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PubMed2004

Technology-dependent children and their families: a review.

BACKGROUND: Advances in medical technology and nursing care have enabled children who rely on long-term medical and technical support to reunite with their families and community. The impact of discharging these children into the community involves a number of unprecedented social implications that warrant policy consideration. To begin with, an effort must be made to understand the phenomenon of caring for technology-dependent children living at home. AIM: The aim of this paper is to provide a comprehensive literature review on caring for technology-dependent children living at home. METHODS: The review was conducted via keyword searches using various electronic databases. These included CINAHL, MEDLINE, Social Science Index, Sociological Abstracts, Australian Family and Society Abstracts, and the Australian Bureau of Statistics. The articles and books found were examined for commonality and difference, significant themes were extracted, and the strength of the research methods and subsequent evidence were critiqued. FINDINGS: In this paper, themes relating to home care for technology-dependent children and their families are elucidated and summarized. These are: chronic illness and children; the impact of paediatric home care on children; the uniqueness of technology-dependent children and their families; and parents' experience of paediatric home care. DISCUSSION: Contentious issues, relevant to the social life of these children and their families, are raised and are discussed with the intention of extending awareness and provoking further debate among key stakeholders. These issues include: the changed meaning of home; family dynamics; social isolation; saving costs for whom?; shifts in responsibility; and parent-professional relationships. CONCLUSION: More research is needed in the arena of paediatric home care, to facilitate relevant policy formation and implementation.

Attitude to Health↗

PubMed1980

Community medicine: the "first-born" of a marriage between medical education and medical care.

In Southern Israel, rapid development and industrialization have generated strains affecting both the population (ca. 0.5 million immigrants and ca. 50,000 Bedouin) and the medical care agencies (of the General Labour Federation and other Sick funds, the Health and other Ministries, etc.). In Beer-Sheva, the Center of Health Sciences (CHS) of the Ben-Gurion University of the Negev (BGUN) is the scene of a concerted effort to change the orientation of health care. The direction of change is away from the impersonal (the hospital and the disease) and towards that demanded by the public (the community and the person). It is being accomplished by fundamentally changing the education of health personnel. Change is being implemented and mediated by a coordinating consortium of in-region and BGUN care and/or welfare agencies, that plans and evaluates the process and progress of change for which each agency is responsible. Infrastructural innovation, somewhat hampered by the inertias of tradition, consists of making the university hospital effectively serve the regional network of hospital-affiliated, community-oriented primary care clinics. Curricular innovation, enthusiastically accepted and flourishing, uses the concept of "the natural history of disease" in basic-science and clinical teaching. Teaching takes place not only in the wards, but also in outpatient and primary care clinics, and in the facilities for occupational health, rehabilitation and public health.

Allied Health Personnel↗

PubMed2002

Apology in the criminal justice setting: evidence for including apology as an additional component in the legal system.

The criminal justice system has reached unprecedented scope in the United States, with over 6.4 million people under some type of supervision. Remedies that have the potential to reduce this number are continually being sought. This article analyzes an innovative strategy currently being reconsidered in criminal justice: the apology. Despite a legal system that only sporadically acknowledges it, evidence for the use of apology is supported by social science research, current criminal justice theories, case law, and empirical studies. Social psychological, sociological and socio-legal studies pinpoint the elements and function of apology, what makes apologies effective, and concerns about apology if it were implemented in the criminal justice system. Theoretical evidence is examined (including restorative justice, therapeutic jurisprudence, crime, shame, and reintegration) to explore the process of apology in the criminal justice context. Attribution theory and social conduct theory are used to explain the apology process specifically for victims and offenders. A brief examination of case law reveals that though apology has no formal place in criminal law, it has surfaced recently under the federal sentencing guidelines. Finally, empirical evidence in criminal justice settings reveals that offenders want to apologize and victims desire an apology. Moreover, by directly addressing the harmful act, apology may be the link to reduced recidivism for offenders, as well as empowerment for victims. This evidence combined suggests that apology is worthy of further study as a potentially valuable addition to the criminal justice process.

Crime↗

PubMed2003

Physician leadership: influence on practice-based learning and improvement.

In response to the technology and information explosion, practice-based learning and improvement is emerging within the medical field to deliver systematic practice-linked improvements. However, its emergence has been inhibited by the slow acceptance of evidence-based medicine among physicians, who are reluctant to embrace proven high-performance leadership principles long established in other high-risk fields. This reluctance may be attributable to traditional medical training, which encourages controlling leadership styles that magnify the resistance common to all change efforts. To overcome this resistance, physicians must develop the same leadership skills that have proven to be critical to success in other service and high-performance industries. Skills such as self-awareness, shared authority, conflict resolution, and nonpunitive critique can emerge in practice only if they are taught. A dramatic shift away from control and blame has become a requirement for achieving success in other industries based on complex group process. This approach is so mainstream that the burden of proof that cooperative leadership is not a requirement for medical improvement falls to those institutions perpetuating the outmoded paradigm of the past. Cooperative leadership skills that have proven central to implementing change in the information era are suggested as a core cultural support for practice-based learning and improvement. Complex adaptive systems theory, long used as a way to understand evolutionary biology, and more recently computer science and economics, predicts that behavior emerging among some groups of providers will be selected for duplication by the competitive environment. A curriculum framework needed to teach leadership skills to expand the influence of practice-based learning and improvement is offered as a guide to accelerate change.

Delivery of Health Care↗

PubMed2002

Applying ecological risk principles to watershed assessment and management.

Considerable progress in addressing point source (end of pipe) pollution problems has been made, but it is now recognized that further substantial environmental improvements depend on controlling nonpoint source pollution. A watershed approach is being used more frequently to address these problems because traditional regulatory approaches do not focus on nonpoint sources. The watershed approach is organized around the guiding principles of partnerships, geographic focus, and management based on sound science and data. This helps to focus efforts on the highest priority problems within hydrologically-defined geographic areas. Ecological risk assessment is a process to collect, organize, analyze, and present scientific information to improve decision making. The U.S. Environmental Protection Agency (EPA) sponsored three watershed assessments and found that integrating the watershed approach with ecological risk assessment increases the use of environmental monitoring and assessment data in decision making. This paper describes the basics of the watershed approach, the ecological risk assessment process, and how these two frameworks can be integrated. The three major principles of watershed ecological risk assessment found to be most useful for increasing the use of science in decision making are (1) using assessment endpoints and conceptual models, (2) holding regular interactions between scientists and managers, and (3) developing a focus for multiple stressor analysis. Examples are provided illustrating how these principles were implemented in these assessments.

Conservation of Natural Resources↗

PubMed2005

Hepatitis A and B seropositivity among medical students.

OBJECTIVE: Health science students are commonly exposed to some infectious agents, including hepatitis A virus (HAV) and hepatitis B virus (HBV), which may cause substantial morbidity and even deaths. The identification of prevalence and risk factors is essential for implementing efficacious preventive measures. A serological survey was performed among medical students of Adnan Menderes University Medical Faculty to determine the prevalence of antibodies against HAV and HBV, and, as a secondary objective, to determine risk factors for acquisition of these infections. METHODS: Nearly all students were included in the study. All participants completed a structured questionnaire that assessed demographic and socio-economic characteristics. Anti-HAV IgG, anti-HBc IgG, HbsAg and anti-HBs were tested using commercially available Elisa kits. RESULTS: A total of 247 students, 146 (59.1%) male and 101 (40.9%) female, were included in the study. The prevalence of anti-HAV IgG was detected as 64%. Number of siblings and place of residence were detected as independent factors affecting the anti-HAV seropositivity. The prevalence of anti-HBc IgG was detected as 7.3%. Among the students positive for anti-HBc IgG, 5 (2%) students were HBsAg positive and the other 13 (5.3%) were anti-HBs positive. HBV infection in household members, risky sexual behaviour and vaccination were independent factors affecting the prevalence of anti-HBc IgG positivity. CONCLUSIONS: The high susceptibility of medical students and their increased risk of clinical HAV and HBV infection identify a need for primary prevention through the administration of vaccination in this group in western Turkey.

Adolescent↗

PubMed1999

The dental hygienist as a co-therapist in the endodontic practice.

This paper explores the potential contributions to patients, the practice, the endodontist, and the dental hygienist that may be realized by the employment of one or more dental hygienists to serve as endodontic co-therapists in the delivery of endodontic treatment. An endodontic co-therapist is an individual who participates with the endodontist in the assessment, planning, implementation, and evaluation of treatment much like the periodontal co-therapist relationship that exists between periodontists and dental hygienists. Dental hygienists are ideal individuals for this role because of their education in basic, clinical, and behavioral sciences. Suggestions are provided for which services could be delegated by the endodontist to the dental hygienist during each phase of care. Advantages of this contemporary approach to the delivery of endodontic treatment are also addressed.

Dental Hygienists↗

PubMed2005

Groundwater monitoring in the context of EU legislation: reality and integration needs.

A wide range of environmental policies are based on the monitoring of chemical and/or biological parameters which are used to evaluate the environmental status of relevant compartments (e.g. water, soil, air) with the ultimate aim of making appropriate management decisions. The soundness of policy decisions is therefore directly related to the reliability of the environmental monitoring programmes. Monitoring reliability in turn is predominantly linked to scientific and technological progress. Hence a correct design, development and implementation process of environmental policies is, at least in part, dependent upon a proper integration of scientific and technological advances (in monitoring, but also for all kinds of permit procedures, remediation strategies etc.). This paper examines science-policy integration needs in support of groundwater environmental monitoring, with focus on on-going policy developments. The article aims to summarise key information on groundwater policy and EU scientific developments to raise awareness of the scientific community involved in this issue and to enhance communication among scientists and policy-makers.

Communication↗

PubMed1998

The roles of library liaisons in a problem-based learning (PBL) medical school curriculum: a case study from University of New Mexico.

The relationships between problem-based learning (PBL) curricula and libraries have generated a substantial number of journal articles, but few have addressed the importance of the interaction between health science libraries and PBL curricula. This article attempts to contribute to this dimension through a description of the roles of library liaisons. First we describe the evolution of the liaison roles beginning 2 years prior to the implementation of a PBL curriculum. We then describe the core responsibilities of liaisons at the University of New Mexico (UNM) with mention of other innovative roles developed by some liaisons.

Curriculum↗

PubMed2005

Ab initio quantum chemistry: methodology and applications.

This Perspective provides an overview of state-of-the-art ab initio quantum chemical methodology and applications. The methods that are discussed include coupled cluster theory, localized second-order Moller-Plesset perturbation theory, multireference perturbation approaches, and density functional theory. The accuracy of each approach for key chemical properties is summarized, and the computational performance is analyzed, emphasizing significant advances in algorithms and implementation over the past decade. Incorporation of a condensed-phase environment by means of mixed quantum mechanical/molecular mechanics or self-consistent reaction field techniques, is presented. A wide range of illustrative applications, focusing on materials science and biology, are discussed briefly.

Biophysics↗

PubMed1977

Toward a Biocommunications Network.

Development and implementation of the Biocommunications Network in the Memphis region have relied on sharing of resources among hospital libraries. Implied in this system is the recognition that all health care professionals have a right of access to health sciences libraries.

Costs and Cost Analysis↗

PubMed1997

The impact of the National Cancer Institute's Data-based Intervention Research program on state health agencies.

To assist state health agencies adopt a new role in cancer prevention and control, the National Cancer Institute (NCI) initiated the Data-based Intervention Research (DBIR) program. The goal of DBIR was to stimulate data-driven activities and to build capacity for ongoing programs within state health agencies to ensure the translation of cancer prevention and control science into practice across the US. Each state funded under the DBIR program was required to conduct four phases of activity: identifying and analyzing relevant data, using these data to develop a state cancer control plan, and implementing and evaluating prevention and control interventions at the local level. This paper presents the results of survey of the 22 states that participated in the DBIR program. The survey is intended as a supplement to the case study also reported in this issue of Health Education Research. Results indicated that states were able to implement the DBIR model and they show the process to be useful to their cancer prevention efforts. DBIR had a major impact on how states will use data in future planning for cancer prevention and control. States had a number of recommendations for how NCI could improve its working relationships with state health agencies.

National Institutes of Health (U.S.)↗

PubMed1991

A multidisciplinary program to improve the teaching skills of incoming housestaff.

Residents at the School of Medicine and Biomedical Sciences at the State University of New York at Buffalo (SUNY at Buffalo) expressed an interest in receiving instruction in teaching skills. In 1988, under sponsorship of the Graduate Medical-Dental Education Consortium, faculty and residents implemented an orientation program for 110 incoming housestaff. Residents received instruction in large-group teaching skills, bedside teaching, small-group discussion, and student evaluation. The program was rated positively by the residents, 5% of whom became instructors in the orientation program for the following year. Because of the program's structure, both faculty and housestaff receiving training in teaching skills, which may lead to an overall improvement in the teaching of SUNY at Buffalo's medical students.

Attitude of Health Personnel↗

PubMed1992

Nursing care partnerships at the Denver Nursing Project in Human Caring: an application and extension of caring theory in practice.

Jean Watson's theory of nursing as the art and science of human caring provides the framework for practice at the Denver Nursing Project in Human Caring, a nurse-managed center for people living with HIV/AIDS. The purpose of this article is to describe the development, implementation, and evaluation of a new model of nursing practice at the Caring Center, called nursing care partnerships. Client and nurse narrative accounts are presented as a means of grounding the reader in the care partners' relationships that are formed during the journey of HIV/AIDS.

Ambulatory Care↗

PubMed2005

Medical decision making: a selective review for child psychiatrists and psychologists.

Physicians, including child and adolescent psychiatrists, show variability and inaccuracies in diagnosis and treatment of their patients and do not routinely implement evidenced-based medical and psychiatric treatments in the community. We believe that it is necessary to characterize the decision-making processes of child and adolescent psychiatrists using theories and methods from cognitive and social sciences in order to design effective interventions to improve practice and education. This paper selectively reviews the decision-making literature, including recent studies on naturalistic decision making, novice-expert differences, and the role of technology on decision making and cognition. We also provide examples from other areas of medicine and discuss their implications for child psychiatry.

Adolescent↗

PubMed2004

Open psychiatric services in interwar France.

The open psychiatric service established in Paris by Edoward Toulouse was meant to provide early, active psychiatric treatment to mildly afflicted individuals without subjecting them to legal commitment. Psychiatric reformers also hoped that the service would help to raise the status of psychiatry by typing their specialty's fate to laboratory science and hospital medicine. This article traces the genesis of open psychiatric services in interwar France and survey the debates they engendered within the French psychiatric community. It highlights the role of World War I in the implementation of open services and in the creation of a pool of patients who required assistance.

Community Mental Health Services↗

PubMed2005

State of the art of expert searching: results of a Medical Library Association survey.

OBJECTIVES: Medical Library Association (MLA) members were surveyed to gather background about the current state of expert searching in institutions. The survey results were intended to guide the recommendations of the Task Force on Expert Searching for promoting the importance of expert searching and implementing those recommendations. METHODS: MLA members were surveyed, and data obtained from the survey were compiled and analyzed to answer three general questions: what is the perceived value of searching skills to the institution, how do health sciences librarians maintain and improve their searching skills, and how are searching services promoted and/or mandated in the institution. RESULTS: There were 256 responses to the survey. Over 95% of the respondents saw their expert-searching skills were of value to their institutions, primarily through performing mediated searches and search consultations. Over 83% of the respondents believed that their searching skills had improved over the past 10 years. Most indicated that continued training was very important in maintaining and improving their skills. Respondents promoted searching services most frequently through orientations, brochures, and the libraries' Web pages. No respondent's institution mandated expert searching. Less than 2% of respondents' institutions had best practice guidelines related to expert searching, and only about 8% had guidelines or policies that identified situations where expert searching was recommended. CONCLUSIONS: The survey supports the belief that health sciences librarians still play a valuable role in searching, particularly in answering questions about treatment options and in providing education. It also highlights the need for more expert searching courses. There has been minimal discussion about the perceived need for expert-searching guidelines in the institutions represented by survey respondents.

Health Education↗

PubMed2002

The development and implementation of patients' rights: Dutch experience of the right to information.

Many initiatives have been taken to advocate, develop and emphasize patients' rights. The existence of legislation, case law or charters in the area of patients' rights does not guarantee that these rights are or will be successfully implemented in everyday practice. The implementation of patients' rights requires specific actions and expertise. It is important to develop strategies to enhance the successful implementation of patients' rights. This is illustrated by using the example of the developments in the Netherlands regarding the patient's right to information. This development shows that legal interventions, such as legislation, will always have to be embedded in and/or supplemented by non-legal policy measures. This calls for a broad and well-considered implementation policy, including items at various levels (legislation, patient and patient organizations, health providers and health institutions, contextual conditions). Such a strategy calls for a multidisciplinary approach, involving input from the areas of law, ethics, medicine, the sciences etc.

Access to Information↗