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Factors affecting film-screen mammographic image quality.

This paper discusses the technical aspects of mammographic image quality and the factors that affect it. Emphasis is placed on the role of the service professional and the challenges he or she faces as a result of implementation of the Mammography Quality Standards Act of 1992 (MQSA). The passage of the MQSA represented the first attempt to legislate diagnostic image quality. Such legislation will only succeed, however, if all members of the mammographic imaging team fully understand the factors that affect image quality, the role that each member plays in assuring image quality, and the mandates of the MQSA.

Breast Neoplasms↗

QALYs (Quality Adjusted Life Years): a nurse's view.

Examines the political and ideological significance of measures of quality of life, specifically Quality Adjusted Life Years (QALYs). Briefly reviews recent developments in the debate surrounding the economic and political functions of quality of life measures. The dialectic between conceptions of the quality of life and the implicit realpolitik of socio-economic pressures, ecological conditions, political ethos and cultural norms and expectations, is conceived as a powerful means for the critique of our aspirations concerning health. Argues that existing approaches to assessing quality of life, in denying this dialectic, have jeopardized their potential contribution to the planning, implementation and evaluation of health are policy. Resource allocation challenges us to develop openly ideological strategies and measures.

Australia↗

Leadership: a new perspective.

AIM: This overview article aimed at outlining the image of an effective future-orientated nurse leader in the health care context through a pragmatic approach. The future nurse leaders on different levels in health care institutions is challenged in the current health care environment of culturally diverse countries, such as South Africa. This article should make all nursing leaders more aware of their important role in taking the lead in challenges faced in the current health service environment. BACKGROUND: Leaders have the essentials of authority, power and influence to lead followers to their goals. The use of these essentials has changes from the past, to the present and into the future health care environment. Different changes and challenges are facing nurse leaders and they need to implement an effective leadership style in a complex health care environment. EVALUATION: This overview article focuses on key elements of an effective future leader using a conceptual framework as departure, incorporating relevant literature. It analyses and evaluates the efficiency of past and present roles of authority, power and influence in leadership and summarizes a new perspective of a future nurse leader. Solutions and future actions are indicated for the future role of the nurse leader. KEY ISSUES: The past, present and future leadership setting, role of authority, power and influence in leadership, components of the arch of leadership and solutions to effective leadership in a future dimension is all domains that is presented with the intention of motivating future nurse leaders. CONCLUSION: It was identified that a different kind of leader should emerge to lead in a new way, different from those leadership styles that we have known in the past. The 21st century is a new timeframe and different timeframes demand different leadership approaches.

Attitude of Health Personnel↗

Bayesian identification of admixture events using multilocus molecular markers.

Bayesian statistical methods for the estimation of hidden genetic structure of populations have gained considerable popularity in the recent years. Utilizing molecular marker data, Bayesian mixture models attempt to identify a hidden population structure by clustering individuals into genetically divergent groups, whereas admixture models target at separating the ancestral sources of the alleles observed in different individuals. We discuss the difficulties involved in the simultaneous estimation of the number of ancestral populations and the levels of admixture in studied individuals' genomes. To resolve this issue, we introduce a computationally efficient method for the identification of admixture events in the population history. Our approach is illustrated by analyses of several challenging real and simulated data sets. The software (baps), implementing the methods introduced here, is freely available at http://www.rni.helsinki.fi/~jic/bapspage.html.

Alleles↗

Navigating federalwide assurance requirements when conducting research in community-based care settings.

There is an urgent need for research on quality of life and healthcare delivery for older adults living in community-based care settings, yet implementing current federalwide assurance (FWA) requirements can be a challenge in these settings. This paper discusses FWA requirements for engagement in federally funded research as the requirements pertain to community-based care settings. Factors that impede community facilities in achieving FWA approval include lack of organizational structure to provide oversight for the ethical conduct of research, administrator concerns regarding potential liability associated with obtaining the FWA, lack of resources to complete required paperwork, and lack of staff knowledge about human subjects protection and federal requirements for participating in research. Effects of the FWA process on investigators include the burden of extra time needed to support community-based facilities to acquire a FWA and concerns that studies may be limited to only those community facilities with the resources to complete the FWA process. Investigator-initiated strategies for conducting research in community-based settings include considering study designs that are exempt from the FWA process and proactively assisting community-based facilities to acquire FWA status. Investigators need to work with potential research sites and the office for human research protections to ensure that subjects are protected without shifting the burden of protection to ill-prepared community administrators.

Aged↗

Diabetes: can we stop the time bomb?

Type 2 diabetes is increasing in prevalence and it is estimated that three million individuals in the UK will have the disease by 2010. People with diabetes have a high risk of cardiovascular disease-coronary heart disease is more prevalent, more extensive, and more diffuse. For all cardiovascular syndromes, the mortality is virtually doubled in patients with diabetes. Large clinical trials have provided clear evidence of the reduction in cardiovascular risk that can be achieved by treating hyperglycaemia as well as traditional risk factors, such as hypertension and hyperlipidaemia. The challenge now is for all health care professionals to implement the treatment guidelines.

Anticholesteremic Agents↗

The politics of public health policy.

Politics, for better or worse, plays a critical role in health affairs. The purpose of this article is to articulate a role for political analysis of public health issues, ranging from injury and disease prevention to health care reform. It begins by examining how health problems make it onto the policy agenda. Perceptions regarding the severity of the problem, responsibility for the problem, and affected populations all influence governmental responses. Next, it considers how bounded rationality, fragmented political institutions, resistance from concentrated interests, and fiscal constraints usually lead political leaders to adopt incremental policy changes rather than comprehensive reforms even when faced with serious public health problems. It then identifies conditions under which larger-scale transformation of health policy can occur, focusing on critical junctures in policy development and the role of policy entrepreneurs in seizing opportunities for innovation. Finally, it reviews the challenges confronting officials and agencies who are responsible for implementing and administering health policies. Public health professionals who understand the political dimensions of health policy can conduct more realistic research and evaluation, better anticipate opportunities as well as constraints on governmental action, and design more effective policies and programs.

Government Agencies↗

On the use of neural network techniques to analyse sleep EEG data. First communication: application of evolutionary and genetic algorithms to reduce the feature space and to develop classification rules.

To automate sleep stage scoring, the system sleep analysis system to challenge innovative artificial networks (SASCIA) has been developed and implemented. The aims of our investigation were twofold: In addition to automatic sleep stage scoring the hypothesis was tested that the information of only 1 EEG channel (C4-A2) should be sufficient to automatically generate sleep profiles which are comparable with profiles made by sleep experts on the basis of at least 3-channel EEG (C4-A2), EOG and EMG, as EOG and EMG are seen as epiphenomena during sleep and the full information about the sleep stage should--according to our hypothesis--be available in the EEG. The main components of the SASCIA sleep analysis system are designed to meet the requirements of flexible adaptation to the interindividual differences of the sleep EEG. The core of the SASCIA sleep analysis system consists of neural networks. Supervised learning was implemented and the experts' scorings were included into the learning set and test set. The feature selections out of a large number (118) are performed by genetic algorithms and the topologies of the networks are optimized by evolutionary algorithms. Different mathematical procedures were used to evaluate and optimize the efficiency of the system. The profiles generated by SASCIA are in reasonable agreement with the sleep stages scored by experts according to RKR. The development of the system is communicated in three parts: the first communication deals with the application of the neural network techniques using evolutionary and genetic algorithms and with the selection of feature space. The second communication shows the training of these evolutionary optimized network techniques with multiple subjects and the application of context rules, while the third communication shows an improvement in the robustness by the simultaneous application of 9 different networks obtained from 9 subject types which were used in combination with context rules.

Algorithms↗

Health workforce issues and the Global Fund to fight AIDS, Tuberculosis and Malaria: an analytical review.

Recent studies have shown evidence of a direct and positive causal link between the number of health workers and health outcomes. Several studies have identified an adequate health workforce as one of the key ingredients to achieving improved health outcomes. Global health initiatives are faced with human resources issues as a major, system-wide constraint. This article explores how the Global Fund addresses the challenges of a health workforce bottleneck to the successful implementation of priority disease programmes. Possibilities for investment in human resources in the Global Fund's policy documents and guidelines are reviewed. This is followed by an in-depth study of 35 Global Fund proposals from five African countries: Ethiopia, Ghana, Kenya, Malawi and Tanzania. The discussion presents specific human resources interventions that can be found in proposals. Finally, the comments on human resources interventions in the Global Fund's Technical Review Panel and the budget allocation for human resources for health were examined. Policy documents and guidelines of the Global Fund foster taking account of human resources constraints in recipient countries and interventions to address them. However, the review of actual proposals clearly shows that countries do not often take advantage of their opportunities and focus mainly on short-term, in-service training in their human resources components. The comments of the Technical Review Panel on proposed health system-strengthening interventions reveal a struggle between the Global Fund's goal to fight the three targeted diseases, on the one hand, and the need to strengthen health systems as a prerequisite for success, on the other. In realizing the opportunities the Global Fund provides for human resources interventions, countries should go beyond short-term objectives and link their activities to a long-term development of their human resources for health.

Journal Article↗

Emergency department digital radiology: moving from photos to pixels.

Emergency department (ED) patient care relies heavily on radiologic imaging. As advances in technologic innovation continue to present opportunities to streamline and simplify the delivery of care, emergency medicine (EM) practitioners face the challenge of transitioning from a system of primarily film-based radiography to one that utilizes digitized images. The move to digital radiology can result in enhanced quality of patient care, reduction of errors, and increased ED efficiency; however, making this transition will necessarily involve changes in EM practice. As the technology evolves, digital radiology will gradually become ingrained into everyday practice because of these and other notable benefits; however, EM practitioners will need to overcome several challenges to make the transition smoothly and consider the potential impacts that this change will have on ED workflow. The authors discuss the benefits, challenges, and other operational considerations involved with the ED implementation of digital radiology and close by presenting guiding principles for current and future users. Despite the unresolved issues, digital radiology will mature as a technology and improve EM practice, making it one of the great information technology advances in EM.

Diagnostic Imaging↗

Instructional technology in medical education: lessons learnt.

New instructional technologies, especially Web-based applications, may play an increasing role in medical education, particularly for distance and distributed learning. As medical educators turn to this medium, numerous benefits and opportunities, but also challenges and pitfalls, will arise. The successful development and implementation of instructional technologies in medicine require an appreciation of the medium's heterogeneous nature, its strengths, weaknesses and limitations. These in turn rely on partnerships with various experts and the early adoption of evaluation. We have summarized the lessons learnt from developing Web-based courses on palliative care in a framework for adopting instructional technologies. This framework incorporates development, implementation and evaluation.

Education, Distance↗

Prescription for health: changing primary care practice to foster healthy behaviors.

PURPOSE: The leading causes of premature death in the United States are linked to 4 behaviors: smoking, unhealthy diet, physical inactivity, and risky alcohol use. We report lessons from 17 exploratory projects funded under Prescription for Health that tested the feasibility of innovative behavior change strategies for at least 2 of these behaviors in primary care practices. METHODS: Seventeen practice-based research networks (PBRNs) implemented and evaluated tools, cues, and techniques in 120 family medicine, internal medicine, pediatric, and nursing practices across an ethnically diverse sample of adults, children, and adolescents in rural and urban settings. We reviewed progress reports and notes from site visits and 3 meetings to generate overarching lessons. RESULTS: PBRNs successfully implemented their projects in diverse practices despite reported logistical challenges and practice constraints. The networks showed that distributing the effort across the care team and throughout the practice and community is possible. Although each behavior required specific attention, each did not require its own separate staff and system. Three models emerged as helpful guides for the comprehensive redesign of health behavior counseling, but they require adaptation for use in real-world primary care settings. Traditional methods of collaboration yielded mixed results, making obvious a need for dedicated collaboration funds and a better framework to identify and align high-yield opportunities. CONCLUSIONS: These projects confirm the feasibility of health behavior counseling in primary care practice. They also highlight the need for substantive practice redesign, and the value of models and frameworks to guide redesign and collaborative efforts.

Health Behavior↗

Prediction and prevention of type 2 diabetes.

Type 2 diabetes mellitus is one of the most costly and burdensome chronic diseases of our time and a condition that is increasing in epidemic proportions worldwide. Its complications are a significant cause of morbidity and mortality and a tremendous economic burden to the society. Effective prevention programs are therefore urgently needed. Some of the risk factors for the development of type 2 diabetes, such as obesity, physical inactivity and high-fat diet, can potentially be modified. Compelling evidence now exists from well designed randomized studies that the disease can be prevented or delayed in subjects at high risk for its development, i.e. subjects with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). The interventions studied include lifestyle modifications (with diet and exercise) and drug treatment. Weight loss with lifestyle modification seems to be the most effective way so far, given the fact that it addresses other cardiovascular disease risk factors as well. The big challenge we are facing now is to try to implement these findings in our society or among our high-risk patients, taking into consideration the great difficulties involved in changing lifestyle and in maintaining lifestyle modifications.

Journal Article↗

Informing environmental health policy in urban areas: the HEADLAMP approach.

Urban areas represent complex environments in which to protect health. Accurate and highly resolved information is thus a prerequisite for effective environmental health policy. The HEADLAMP approach is designed to improve decision-making by providing indicators, based on sound science, to all relevant stakeholders, in an appropriate and usable form. The approach comprises three linked stages: categorization of the issues to be addressed, construction of relevant indicators, and policy formulation and implementation. Nevertheless, the application of this approach faces many challenges. The environment-health chain is both lengthy and complex, so that a wide range of indicators is needed from different points in this chain. The DPSEEA framework provides a useful, though limited, structure to help define and organize these indicators. This complexity also means that the indicators have to be linked, so that problems can be tracked from cause to effect and the effectiveness of actions at different points in the DPSEEA chain can be evaluated. Indicators also have to be designed in ways reflecting the spatial and temporal complexity of urban areas--namely, the rapid rates of change in urban environments and the marked spatial variations in environmental and sociodemographic conditions. Effective methods of participation are equally essential if the indicators are to represent the concerns of the stakeholders involved, and if decisions are to be made on a collective basis. Good indicators thus must be designed to fit many different and varying purposes. The challenge is to devise indicators that serve these purposes by representing the intricacies that are inherent in urban areas, rather than by hiding that complexity.

Data Collection↗

Quality assurance practices in care management: a perspective from the United Kingdom.

Alongside the development of care management in many countries has emerged a need to monitor the quality of both care management practices, as well as the quality of services provided as a consequence of care planning by care managers. Designing and implementing quality assurance practices in care management present special challenges. This article examines current practices from the perspective of the United Kingdom (UK). First, current performance initiatives at the central government level are described, including an indication of their limitations in judging quality in care management; second, existing work on assuring quality in care management is reviewed along with its relevance for the UK; and third, a local study, identifying measures within an analytical framework and using them to monitor care management against set dimensions, is described. Parallel developments are now occurring at both national and local levels in the UK, with local work both influencing and being informed by national developments. Future issues to address include the problems in collecting relevant data and in extending methods of analysis to monitor care management more comprehensively.

Health Care Reform↗

Drug treatment of schizophrenia in the 1990s. Achievements and future possibilities in optimising outcomes.

The current state of the art of the pharmacological treatment of schizophrenia, and a review of the latest findings in antipsychotic drug development are presented. A first step in optimising treatment is an increase in the awareness and implementation of existing treatment standards. The introduction of clozapine challenges the view that all antipsychotics are of similar efficacy; the drug has an established superiority over some of the traditional antipsychotics in treatment-resistant patients. Newer agents such as zotepine, risperidone, quetiapine, olanzapine and sertindole, which have a lower risk of producing extrapyramidal motor symptoms, have been developed in the wake of clozapine. While it is still common to switch nonresponding patients to an antipsychotic of a different chemical class, clozapine treatment remains the only strategy based on sound scientific evidence in these patients, although the novel antipsychotics give rise to hope. Alternatively, combination treatment with benzodiazepines, lithium or an anticonvulsant has been employed. If treatment with a depot antipsychotic is planned, it is advisable to start a patient on the oral form of the same drug in order to obtain dose requirements and tolerability information of the drug in that patient. Long term maintenance therapy is crucial and continuous monitoring for the development of adverse effects essential.

Humans↗

Recognition and treatment of mental disorders in children: considerations for pediatric health systems.

General healthcare systems currently play an active role in the identification and treatment of children with mental disorders. As many as one-third of children identified and treated for mental health problems receive outpatient mental healthcare from primary care providers. Although some children do receive treatment, over half of those who need mental health care do not receive this service. Fortunately, current levels of unmet need for adequate care coincide with mounting scientific evidence to support the efficacious use of psychosocial, community-based, and pharmacological interventions. Scientific evidence indicates that the appropriate identification and treatment of mental disorders in childhood can reduce symptoms of child psychopathology, improve adaptive functioning, and sometimes serve as a buffer to further long-term impairment. However, mental health treatment can only be beneficial if it reaches those families in need, is amenable to clinical practice implementation, and is administered with an adequate dose. Future challenges lie in creating practice-relevant efficacious interventions to improve the identification of child mental health needs and to improve access to high quality, appropriate mental healthcare. Primary care settings will play an important role in this activity. Although many barriers exist, pediatric health systems will continue to play an important role in the identification and treatment of mental disorders in children. The quality of current pediatric mental healthcare could be enhanced by increased opportunities for physician training, a restructuring of current training efforts, an increased focus on patient engagement strategies, equitable care incentives and reimbursement, as well as an integrated view of physical and mental health.

Child↗

Smoking practices among nursing students: a comparison of two studies.

Findings of numerous studies that have explored the smoking practices of nurses reveal a high incidence of smoking that is incongruent with the health beliefs of the profession. Nurses who smoke are less likely to teach or positively influence patients who smoke. They may even undermine health teaching efforts of other health professionals. Studies of smoking practices of nursing students also reveal high incidences of smoking. Included among the determinants of this practice are lack of knowledge of the health effects of smoking, the academic setting, and the role that nursing education may play. In this comparison of two independent studies similar in design, smoking rates were similar to that of the female population and to registered nurses. Students who smoke either started smoking or increased their smoking in nursing school. They knew the health hazards of smoking and most had tried to quit in the past. Challenging opportunities exist for nurse educators to study and implement strategies to prevent smoking initiation and encourage cessation among future nurses.

Adolescent↗