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PubMed1985

A study of current school nurse practice activities.

In this paper a survey of activities of school nurses will be described. A brief summary of the history of school nursing is included as an introduction to the analysis of the current activities of school nurses. Five current school nurse activity clusters are identified from findings of a study of activities: physical, supportive, educative, administrative, and clerical. The development and implementation of administrative skills are cited as major challenges for school nurses in the 1980s.

Adult↗

PubMed2026

Genomic Medicine Sweden: Advancing precision medicine at the national level.

High-throughput sequencing has transformed clinical diagnostics of rare diseases (RD), cancer and infectious diseases by enabling the identification of disease-causing genetic alterations and facilitating individualised treatment and care. In response to these advances, Genomic Medicine Sweden (GMS) was established in 2017 as a national collaborative effort to accelerate implementation of genomics-based precision medicine within Sweden's regionally organized, publicly funded healthcare system. GMS brings together the seven university healthcare regions and their associated medical faculties, in collaboration with healthcare regions across Sweden, Science for Life Laboratory, patient organizations, industry and governmental agencies. Activities are coordinated through national disease-specific expert groups, supported by cross-cutting functions in bioinformatics, health economics, ethics, education and patient engagement. At the operational level, seven Genomic Medicine Centres, embedded at university hospitals, develop and deliver harmonised genomic diagnostics nationwide. The National Genomics Platform provides secure infrastructure for large-scale data storage, analysis, and national and international data sharing. Following initial project-based funding, GMS now receives long-term governmental support. This review describes the national implementation of genomic-based precision diagnostics, discusses challenges and lessons learnt, and highlights key milestones across disease areas, including whole-genome sequencing in RD and paediatric cancer, comprehensive genomic profiling of haematological malignancies and solid tumours, pathogen genomics in microbiology, pharmacogenomic testing and emerging applications of polygenic risk scores in complex diseases. Collectively, these efforts have contributed to more than 500,000 genomic tests being performed within Swedish healthcare between 2017 and 2025. Finally, we outline future diagnostic needs and priority areas to ensure sustainable, scalable and equitable access to precision medicine.

Precision Medicine↗

PubMed2004

Evaluating from the outside: conducting cross-cultural evaluation research on an American Indian reservation.

There is limited guidance for conducting competent and responsive cross-cultural evaluation research with American Indian communities. The authors draw on Fisher and Ball's Tribal Participatory Research Model to highlight ways in which this project is attempting to be culturally appropriate and sensitive as they partner with an American Indian community to implement and evaluate a youth-based initiative. Challenges encountered during the evaluation are shared, as well as the authors' collective responses to such challenges. Implications for future cross-cultural evaluation researchers are also discussed in light of these experiences.

Adolescent↗

PubMedDate not supplied

Complementary and alternative medicine research and cooperative groups: can it happen?

The use of complementary and alternative medicine (CAM) interventions to ameliorate cancer- and treatment-related toxicities is gaining increasing attention among clinical investigators. The National Cancer Institute supports a number of clinical studies, both descriptive and interventional, of CAM interventions across the cancer trajectory, from prevention through diagnosis and treatment, survivorship, and end of life. This report highlights the unique challenges that clinical investigators face when designing and implementing CAM clinical trials through the cooperative groups. This report focuses on 2 CAM trials that opened and accrued participants in the Children's Oncology Group. One trial is aimed at preventing or reducing mucositis and the other at preventing chemotherapy-induced nausea and vomiting.

Child↗

PubMed2001

Management of antiretroviral-related nutritional problems: challenges and future directions.

Survival has been greatly enhanced with the adequate and effective treatment of HIV infection. Surviving and surviving well are important pieces of the disease management puzzle. Nutritional well-being has been closely associated with both survival and quality of life in HIV and other diseases. The effects and interactions of currently used antiretroviral therapies can compromise nutritional well-being. The challenges posed to researchers, clinicians, and patients in evaluating and treating nutrition-related effects of life-saving antiretroviral medications affect health care goals, recommendations, and decisions. Challenges include identifying emerging problems, prioritizing clinical problems, expediting the implementation of clinical trials, developing research-based interventions that are realistic and usable in practice, decreasing the time lag to incorporate research findings into practice, and developing or adapting evidence-based clinical guidelines. This article will explore these challenges, offer thought-provoking questions in the development of research and clinically viable solutions, and propose future directions for management strategies of antiretroviral-related problems.

Clinical Trials as Topic↗

PubMed2006

Advanced visualization platform for surgical operating room coordination: distributed video board system.

One of the major challenges for day-of-surgery operating room coordination is accurate and timely situation awareness. Distributed and secure real-time status information is key to addressing these challenges. This article reports on the design and implementation of a passive status monitoring system in a 19-room surgical suite of a major academic medical center. Key design requirements considered included integrated real-time operating room status display, access control, security, and network impact. The system used live operating room video images and patient vital signs obtained through monitors to automatically update events and operating room status. Images were presented on a "need-to-know" basis, and access was controlled by identification badge authorization. The system delivered reliable real-time operating room images and status with acceptable network impact. Operating room status was visualized at 4 separate locations and was used continuously by clinicians and operating room service providers to coordinate operating room activities.

Computer Communication Networks↗

PubMed2005

Should tuberculosis treatment and control be addressed differently in HIV-infected and -uninfected individuals?

Infection with HIV drives the tuberculosis epidemic, especially in sub-Saharan Africa, where up to 75% of individuals with tuberculosis are co-infected with HIV. This article reviews the epidemiological link between the conditions, how tuberculosis diagnosis and treatment differ between HIV-infected versus -uninfected individuals and the span of additional measures required to prevent and control HIV-related tuberculosis. Tuberculosis chemotherapy using standard short-course regimens is highly effective in both groups, and treatment follows the same principles. It differs in certain aspects, such as when antiretroviral treatment should be started in HIV-infected individuals with tuberculosis and consideration of drug-drug interactions between the rifamycins and certain antiretroviral drugs. Control of HIV-related tuberculosis requires, fundamentally, control of HIV transmission. Meanwhile, it is necessary to make concentrated efforts to intensify high-quality tuberculosis services employing the directly observed treatment, short-course (DOTS) strategy, carry out extensive research towards an evidence-based model for the expanded scope of collaborative tuberculosis and HIV/AIDS interventions, and ensure efficient implementation of the findings and recommended policies. The challenge is gigantic, and both robust within-country and international leadership and competent management capabilities will be required, in addition to substantial human and financial resources.

HIV Infections↗

PubMed2006

Drug information resources used by nurse practitioners and collaborating physicians at the point of care in Nova Scotia, Canada: a survey and review of the literature.

BACKGROUND: Keeping current with drug therapy information is challenging for health care practitioners. Technologies are often implemented to facilitate access to current and credible drug information sources. In the Canadian province of Nova Scotia, legislation was passed in 2002 to allow nurse practitioners (NPs) to practice collaboratively with physician partners. The purpose of this study was to determine the current utilization patterns of information technologies by these groups of practitioners. METHODS: Nurse practitioners and their collaborating physician partners in Nova Scotia were sent a survey in February 2005 to determine the frequency of use, usefulness, accessibility, credibility, and current/timeliness of personal digital assistant (PDA), computer, and print drug information resources. Two surveys were developed (one for PDA users and one for computer users) and revised based on a literature search, stakeholder consultation, and pilot-testing results. A second distribution to nonresponders occurred two weeks following the first. Data were entered and analysed with SPSS. RESULTS: Twenty-seven (14 NPs and 13 physicians) of 36 (75%) recipients responded. 22% (6) returned personal digital assistant (PDA) surveys. Respondents reported print, health professionals, and online/electronic resources as the most to least preferred means to access drug information, respectively. 37% and 35% of respondents reported using "both print and electronic but print more than electronic" and "print only", respectively, to search monograph-related drug information queries whereas 4% reported using "PDA only". Analysis of respondent ratings for all resources in the categories print, health professionals and other, and online/electronic resources, indicated that the Compendium of Pharmaceuticals and Specialties and pharmacists ranked highly for frequency of use, usefulness, accessibility, credibility, and current/timeliness by both groups of practitioners. Respondents' preferences and resource ratings were consistent with self-reported methods for conducting drug information queries. Few differences existed between NP and physician rankings of resources. CONCLUSION: The use of computers and PDAs remains limited, which is also consistent with preferred and frequent use of print resources. Education for these practitioners regarding available electronic drug information resources may facilitate future computer and PDA use. Further research is needed to determine methods to increase computer and PDA use and whether these technologies affect prescribing and patient outcomes.

Journal Article↗

PubMed2002

The NHS Plan: nurse satisfaction, commitment and retention strategies.

The NHS Plan envisages a paradigm shift from a centralized, producer-led National Health Service (NHS) to a devolved, patient-centred health care service, fuelled by a substantial investment in human resources, beds, hospitals and infrastructure. The planned net increase of 20,000 nurses by 2004 is examined in the light of findings from a qualitative study of nurse satisfaction, commitment or intention to leave their hospital, nursing or the NHS, involving 124 nurses in four London hospitals. This paper presents nurses' perceptions and rankings of retention strategies and we compare these with the Plan's proposals. Lastly we propose an integrated approach to examining and dealing with the complex issue of nurse recruitment, retention and quality of patient care, based on a conceptual framework, the Nurse Satisfaction, Service Quality and Nurse Retention Chain, which highlights the scope of the challenges confronting the Plan, in both design and implementation of proposals designed to improve working conditions as a foundation for nurse recruitment and retention. Our principal findings are that just 57% of our interviewees may be viewed as 'core loyals' to the profession, 12% are serious in their intention to leave and the remainder may be sensitive to further deterioration in working conditions or a failure to meet expectations on pay. Such findings if realized clearly threaten the Plan's success.

Health Services Research↗

PubMed2005

Developing evidence-based guidelines for the management of sexually transmitted diseases in former Soviet Union countries.

The countries of the former Soviet Union (FSU) are experiencing overlapping, interrelated and severe epidemics of sexually transmitted diseases (STD), HIV and intravenous drug use. There are reasons to believe that better control of STD in these countries will contribute to the amelioration of these problems. A project was carried out by IUSTI-Europe and World Health Organisation-Europe to facilitate the production of evidence-based management guidelines in the local language in each of five FSU countries. The goals of the project were achieved, although the challenge remains to be faced to ensure the implementation of the recommendations of the guidelines into routine clinical practice in those countries.

Adolescent↗

PubMedDate not supplied

A multi-disciplinary professional practice model: supporting autonomy and accountability in program-based structure.

This article addresses the challenge of maintaining high quality patient care in a large, diverse health care organization as it merged and moved from a functional to a program-based management structure. The article describes the Professional Practice Model (PPM) which was developed to address the professional issues inherent in a program-based management structure. The operationalization of the PPM, including the committee structures which were put in place to support it, are discussed. The final section of the article highlights the strengths and challenges which have arisen through the development and implementation of the Professional Practice Model.

Decision Making, Organizational↗

PubMedDate not supplied

Improving quality of life in venous leg ulceration: a case study.

It is not uncommon to find that patients with venous leg ulcers have a reduced quality of life, but to prevent inappropriate management and thus contribute to the chronicity of these wounds, clinical practice must be based on sound evidence and application of research. The choice of compression options is fairly wide, but occasionally problems are encountered with tailoring a particular product to a patient. In this case study, a number of challenges were presented to the nursing team in implementing evidence-based practice and accommodating patient choice, but these were overcome and the patient's quality of life has significantly improved.

Activities of Daily Living↗

PubMed2005

Understanding targeting from the perspective of program providers in the elderly nutrition program.

Providers' perspectives on need, strategies, and challenges are critical in targeting of programs. This study was undertaken to understand the meanings and challenges of targeting from the perspectives of program providers in the Elderly Nutrition Program (ENP). Qualitative in-depth interviews were done with a sample of 36 local ENP providers from six counties in upstate New York. Each interview was tape-recorded, transcribed, and analyzed. Qualitative analysis revealed four distinct meanings of targeting including maximum outreach, reaching out to the most needy, serving only the most needy, and evaluating coverage. Regardless of the meaning or type of targeting, local providers reported universal challenges for outreach, need assessment, and resources in implementing targeting. Understanding these different meanings about targeting could contribute to crafting better targeting policies and program procedures to deliver adequate nutrition service to elders in need in the community.

Adult↗

PubMed2005

Exercise-induced changes of the upper extremity in chronic stroke survivors.

Problems with daily activities due to decreased aerobic capacity and decreased strength are common in people who survive a stroke. Implementation of exercise for the upper extremity is challenging because of weakness and other impairments that limit performance of exercise activities. Although maximal exercise testing protocols are difficult to administer, submaximal testing may be a safe and effective means for prescribing exercise. Research studies have demonstrated that people with stroke can improve aerobic capacity and upper extremity muscle strength with exercise intervention, although the number of randomized controlled trials is limited and this area requires further investigation.

Adult↗

PubMed2005

Ongoing procedure development in robotically assisted totally endoscopic coronary artery bypass grafting (TECAB).

BACKGROUND: Totally endoscopic coronary artery bypass grafting (TECAB) using robotics requires stepwise introduction into a heart surgery program. It is the aim of this study to evaluate the state of procedure development after continued application of telemanipulation techniques in the clinical setting. We also sought to assess perioperative and intermediate term clinical results after robotically assisted CABG. PATIENTS AND METHODS: From June 2001 to March 2005, robotically assisted CABG using the daVinci system was carried out in 107 patients with single and multi-vessel coronary artery disease. The following procedures were performed: robotically assisted endoscopic left internal mammary artery (LIMA) harvesting and completion of the procedure as conventional CABG, MIDCAB, or OPCAB (n = 22), robotically assisted suturing of LIMA-to-LAD anastomoses during conventional CABG (n = 28), TECAB on the arrested heart using remote access perfusion (n = 48), TECAB on the beating heart using an endostabilizer (n = 8), takedown of adhesions (TECAB intended) (n = 1). RESULTS: Hospital mortality was 0% and cumulative risk adjusted mortality reached 1.6 lives saved versus EuroSCORE predictions. Undesirable surgical events (USE) such as conversion, on table revision, or postoperative revision procedures occurred in 34 out of 107 (32%) patients. Median ventilation time and ICU stay, however, were 11(0-278) hours and 21(11-389) hours, respectively. Cumulative 3 years survival was 100% and freedom from angina at 3 years was 97%. CONCLUSIONS: We conclude that despite being surgically challenging robotically assisted coronary artery surgery can be implemented with acceptable safety. TECAB procedures have reached a reproducible state. Perioperative mortality after robotically assisted CABG may be lower than predicted. Intermediate term clinical results are very satisfactory.

Adult↗

PubMed2005

Comparison of currently available assays for detection of hepatitis B virus DNA in the routine diagnostic laboratory.

Infection with the hepatitis B virus (HBV) continues to present diagnostic and therapeutic challenges worldwide. Today, many routine diagnostic laboratories have implemented assays based on molecular techniques for the detection of HBV DNA. However, the standard algorithm for specific diagnosis of HBV infection still relies on serologic testing. Molecular assays are employed for pretreatment evaluation, clinical staging and monitoring of antiviral therapy. Furthermore, molecular methods are essential for identification of mutations in the HBV genome. Although a continuous improvement of assay performance has been observed during recent years, lack of comparability of different molecular assays remains a problem to be resolved in the future. The limited range of linearity when employing conventional PCR will be overcome by using real-time assays.

DNA, Viral↗

PubMedDate not supplied

[Interdisciplinary integration in nursing teaching and learning: our experience].

In 1996, a group of professors of the areas of Immunology, Histology, Nutrition, Pathology and Foundations of Nursing, began the Educational Project with the Support Program to Integrated Projects of Education and Health Services (PAPIENS), in the Nursing graduation course of the State University of Londrina. This Program is inserted in the project UNI subsidized by the Kellogg Foundation, which has propitiated innovations in the teaching-learning process, as well as changes in the curriculum of courses in the health area of the university mentioned before. This project has as its linking content the subject wounds. The main objective is to propitiate to students the construction of knowledge, regarding this theme, through the articulation and integration of the different areas involved, as well as through the observation of patients who carry wounds. It was observed that the project has facilitated student's learning and also prepared teachers for the challenge of the Nursing Integrated Curriculum to be implemented in the year 2000.

Education, Nursing↗

PubMed2006

[Patients' expectations concerning childbirth care at a public maternity hospital in Rio de Janeiro, Brazil: challenges for the humanization of obstetric care].

This study analyzes patients' expectations at a public maternity hospital in Rio de Janeiro, Brazil, concerning childbirth care. The methodology was based on a thematic analysis of interviews held during the eighth and ninth months of pregnancy. The study analyzed women's information on humanization of childbirth care, experience pertaining to care received during previous deliveries, their notions of ideal treatment during the current delivery, and attention received from the health care team. The results show that women's expectations focus on three main elements: speedy hospital admission, guaranteed admission to the maternity hospital, and treatment by an attentive and skilled team that cares for the patient's own health and that of her infant. Conflicting information on quality of care in the maternity hospital is a source of additional stress for these women, since in their view quality of care is more a matter of luck than routine institutional management. Based on these expectations, the authors assess the challenges for humanization of childbirth care currently under implementation in the city of Rio de Janeiro.

Adult↗