in order to define future policies that will secure the right to safe and nutritious food for all.

Food Supply↗

PubMedDate not supplied

Split gender identity: problem or solution? Proposed parameters for addressing the gender dysphoric patient.

Working with the gender dysphoric patient is complex because of the various clinical issues that arise. One issue that has not been addressed in the psychiatric literature is whether to address the patient with the biologically congruent pronoun or name or with the patient's preferred-gender pronoun or cross-gender name. This article presents clinical examples that allow a template to be developed for pronoun use in working with such patients. Whether the clinician uses biologically congruent names and pronouns may depend upon the patient's progress in adopting the cross gender role as well whether family or friends either know or accept such changes. In certain situations, such as meetings with family members, the therapist may address the patient with gender congruent names; whereas on other occasions use cross-gender pronouns or names.

Adult↗

PubMed2006

Addressing gaps in abortion education: a sexual health elective created by medical students.

Medical school curricula frequently contain gaps in the areas of abortion and sexual health. A group of first- and second-year medical students at the authors' institution organized a collaborative, multidisciplinary elective course to address such omissions in the preclinical curriculum. This paper describes the process of creating and implementing the elective. Medical students identified curricular gaps in the areas of abortion, sexual assault, lesbian/gay/bisexual/transgender health, and HIV counseling. Clinical faculty and community-based professionals were invited to address these topics in a weekly lecture series organized by students. The course also included a half-day experience shadowing at a local abortion clinic. Collaboration with several student groups helped broaden student interest in and increase financial support for the elective. Some 37% of all first- and second-year students enrolled in the elective and received institutional credit for the course. Written and verbal evaluations confirmed student satisfaction with the lectures and the clinical experience. Dynamic and well-prepared speakers who presented interesting medical content received the highest ratings from students. Student leaders identified several challenges in implementing the elective. Ultimately the elective proved to be a successful collaboration among students, faculty, and healthcare providers, and resulted in permanent changes in the standard medical school curriculum. Challenges for student-initiated electives include difficulty in finding administrative support, securing funding and ensuring sustainability. This paper aims to make this process accessible and applicable to other students and faculty interested in addressing curricular gaps at their respective medical schools.

Abortion, Induced↗

PubMed2006

Addressing the health and lifestyle issues of people with a mental illness: the Healthy Living Programme.

OBJECTIVE: The physical health and well-being of mental health patients have been a concern to health professionals for many years. However, very few positive gains have been made to address this problem. This paper outlines the efforts of the Inner North Brisbane Mental Health Service, Royal Brisbane and Women's Hospital, to design and implement a structured educational programme, aimed at addressing and encouraging healthy lifestyle behaviours in its community mental health service recipients. METHODS: Three programme modules were designed, addressing the topics of Nutrition and Healthy Eating, Physical Health, and Community Based Activities and Interests. Referral of patients to the programme was by their case manager or doctor. At the conclusion of each module, participants were asked to complete a satisfaction survey evaluating the programmes. The survey also gathered feedback regarding any suggestions and/or recommendations to improve content suitability and relevance. RESULTS: Since commencing the Healthy Living Program, each module has been conducted at least twice, the topic of Healthy Eating receiving the most referrals and therefore conducted most frequently. To date, 35 satisfaction surveys have been evaluated. The overwhelming majority of respondents offered very positive feedback about the programme, most being able to identify some healthy lifestyle changes they planned to make in response to programme attendance. CONCLUSIONS: This paper highlights the importance of incorporating healthy lifestyle programmes into mental health service delivery. The majority of patients who have attended the Healthy Living Program have indicated satisfaction with the content, but as yet information pertaining to long-term lifestyle change has not been collated. The next phase aims to examine whether the programme attendance has more long-term outcomes in improving health and well-being and promoting healthy behaviour change of mental health service recipients.

Community Mental Health Services↗

PubMed2003

Addressing health needs of an aging society through medical-religious partnerships: what do clergy and laity think?

PURPOSE: This article reports on the interest within the religious community in a medical-religious partnership model designed to address some of the health challenges communities face as the population continues to age and become more diverse. DESIGN AND METHODS: A geographically and religiously diverse group of 183 clergy who were attending a continuing education program on theology and preaching were invited to complete a 16-item survey asking about their interest in working with hospitals to offer health-related programs and activities in their congregations. Another sample, this one consisting of 524 individuals from a religiously diverse group of congregations in Florida, was also asked about their interest in having health programs offered in their congregations. RESULTS: Of the 54% of clergy who completed the surveys, 72% said it was "very important" and 28% said it was "somewhat important" to actively address the health needs of their congregations. Support for specific programs was also strong, with at least 80% reporting it was very likely they would support screenings, preventive interventions, and health-related classes in their congregations. Strong support was also found among the laity surveyed, with 85% expressing interest in faith-based health programs and 45% reporting they would be interested in helping organize and promote such programs. IMPLICATIONS: Health care systems and other organizations interested in addressing health needs of older adults can look to religious institutions for assistance in providing the information and support patients and family members need to prevent or minimize the impact of chronic illnesses.

Aged↗

PubMed1988

Theoretical analysis of 'addressed' chemical modification of DNA.

Chemical "addressed" modification of DNA involves treatment of single-stranded DNA with oligonucleotides complementary to certain target sequences in this DNA and bearing a groupings reactive towards DNA bases. The binding of oligonucleotides can occur both at completely (specific) and incompletely (nonspecific) complementary sites. We analyse the modification of a fragment that is flanked by two target sequences complementary to a given oligonucleotide address, contains no more such targets and has some randomly distributed sites for nonspecific binding. Conditions for the maximum ratio between specific and non-specific modification are determined. We find the probability of both target termini being specifically modified without any non-specific modification occurring within the fragment up to a given moment in time. Quantitative analysis is based on the use of known features of the specific and non-specific binding of an oligonucleotide to DNA sites. This analysis shows the possibility of specific cutting of DNA based on addressed modification.

Base Composition↗

PubMed2003

Addressing the inverse care law in cardiac services.

BACKGROUND: Wide variation in rates of angiography and revascularization exist that are not explained by the level of need for these services. The National Service Framework for Coronary Heart Disease has set out a number of standards with the aim of increasing the number of revascularizations and reducing inequalities in access to care. In this study we aimed to investigate inequity in angiography and revascularization rates between the four Primary Care Group (PCG) areas in Camden and Islington Health Authority and to put in place measures to address the problems identified. METHODS: Routinely available data were collected on all residents within Camden and Islington Health Authority undergoing angiography, angioplasty (PTCA) or coronary artery bypass grafting (CABG) between 1997 and 2001. These were used to calculate intervention rates per million population for each of the three procedures within each PCG. Semi-structured interviews were carried out with a sample of clinicians to explore their views on the provision of revascularization services within the Health Authority. RESULTS: Angiography and revascularization rates varied widely between the four PCGs. In 2001 there was a two-fold difference for angiography and CABG and a 3.5-fold difference for PTCA. The variations were not explained by a measure of the level of need for these services. The highest rates were in the area with the lowest standardized mortality ratio for coronary heart disease. The interviews identified a number of possible explanations for the variations that related to differences in clinical behaviour atthe consultant level and barriers in access to interventional cardiology and cardiac services. Following this research, a further interventional cardiologist appointment is planned, joint protocols of care are being established and barriers to access are being addressed. CONCLUSIONS: The new strategic health authorities should make it a priority to assess inequity in the provision of services within their areas, investigate the possible causes and support the primary care trusts to implement plans to address them.

Angioplasty, Balloon, Coronary↗

PubMed2005

Developing effective interuniversity partnerships and community-based research to address health disparities.

Health disparities are an enormous challenge to American society. Addressing these disparities is a priority for U.S. society and especially for institutions of higher learning, with their threefold mission of education, service, and research. Collaboration across multiple intellectual disciplines will be critical as universities address health disparities. In addition, universities must collaborate with communities, with state partners, and with each other. Development of these collaborations must be sensitive to the history and unique characteristics of each academic institution and population. The authors describe the challenges of all three types of collaboration, but primarily focus on collaboration between research-intensive universities and historically black colleges and universities. The authors describe a four-year collaboration between Shaw University and the University of North Carolina at Chapel Hill (UNC-CH). These universities strategically developed multiple research initiatives to address health disparities, building on modest early success and personal relationships. These activities included participation by Shaw faculty in faculty development activities, multiple collaborative pilot studies, and joint participation in securing grants from the Agency for Health care Research and Quality of the federal Department of Health and Human Services and the National Institutes of Health, including a P-60 Project EXPORT center grant. These multiple activities were sometimes led by UNC-CH, sometimes by Shaw University. Open discussion of problems as they arose, realistic expectations, and mutual recognition of the strengths of each institution and its faculty have been critical in achieving successful collaboration to date.

Academic Medical Centers↗

PubMed2004

Radio frequency selective addressing of localized atoms in a periodic potential.

We study the localization and addressability of ultracold atoms in a combined parabolic and periodic potential. Such a potential supports the existence of localized stationary states and we show that applying a radio frequency field allows us to selectively address atoms in these states. This method is used to measure the energy and momentum distribution of the atoms in the localized states. We also discuss possible extensions of this scheme to address and manipulate atoms in single lattice sites.

Journal Article↗

PubMed2002

A literature review of the problems of delayed presentation for treatment and non-completion of treatment for tuberculosis in less developed countries and ways of addressing these problems using particular implementations of the DOTS strategy.

Tuberculosis is the cause of a large burden of disease in less developed countries. With the development of drug resistance and the co-epidemic of HIV, tuberculosis has already started to make a comeback in wealthier countries. The WHO's solution to this global tuberculosis epidemic is the DOTS strategy, the implementation of which presents many problems. The two issues most common to the majority of locations are delay in presentation for treatment and non-completion of treatment. This review looks at the reasons for these problems in the less developed world, and addresses some solutions. The main reasons for delayed presentation are: a lack of understanding about TB; the stigma associated with the disease; the inaccessibility of treatment; and a preference for private practitioners. The main reasons for non-completion of treatment are: the stigma of the disease; a lack of information; dissatisfaction with the treatment and its delivery; and inaccessibility of treatment. Successful implementations of the DOTS strategy need to address all these issues. There is little evidence that DOT enhances treatment completion unless combined with other strategies. Community-based, patient-orientated DOTS appears to be an appropriate way of addressing many of these issues. The involvement of volunteers in community-based strategies is common, but needs more research in order for this strategy to realise its full potential.

Cost of Illness↗

PubMed2003

Quality improvement in critical access hospitals: addressing immunizations prior to discharge.

CONTEXT: Many patients hospitalized in critical access hospitals (CAHs) are at high risk for influenza and pneumonia. These hospitalizations may represent a missed opportunity to address immunizations. Addressing these missed immunizations could provide an opportunity for CAHs to gain practical experience in data-driven quality improvement. PURPOSE: To improve documentation and delivery of influenza and pneumococcal immunizations prior to hospital discharge and provide CAHs with quality improvement experience. METHODS: We recruited 17 CAHs in Kansas to participate in a rapid-cycle quality improvement project to address inpatient immunizations. Each hospital identified patient discharges on a monthly basis and abstracted medical records to see if the patient's immunization status had been assessed and if patients had been vaccinated prior to discharge. FINDINGS: Documentation of influenza immunization status improved from 17% of admissions at baseline to 62% at follow-up (P < 0.001). Documentation of pneumococcal immunization status increased from 36% at baseline to 51% at follow-up (P < 0.001). Documentation of immunizations was significantly higher among the 8 hospitals that developed standard charting forms for recording immunization status (P < 0.01). Despite improved documentation of immunization status, at remeasurement only 3.4% received an influenza vaccination and 1.3% received a pneumococcal vaccination prior to discharge. CONCLUSIONS: Critical access hospitals can effectively participate in quality improvement activities, but increased involvement of medical staff or standing immunization orders may be needed to improve actual vaccine administration prior to discharge.

Documentation↗