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At least 1,225 records · Page 68Linked to original sources

PubMed2000

Capital investment strategies in health care systems.

Capital investment decisions are among the most important decisions made by firms. They determine the firm's capacity for providing services and commit the firm's cash for an extended period of time. Interviews with chief financial officers of leading health care systems reveal capital investment strategies that generally follow the recommendations of modern finance theory. Still, there is substantial variation in capital budgeting techniques, methods of risk adjustment, and the importance of qualitative considerations in investment decision making. There is also variation in delegation of investment decision making to operating units and methods of performance evaluation. Health care systems face the same challenges as other organizations in developing and implementing capital investment strategies that use consistent methods for evaluation of projects that have inconsistent aims and outcomes.

Budgets↗

PubMed2000

Predictors of smoking cessation in an incentive-based community intervention.

The Quit and Win Challenge, an incentive-based intervention, was implemented in two counties in Eastern Ontario to encourage adult smokers to quit smoking. Participants (n = 231) were compared with adult smokers selected at random (n = 385) from a larger, four-county area. Baseline characteristics were assessed by telephone interview, including socio-demographic and smoking-related factors. Follow-up interviews were also conducted by telephone. Initial and follow-up response rates were high (over 84%) in both groups. Compared with the random survey group, Quit and Win participants tended to be younger, more educated, employed and heavier smokers, with fewer friends or co-workers who smoked. After one year, 19.5% of them reported that they were smoke-free, whereas less than 1% of the random group had achieved cessation. This translates into an impact rate of 0.17%, affecting 1 in 588 adult smokers. With the exception of the smokers' baseline "stage of change," none of the socio-demographic or smoking factors was predictive of cessation. We conclude that this intervention achieved only limited success and attracted certain sectors of the community disproportionately, i.e. smokers who were highly motivated to quit. We argue that increased access to proven cessation therapies would improve the impact of such interventions.

Adult↗

PubMed2000

Telemedicine: evolving technology in an e-health care world.

This article provides an overview of telemedicine and its expanding capabilities to deliver health care services. Clinical applications, including home care, continue to evolve and expand as the technology improves and the experience of telemedicine service providers grows. As an emerging technology in a changing health care environment, implementation of telemedicine is not without its challenges. The future of telemedicine will be impacted by the emerging emphasis on e-health care.

Community Health Planning↗

PubMed2000

Systematic methods to enhance diversity knowledge gained: a proposed path to professional richness.

Faculty members in nursing schools have the responsibility to provide learning experiences for students that have the potential to solidly link indicators of professional richness, knowledge gained about diversity, enhanced critical thinking skills, ethical reasoning and decision-making. The challenge then is for faculty members to implement systematic methods to ensure that students are exposed to in- and out-of classroom experiences that result in measurable outcomes indicating a strong association between what a student is expected to learn and the diversity knowledge gained. The purpose of this study is to describe the effect of a target intervention derived from synthesizing multiple theories (social, cognitive, moral and ethical) and learning experiences on students' perception of global diversity. Two independent cohorts of senior nursing students, (control group, N = 65 and experimental group, N = 55) were taught a required undergraduate course: Societal Health Issues (SHI) with the same objectives over two consecutive years. Drastic and remarkable differences were demonstrated using separate multiple regression analyses of the experimental group (adjusted R2 change of 47% (F = 11.123, (df1 = 4; df2 = 47), p = .000) and control group (adjusted R2 change of 1% (F = 1.36, (df1 = 4; df2 = 52), p = .259). This study suggests preliminary empirical support for exploring how conceptual frameworks may guide faculty to consider pushing beyond traditional teaching methods to develop and organize systematic methods for infusing diversity content in courses.

Adult↗

PubMedDate not supplied

Current opportunities and future challenges in child health in Papua New Guinea.

Papua New Guinea (PNG) is at a crossroads in child health care. We know how to treat or prevent most of the diseases causing child and maternal mortality, but we are failing to deliver the services to where most of the people are dying. There is much to be learnt from early achievements in the development of health services in PNG. Between the 1950s and 1970s the infant mortality rate fell from 250-500 per 1000 livebirths to 77-100 per 1000 livebirths. This occurred predominantly because of an emphasis on public health programs and cost-effective standard treatment. Now the public health services have deteriorated, vaccine coverage is poor and health workers are not fully using the standard treatment resources available to them. The greatest academic and practical challenges facing medicine in PNG are to implement effective and consistent delivery of vaccines, and nutritional, basic curative and maternal care to remote or impoverished communities. The other unmet prerequisites for improvement in health status are that communities participate in and take some responsibility for their health care needs. There are now unprecedented opportunities for collaboration with international partners, churches, non-government organizations and community groups to achieve these goals. Specific key strategies in child health include the more widespread utilization of the 10-Step Checklist, adoption of some of the World Health Organization Integrated Management of Childhood Illness strategies, increased output of child health nursing training, improving vaccine delivery and cold-chain services, and new immunization strategies for acute respiratory infections. The National Health Plan 2001-2010, launched in August 2000, emphasizes the vital importance of public health; the need for greater access to quality health services; improving clinical skills among health workers at all levels; and cooperation between all interested parties. By 2010 the National Health Plan must be judged not on how good the plan seemed on paper, but on whether there was a measurable reduction in maternal and child mortality over the first decade of this century.

Child↗

PubMed2001

10 steps to successful billing under PPS.

Submission of RAPs and claims, and the proper reimbursement subject to various payment adjustments, has been an ongoing challenge for home health agencies since the implementation of home health prospective payment system (PPS). Home health agencies must constantly be aware of the effect of current PPS policies on reimbursement. Agencies should use all of the resources available to them to improve their ability to process RAPs and claims and be paid as quickly and accurately as possible.

Aged↗

PubMed2002

Spirituality and effective leadership in healthcare: is there a connection?

Does the level of a leader's spirituality affect his or her effectiveness as a leader? The existence or nonexistence of a link between leadership and spirituality is an emerging issue in the healthcare leadership and management literature. This article defines effective leadership and spirituality and reviews the literature for both healthcare and other organizations in the discussion of this link. It concludes that healthcare leaders who are more developed in terms of their actualized spirituality simultaneously implement the five practices of effective leaders: challenge the process, inspire a shared vision, enable others to act, model the way, and encourage the heart. Moreover, they achieve more positive results for their organizations.

Decision Making, Organizational↗

PubMed2002

[Cardiovascular prevention: new biochemical plasmatic markers of risk].

The primary prevention of acute coronary syndromes is an open question. The scientific progress has discovered new biochemical markers of cardiovascular disease risk that may be useful for primary prevention. They are plasmatic markers of inflammation (serum amyloid A, C-reactive protein, phospholipase A2) and of infection (seropositivity to Chlamydia pneumoniae, cytomegalovirus). They are plasmatic markers of endothelial activation (adhesion molecules such as ICAM-1, VCAM-1) immunological markers (autoantibodies against oxydized LDL, hemostatic markers (TFPI, PAI-1) and metabolic indices (Lpa, homocystein). A gap is evident between the scientific progress in the knowledge of the epidemiology of cardiovascular pathology and its application in clinical practice. The priority should become the population approach to primary prevention: the rapidly changing and complex global context presents new challenges for public health practitioners struggling to implement preventive policies and programmes. New risk factors of cardiovascular disease have been pointed out by research. This study shows the situation on the topic with critique and updated analysis.

Biomarkers↗

PubMed2003

International environmental health for the pediatrician: case study of lead poisoning.

Childhood lead poisoning is a preventable illness. In the past 3 decades, removal of key lead sources and prevention of exposure in the United States have led to dramatic decreases in population blood lead concentrations and also in instances of severe lead poisoning requiring treatment. From an international perspective, childhood lead poisoning seems to be of greatest concern in developing countries. The phasing out of lead from gasoline is a critical first step in decreasing worldwide blood lead concentrations. However, many focal sources that can cause lead poisoning remain, such as lead from flour mills, lead-glazed ceramics, mining and smelting, and battery repair and recycling. A large and diverse country, such as India, may have many sources of lead. The challenge will be for developing countries to implement effective national and regional efforts to address their specific sources of lead.

Child↗

PubMed2005

Health concerns associated with disaster victim identification after a tsunami--Thailand, December 26, 2004-March 31, 2005.

The number of persons confirmed dead from the Indian Ocean tsunami that struck on December 26, 2004, had exceeded 174,000 as of March 31, 2005; the majority of decedents were buried or cremated without being identified. In contrast, in Thailand, disaster victim identification (DVI) continues, with approximately 1,800 persons identified among the 5,395 persons confirmed dead; of the dead, approximately 50% were not citizens of Thailand. This large-scale, multinational effort faced immediate challenges, including establishment of four temporary morgues, implementation of safeguards against environmental and occupational health hazards, and coordination of forensic procedures and safety protocols among Thai and international forensic teams. Public health and other agencies performing large-scale DVI in temporary morgues might consider implementing the recommendations and procedures described in this report.

Disasters↗

PubMed2004

The hospital organization of the future.

The future of hospital Nuclear Medicine is triggered by the hospital organisation itself. In general, the hospital organisation of the present requires substantial changes in order to be competitive, economical, and abreast of the rapid progresses in medical developments and patient management. It also must be flexible to changes in health politics. In this special report an organisational hospital structure is outlined which may help encounter the challenging hospital future. Some hospitals have already implemented convincing changes, whereas others are far behind.

Delivery of Health Care↗

PubMed2005

Educational and health services innovation to improve care for rural Hispanic communities in the USA.

BACKGROUND: Access to comprehensive and quality healthcare services is difficult for socioeonomically disadvantaged groups in rural regions. Barriers to health care for rural Latinos include lack of insurance, language barriers and cultural differences. For the Latino immigrant population in rural areas, barriers to access are compounded. HEALTH NEEDS OF RURAL AREAS: THE CASE OF WALHALLA, SC: The town of Walhalla, South Carolina, USA, is a rural community located in Oconee County, the northwest corner of the state. Disparities exist between rural and urban residents in several health categories, and these disparities illustrate the need to provide competent, appropriate and affordable healthcare to rural populations. The Hispanic population of Oconee has dramatically increased in the past decade, and the majority of these immigrants have no health insurance and have limited access to health services. DESIGNING A PROGRAM TO FIT THE COMMUNITY--THE "WALHALLA EXPERIENCE": The purpose of the Accessible and Culturally Competent Health Care Project (ACCHCP) is to provide care for underserved populations, in Oconee County, South Carolina while providing rural educational opportunities for health services students. Funded by the Health Resources and Services Administration of DHHS, the program is designed to offer culturally appropriate, sensitive, accessible, affordable and compassionate care in a mobile clinic setting. In this interdisplinary program, nurse practitioners, health educators, bilingual interpreters, medical residents and Clemson University students and professors all played key roles. Women in the community also serve as promotoras or lay health advisors. The program is unique in using educational initiatives and innovative strategies for bringing health care to this underserved community and offers important information for rural healthcare initiatives targeting minority groups. This article reports on the challenges and successes in the development and implementation of the ACCHCP program in Walhalla, South Carolina.

Adolescent↗

PubMed2005

MorphoSaurus--design and evaluation of an interlingua-based, cross-language document retrieval engine for the medical domain.

OBJECTIVES: We propose an interlingua-based indexing approach to account for the particular challenges that arise in the design and implementation of cross-language document retrieval systems for the medical domain. METHODS: Documents, as well as queries, are mapped to a language-independent conceptual layer on which retrieval operations are performed. We contrast this approach with the direct translation of German queries to English ones which, subsequently, are matched against English documents. RESULTS: We evaluate both approaches, interlingua-based and direct translation, on a large medical document collection, the OHSUMED corpus. A substantial benefit for interlingua-based document retrieval using German queries on English texts is found, which amounts to 93% of the (monolingual) English baseline. CONCLUSIONS: Most state-of-the-art cross-language information retrieval systems translate user queries to the language(s) of the target documents. In contra-distinction to this approach, translating both documents and user queries into a language-independent, concept-like representation format is more beneficial to enhance cross-language retrieval performance.

Abstracting and Indexing↗

PubMed2006

Medical practitioner regulation in Indonesia.

Against a background of little by way of health practitioner regulation, Indonesia's Medical Practice Act 2004 has introduced a regime of both ethical obligations for medical practitioners and a system of disciplinary oversight over practitioners' conduct. This editorial describes the Indonesian initiatives and evaluates the challenges that are likely to confront their implementation.

Government Regulation↗

PubMed1990

Pharmacologic review of thrombolytic agents.

Thrombolytic therapy has significantly reduced the morbidity and mortality that was once associated with acute myocardial infarction. Because of the substantial benefits associated with this therapy, investigation has intensified in search of the optimal agent or agents. Five agents are currently being investigated individually and in various combinations to determine which agent(s) will outperform the others in terms of reperfusion, patency, mortality reduction, and clinical events. Two of the agents, t-PA and scu-PA, are considered fibrin selective, whereas the other three, streptokinase, urokinase and APSAC are nonselective. Whether this distinction provides substantial benefit is still not known. All of the FDA-approved agents (streptokinase, t-PA, and APSAC) have demonstrated survival benefit and will continue to be administered in AMI patients. In addition, the 1990s begins a new era that includes broadened selection criteria for AMI patients as well as expanding cardiovascular indications for thrombolytic therapy. The challenge to nurses is to improve and implement nursing care practices at the same rapid pace set by the medical discipline. This includes astute assessment and observational skills necessary to prevent and detect potential complications associated with thrombolytic therapy. Rapidly changing medical techniques mandate ongoing nursing research, which is needed to determine the most effective interventions in reducing complications associated with thrombolytic therapy and in promoting positive adaptive behaviors in the AMI patient. Thrombolytic therapy is an intervention for the 1990s, and nursing care is essential in maintaining the beneficial effects of this dynamic therapy.

Blood Coagulation↗

PubMed1990

A new challenge for pediatric audiology: Public Law 99-457.

When fully implemented, the most recent amendments to the Education of the Handicapped Act will have a substantial impact on expanding services to infants and toddlers with handicapping conditions and their families. Audiologists in many settings will be called upon to participate in the implementation of this new mandate. It is imperative that audiologists be well informed about Public Law 99-457 as state and local policies are being developed and implemented. This article reviews the new law with emphasis on its implications for young hearing-impaired children, their families, and the audiologists who serve them.

Audiology↗

PubMedDate not supplied

Managing nutritional problems in people with AIDS.

The complicated clinical picture presented by people with AIDS is often exacerbated by compromised nutritional status. Oral and esophageal pain, diarrhea, malabsorption, and weight loss frustrate efforts to achieve or maintain adequate nutrition. It is, therefore, an important and challenging responsibility for nurses to ascertain and implement appropriate interventions to assist patients with HIV infections to improve their nutritional status, thereby potentially delaying disease progression and significantly contributing to improved quality of life.

Acquired Immunodeficiency Syndrome↗

PubMed1986

Dietary intake in the Multiple Risk Factor Intervention Trial (MRFIT): nutrient and food group changes over 6 years.

The Multiple Risk Factor Intervention Trial (MRFIT) was a randomized clinical trial in the primary prevention of coronary heart disease. Middle-aged men determined to be at high risk for coronary heart disease were randomized into either a special intervention (SI) group or a group referred to usual sources of medical care (UC). Twenty-four hour dietary recall data were used to monitor the nutrient intake of the MRFIT population and guide the nutrition education program for the SI group. The SI group of participants decreased intake of dietary cholesterol by 40% and saturated fatty acids by more than one-fourth and increased intake of polyunsaturated fatty acids by one-third. Evaluation of SI dietary intake data by food groups indicates that some dietary changes were relatively easy to implement, whereas others presented more of a challenge. Changes made with relative ease included increasing the consumption of fish and poultry, skim and low-fat milk, polyunsaturated margarines and oils, fruits, and low-fat breads and cereals and reducing the consumption of egg yolks. More difficult changes included eliminating, or even reducing, the intake of high-fat beef and pork, high-fat cheeses, high-fat crackers, snacks, and desserts, and increasing the intake of vegetarian meat alternatives.

Cholesterol, Dietary↗