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PubMedDate not supplied

Recommended modifications and applications of the Hospital Emergency Incident Command System for hospital emergency management.

The Hospital Emergency Incident Command System (HEICS), now in its third edition, has emerged as a popular incident command system model for hospital emergency response in the United States and other countries. Since the inception of the HEICS in 1991, several events have transformed the requirements of hospital emergency management, including the 1995 Tokyo Subway sarin attack, the 2001 US anthrax letter attacks, and the 2003 Severe Acute Respiratory Syndrome (SARS) outbreaks in eastern Asia and Toronto, Canada. Several modifications of the HEICS are suggested to match the needs of hospital emergency management today, including: (1) an Incident Consultant in the Administrative Section of the HEICS to provide expert advice directly to the Incident Commander in chemical, biological, radiological, nuclear (CBRN) emergencies as needed, as well as consultation on mental health needs; (2) new unit leaders in the Operations Section to coordinate the management of contaminated or infectious patients in CBRN emergencies; (3) new unit leaders in the Operations Section to coordinate mental health support for patients, guests, healthcare workers, volunteers, and dependents in terrorism-related emergencies or events that produce significant mental health needs; (4) a new Decedent/Expectant Unit Leader in the Operations Section to coordinate the management of both types of patients together; and (5) a new Information Technology Unit Leader in the Logistics Section to coordinate the management of information technology and systems. New uses of the HEICS in hospital emergency management also are recommended, including: (1) the adoption of the HEICS as the conceptual framework for organizing all phases of hospital emergency management, including mitigation, preparedness, response, and recovery; and (2) the application of the HEICS not only to healthcare facilities, but also to healthcare systems. Finally, three levels of healthcare worker competencies in the HEICS are suggested: (1) basic understanding of the HEICS for all hospital healthcare workers; (2) advanced understanding and proficiency in the HEICS for hospital healthcare workers likely to assume leadership roles in hospital emergency response; and (3) special proficiency in constituting the HEICS ad hoc from existing healthcare workers in resource-deficient settings. The HEICS should be viewed as a work in progress that will mature as additional challenges arise and as hospitals gain further experience with its use.

Emergency Medical Service Communication Systems↗

PubMedDate not supplied

A nursing model of community organization for change.

Community health nursing has the potential to reach beyond the individual and create interventions that affect the community as a whole. The Nursing Model of Community Organization for Change presented in this article describes the relationships among the concepts of empowerment, partnership, participation, cultural responsiveness, and community competence within a community organizing context. These concepts are implemented through the use of the Nursing Model of Community Organization for Change, which consists of four phases: assessment/reassessment, planning/design, implementation, and evaluation/dissemination. This nursing model provides a theoretical framework for community health professionals when creating community health interventions in partnership with community members.

Community Health Nursing↗

PubMed2024

Value of HCC surveillance in a landscape of emerging surveillance options: Perspectives of a multi-stakeholder modified Delphi panel.

HCC surveillance is recommended by liver professional societies but lacks broad acceptance by several primary care and cancer societies due to limitations in the existing data. We convened a diverse multidisciplinary group of cancer screening experts to evaluate current and future paradigms of HCC prevention and early detection using a rigorous Delphi panel approach. The experts had high agreement on 21 statements about primary prevention, HCC surveillance benefits, HCC surveillance harms, and the evaluation of emerging surveillance modalities. The experts agreed that current data have methodologic limitations as well as unclear generalizability to Western populations. Although a randomized clinical trial of surveillance versus no surveillance is unlikely feasible, they concurred that alternative designs, such as a comparison of 2 surveillance modalities, could provide indirect evidence of surveillance efficacy. The panel acknowledged the presence of surveillance harms, but concurred the overall value of surveillance appears high, particularly given a greater emphasis on benefits over harms by both patients and clinicians. The experts underscored the importance of a framework for measuring both benefits and harms when evaluating emerging surveillance strategies. The panel acknowledged performance metrics of emerging methods may differ from other cancer screening programs given differences in populations, including higher risk of cancer development and competing risk of morality, and differences in diagnostic workflow in patients at risk of HCC. These data provide insights into the perceived value of HCC surveillance in an era of emerging blood- and imaging-based surveillance strategies.

Humans↗

PubMed2004

Possible reentrance of the fractional quantum Hall effect in the lowest Landau level.

In the framework of a recently developed model of interacting composite fermions, we calculate the energy of different solid and Laughlin-type liquid phases of spin-polarized composite fermions. The liquid phases have a lower energy than the competing solids around the electronic filling factors nu = 4/11,6/17, and 4/19 and may thus be responsible for the fractional quantum Hall effect at nu = 4/11. The alternation between solid and liquid phases when varying the magnetic field may lead to reentrance phenomena in analogy with the observed reentrant integral quantum Hall effect.

Journal Article↗

PubMed1998

Primary Health Care and partnerships: collaboration of a community agency, health department, and university nursing program.

Health care reform proposals emphasize health care that is essential, practical, scientifically sound, coordinated, accessible, appropriately delivered, and affordable. One route to achievement of improved health outcomes within these parameters is the formation of partnerships. Partnerships adopting the philosophy and five principles of Primary Health Care (PHC) focus on health promotion and prevention of illness and disability, maximum community participation, accessibility to health and health services, interdisciplinary and intersectoral collaboration, and use of appropriate technologies such as resources and strategies. A community service agency serving a multicultural population initiated a partnership with a health department and a university undergraduate nursing program. The result was a preschool health fair and there were benefits for each partner-benefits which could not have been realized without the collaboration. The health fair partnership planning, implementation, and evaluation process was guided by a framework shaped by the philosophy and five principles of PHC. The educational process described can be applied to other learning experiences where the goal is to help students understand and apply the concepts of PHC, develop myriad nursing competencies, and form collaborative relationships with the community and health agencies. Community health care dilemmas and nursing education challenges can be successfully addressed when various disciplines and sectors form effective partnerships.

British Columbia↗

PubMed1999

[The role of the veterinarian during natural disasters].

After a reminder of the main types of natural hazards that can lead to genuine disasters, the author examines the impact of such disasters on animal health. The conceptual approach to various groups of animals in a disaster situation is explained, as well as the direct and indirect effects of such disasters. Preparatory measures are presented within the general framework of prevention and forecasting, together with the veterinary measures to be implemented. Training of veterinarians and planning of activities are described in detail. A traditional approach to organising large-scale assistance is advocated, based on the competence of the personnel involved and a predefined hierarchical organisation. The author then describes veterinary actions to be taken in a disaster situation where emergency aid is required. Particular reference is made to providing assistance to save human lives, including search operations by dog teams for buried victims, and the subsequent phase of restoring human activities, during which assistance to animals is taken into account. Inter-ministerial co-ordination using crisis units and priority management implying real political choices are discussed. Finally, based on the example of the operational organisation of the French Civil Defence, the author describes the support available to Veterinary Services and the potential involvement of the profession, in particular veterinary officers attached to the emergency fire service.

Animals↗

PubMedDate not supplied

[Sensory integration: hierarchy and synchronization].

This is the first in the series of mini-reviews devoted to the basic problems and most important effects of attention in terms of neuronal modeling. We believe that the absence of the unified view on wealth of new date on attention is the main obstacle for further understanding of higher nervous activity. The present work deals with the main ground problem of reconciling two competing architectures designed to integrate the sensory information in the brain. The other mini-reviews will be concerned with the remaining five or six problems of attention, all of them to be ultimately resolved uniformly in the framework of small modification of dominant model of attention and memory.

Attention↗

PubMed1979

The environment as a support system for independent living.

In extended interviews and visits with 150 physically disabled young adults living independently in Berkeley, CA, the author studied the environment as they experienced it and evaluated its accommodation to their special needs. The environment in this study is considered in physical and psychosocial terms, that is, as a support system for the multifaceted needs of the whole person. The framework for organizing the data was Mayer Spivak's construct of "archetypal place" in which he defines 13 fundamental places in terms of the behaviors they support: shelter, sleep, mate, groom, feed, excrete, store, territory, play, route, meet, compete, and work. For purposes of the present work, shelter and mate are discussed--shelter, because of the clarity of its relationship between existence and physical form, and mate because of its more abstract relevance to physical form.

Activities of Daily Living↗

PubMed1982

Adolescent sexuality and the family.

The pediatrician is in an excellent position to provide anticipatory guidance to parents in their attempts to cope with their teenagers' sexuality. The primary approach is early recognition of the child as a "sexual" being. Encouragement of dialogue between parent and child about many issues, including sexuality, appears to be the most natural course. Age-appropriate publications can be used along with parent discussions (not as a substitute for discussion). By the time the child reaches adolescence, a parent should have taken as much opportunity as was given to provide the basis for reasonable decision-making by the adolescent. The parent may offer support and guidance in decision-making, but often finds that dogmatic, obedience-centered dictates fall on deaf ears. Handling one's sexuality is a part of the normative process in attaining adulthood. Adolescents who are developmentally competent should be given full support in taking responsibility for their own sexual behavior. This includes consenting for one's own care when appropriate. A developmental perspective in consideration of the needs of parents and teens provides the framework for the pediatrician to be a resource for both.

Adolescent↗

PubMedDate not supplied

Current controversies in occupational medicine education in Europe.

The progressive implementation of the framework directive concerning occupational health and safety into che legislation of single European Union members is leading to changes in the role of occupational health professionals. It is important that Schools of Occupational Medicine contribute to training for competence and that occupational physicians continue to provide a high quality occupational health service in a changing environment. This could lead to a new and emerging role for the occupational physician, a key figure in prevention and health protection, capable not only to act as an expert but also as an advisor able to comply with employee and employer needs. The changing role of occupational physician will require new educational models which should allow the occupational physicians to be able to cope with problems and situations which can be encountered during their professional life. This will require a better harmonisation of educational and training programmes across the European Schools of Occupational Medicine. In fact, a variety of educational and training methods are currently adopted, although there is a substantial agreement about core values, core knowledge and core skills, which characterise the speciality.

Clinical Competence↗

PubMed2002

Initiating committal proceedings "just in case" with voluntary patients: a critique of nursing practice.

Voluntary patients entering mental health units retain the right to accept or refuse treatment, including ongoing admission, as they see fit. However the nature of acute mental distress means that some patients have fluctuations in their mental status and competency to make informed decisions. Inpatient mental health nurses face the ongoing challenge of practising in a way that balances the requirement to support and promote the autonomy of voluntary patients with the need, occasionally, to take actions which although they may appear paternalistic are needed to protect those patients or other people. Anecdotal evidence together with a clinical audit undertaken by the authors suggest that the practice of nurses requesting that doctors sign medical certificates which are then placed on patients' files 'just in case' they are needed has become a mechanism by which a minority of nurses deal with such challenges. A conceptual analysis of these issues indicates that such a practice is both legally questionable and ethically inappropriate. We suggest an alternative framework for practice that is legally and ethically preferable for both nurses and patients.

Benchmarking↗

PubMed1997

Comparison of non parallel immunoassay curves resulting from mixtures of competing antigens.

Relative potency is a measure that has been used for many years to summarize the comparison of dose-response curves in parallel line bioassays. When response curves for two preparations are not parallel the traditional definition of relative potency no longer applies. We review the concept of relative potency and show that, in some situations, it can be given meaning for non-parallel curves as the ratio of biological activity in full strength assay preparations. Under an assumption that non-parallel curves result from the competition of mixtures of antigens for receptor binding sites, estimation of relative potency for non-parallel curves can be accomplished. We show that estimation of models for both parallel curve and response attenuation situations may be accomplished within the framework of generalized linear models. This estimation depends on the ability to deal with non-linear parameters appearing in the link function, and an iterative algorithm depending on direct parameter updates is outlined. The topics discussed are illustrated with the analysis of data from two immunoassays conducted with veterinary vaccines. The models developed here depend in an essential way on the assumption of response attenuation by competing antigens. Our methods may not be appropriate for non-parallel curves caused by other phenomena.

Algorithms↗

PubMed2002

Developing a theoretical framework on postpartum care from Tanzanian midwives' views on their role.

OBJECTIVES: to describe a theoretical framework developed from the views of midwives in relation to provision of systematic postpartum care. DESIGN: qualitative focus group study using grounded theory approach. SETTING: Dar es Salaam, Tanzania. PARTICIPANTS: 49 nurse-midwives in five focus group discussions each having 9-11 participants. FINDINGS: the components of the Basic Social Process of 'Becoming a good resource and support person for the postpartum woman' consisted of 'reflection' as an entry point into the process. Integration, networking, balancing, and dealing with reality, emerged as categories related to process activities. The category of 'defining abilities' required that midwives become aware of their competency and their limitations in reflection and all process activities, so that improvement can be part of 'getting ready', a category that describes what needs to be done at individual and health system level to prepare for systematic postpartum care programmes. The 'caring' category was linked to an outcome of the process 'doing things in the right way', which means providing quality postpartum care. The conditional matrix shows the midwife as an individual affected by several micro and macro conditions. CONCLUSIONS: the proposed theoretical framework can be used in understanding the dynamics of work situations and in assisting midwives to achieve the goal of being good resource and support persons for postpartum women. Interventions for midwives should focus on the major components of the framework but also on the concepts that relate the proposed framework to other central concepts in midwifery and nursing, issues in the theory-practice gap, empowerment, political awareness, involvement in policy making, decision making and dealing with job stress.

Attitude of Health Personnel↗

PubMed2005

Contextual considerations in summative competency examinations: relevance to the long case.

Long-case patient-based examinations previously formed the basis of summative competency testing in physician certification examinations. These exams were found to be unreliable and have fallen from favor. During the authors' deliberation of the long case in the neurology certification examinations of the Royal College of Physicians and Surgeons of Canada, they considered the examination context and concluded that the appropriate psychometric analysis of the exams is highly contingent on the context. The examination context underlying certification examinations has evolved considerably; within a different context, a more cohesive test system based on a quality assurance framework could better manage substantive psychometric issues around case specificity, comprehensiveness, reliability, and compensability. These arguments are in small part psychometric, but are mostly philosophical and have relevance to the profession and the public.

Certification↗

PubMed1993

Ventricular assist devices for the failing heart: a nursing focus.

The last decade has witnessed phenomenal advances in the therapies available for critically ill patients, especially for those patients in circulatory failure. This paper presents an overview of mechanical assist devices, focusing on the use of ventricular assist for the failing heart. From a basic review of cardiac failure, the principles of ventricular assist and the indications for its use are examined. After reviewing the ventricular assist devices currently available, the discussion moves to the expert nursing skills required by a patient receiving ventricular assist therapy. All aspects of clinical practice are discussed, with particular emphasis on the full use of assessment skills in order to facilitate care planning and ensure safe delivery of care. These expert nursing skills are considered within the framework of collaborative care. Patients needing ventricular assist may require some of the most advanced holistic nursing skills that critical care nurses possess.

Clinical Competence↗

PubMed2006

Behavioral and neuroeconomics of drug addiction: competing neural systems and temporal discounting processes.

We review behavioral- and neuroeconomic research that identifies temporal discounting as an important component in the development and maintenance of drug addiction. First, we review behavioral economic research that explains and documents the contribution of temporal discounting to addiction. This is followed with recent insights from neuroeconomics that may provide an explanation of why drug-dependent individuals discount the future. Specifically, neuroeconomics has identified two competing neural systems that are related to temporal discounting using brain-imaging techniques that examine the relative activation of different brain regions for temporal discounting. According to the competing neural systems account, choices for delayed outcomes are related to the prefrontal cortex (i.e., the "executive system") and choices for immediate outcomes are related to the limbic brain regions (i.e., the "impulsive system"). Temporal discounting provides a useful framework for future imaging research, and suggests a novel approach to designing effective drug dependence prevention and treatment programs.

Awareness↗

PubMed2004

High affinity, paralog-specific recognition of the Mena EVH1 domain by a miniature protein.

Many protein domains involved in cell signaling contain or interact with proline-rich sequences, and the design of molecules that perturb signaling pathways represents a foremost goal of chemical biology. Previously we described a protein design strategy in which the well-folded alpha-helix in avian pancreatic polypeptide (aPP) presents short alpha-helical recognition epitopes. The miniature proteins designed in this way recognize even shallow protein clefts with high affinity and specificity. Here we show that the well-folded type-II polyproline helix in aPP can present the short PPII-helical recognition epitope within the ActA protein of Listeria monocytogenes. Like miniature proteins that use an alpha-helix for protein recognition, the miniature protein designed in this way displays high affinity for a natural ActA target, the EVH1 domain Mena1-112, and achieves the elusive goal of paralog specificity, discriminating well between EVH1 domains Mena1-112, VASP1-115, and Evl1-112. Most importantly, the miniature protein competed with ActA in Xenopus laevis egg cytoplasmic extracts, decreasing actin-dependent motility of L. monocytogenes and causing extreme speed variations and discontinuous tail formation. Our results suggest that miniature proteins based on aPP may represent an excellent framework for the design of ligands that differentiate the roles of EVH1 domains in vitro and in vivo.

Amino Acid Sequence↗

PubMed2006

Integrating multi-attribute similarity networks for robust representation of the protein space.

MOTIVATION: A global view of the protein space is essential for functional and evolutionary analysis of proteins. In order to achieve this, a similarity network can be built using pairwise relationships among proteins. However, existing similarity networks employ a single similarity measure and therefore their utility depends highly on the quality of the selected measure. A more robust representation of the protein space can be realized if multiple sources of information are used. RESULTS: We propose a novel approach for analyzing multi-attribute similarity networks by combining random walks on graphs with Bayesian theory. A multi-attribute network is created by combining sequence and structure based similarity measures. For each attribute of the similarity network, one can compute a measure of affinity from a given protein to every other protein in the network using random walks. This process makes use of the implicit clustering information of the similarity network, and we show that it is superior to naive, local ranking methods. We then combine the computed affinities using a Bayesian framework. In particular, when we train a Bayesian model for automated classification of a novel protein, we achieve high classification accuracy and outperform single attribute networks. In addition, we demonstrate the effectiveness of our technique by comparison with a competing kernel-based information integration approach.

Algorithms↗