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PubMed1996

The Family Preservation and Support Services Program.

Two recent issues of The Future of Children have examined programs that support families with young children: the Winter 1993 issue on home visiting and the Winter 1995 issue on the long-term outcomes of early childhood programs. In both issues, the legislation creating the Family Preservation and Support Services Program was discussed as a possible funding source for such programs. This Revisiting article summarizes the key elements of that federal program and discusses some of the challenges states have faced as they have tried to implement the new law. Thus far, the legislation has had only a modest impact on the availability of services, but it has triggered a comprehensive and broad-based planning process that is likely to have lasting benefits.

Child↗

PubMed1998

Diagnosis and treatment of depression in late life.

Major depression and dysthymia are common and often disabling disorders in late life. Several features of late-life depression, such as its frequent association with general medical conditions, polypharmacy, cognitive disturbances, and adverse life events, make accurate diagnosis a substantial clinical challenge. Yet, prompt diagnosis is an important component of implementing appropriate treatment strategies. An ideal treatment program integrates patient and family education, focused psychotherapy, and pharmacotherapy. Because of pharmacokinetic and pharmacodynamic changes associated with aging, lower doses of medication and more gradual dose increases than are required in younger adults are needed in the treatment of elderly depressed patients. In addition, medications should be selected that have minimal antihistaminic, anticholinergic, and antiadrenergic effects, minimal cardiovascular risk, and minimal drug-drug interactions. Since depression in late life tends to be at least as chronic and/or recurrent as depression earlier in life, treatment for acute depressive episodes should last at least 6-8 months, and long-term maintenance treatment should be considered in selected individuals.

Adult↗

PubMed2002

Theoretical basis and program design of a school-based mental health intervention for traumatized immigrant children: a collaborative research partnership.

This article describes a collaborative research model for school-based mental health services that targets children who are recent immigrants with violence-related mental health symptoms. The model describes a conceptual framework used in the establishment of an academic-community partnership during the development, evaluation, and implementation of the Mental Health for Immigrants Program (MHIP), a school-based mental health intervention. The article discusses the challenges that occurred and provides specific examples of how a participatory research partnership may work together through all program phases--design through implementation and program evaluation--to meet a specific community's needs and produce generalizable knowledge. The challenges and limitations of collaborative research approaches also are discussed, with particular emphasis on the role of participatory research in the development and evaluation of school-based mental health programs.

Behavioral Medicine↗

PubMed2006

Cluster clinics for migrant Hispanic farmworkers with diabetes: perceptions, successes, and challenges.

INTRODUCTION: Diabetes is a chronic disease that requires individuals to schedule multiple office visits with a multidisciplinary team to learn how to successfully manage and delay the progression of complications. To respond to the health-care and educational needs of Hispanic migrant farmworkers who travel to Minnesota and North Dakota, the Migrant Health Service Inc diabetes program coordinator implemented evening cluster clinics. The purpose of this research project was to describe Hispanic migrant farmworkers' perceptions of the services provided to them at 37 multidisciplinary cluster clinics designed to serve this rural population diagnosed with diabetes. METHODS: This descriptive research employed a questionnaire and individual interviews. Both quantitative and qualitative data were obtained from cluster clinic clients. Quantitative data consisted of the numbers and percentages of clients providing various responses to questionnaire items. The qualitative data consisted of the verbal responses of clients to two open-ended questionnaire items and to an interview protocol. RESULTS: The main findings of the project indicated that 75-88% of the clients rated the services provided at the 37 cluster clinics as 'excellent'; an additional 21-25% rated them as 'good.' More than 85% of the clients indicated either that 'nothing should be changed' (59%) or that 'everything was fine' (26%). These ratings and content analysis of the interview data revealed that the clients perceived they had received quality services at these cluster clinics. The authors also discuss six characteristics that they believed contributed to the successful delivery of health care and education through cluster clinics. These characteristics include: (1) provision of both direct and referral services for this underserved population; (2) comprehensive delivery of services in a single setting; (3) collaborative delivery of services; (4) access-driven delivery of services; (5) delivery of culturally-sensitive and linguistically-appropriate services; and (6) evidence-based service delivery. CONCLUSIONS: Cluster clinics are an effective way to improve health-care services, education, and counseling for the under-served or unserved Hispanic migrant population diagnosed with diabetes. The authors conclude with four primary challenges to the implementation of these cluster clinics which include: (1) locating and preparing facilities; (2) recruiting health-care providers for the clinics; (3) achieving effective, appropriate communication with clients; and (4) securing funding.

Adult↗

PubMed2006

From research to reality: from the National Cooperative Inner-City Asthma Study to the inner-city asthma implementation.

Several themes emerged from the information provided in this supplement. 1. Implementation of the protocol was feasible, although retention of participants was challenging and customization at each site was essential. 2. Master's degree level social workers were well suited to partnering with health care professionals to address the many issues involved in caring for children with asthma and their families. 3. Collaboration between team members and community partners was critical to successful implementation. 4. Sustainability beyond external funding is attainable if local funding is sought and outcome measures that are considered important to the community are measured and reported.

Asthma↗

PubMedDate not supplied

Funding decisions in chronically sick individuals.

This article examines current research, literature and government policy that influences how health funding is allocated for treatment and care of the chronically sick. Chronic disease represents a huge burden of ill health in the UK and a substantial cost to the NHS. With both an increase in the ageing population and advancing technological developments giving doctors the theoretical ability to sustain the most fragile life, the issue of providing unlimited access of care to the chronically sick within financial limitations is clearly untenable. This article explores the issue of funding the needs of the chronically sick while posing a significant challenge both politically and financially to the healthcare system. It examines the controversial policies of rationing implemented by various governments since the conception of the NHS. Some have proved unworkable, all have been controversial, and still the challenge remains to provide a comprehensive care package with limited resources. The issue of how to ration resources to the chronically sick remains unresolved. Social gerontologists predict that living to 120 years of age may become the norm before the end of this century. Exploitation of the genome map and society's unwillingness to accept the inevitability of disability resulting from chronic illness will further increase pressure on healthcare financing and, as a result, demands will be forever increasing despite the most rigorous attempts at rationing.

Aged↗

PubMed2004

Challenging intolerance.

Social identity is multilayered and complex. Schools, communities, and nations can implement structures and approaches that help youth to understand one another and respect differences.

Cultural Diversity↗

PubMed2006

Building interdisciplinary/intersectoral research partnerships for community-based mental health research with older minority adults.

Community-based research often brings investigators from different disciplinary backgrounds together with community representatives to conduct research on topics of mutual concern. This paper describes a case example that illustrates an interdisciplinary/intersectoral study of depression and barriers to mental health care among older adults and illustrate the factors central to implementing a successful research partnership. It will address the following conditions that facilitate and challenge interdisciplinary/intersectoral research: (1) achieving commonality of purpose in study design and research and referral approaches; (2) ensuring the ability to develop, field-test and implement psychometrically rigorous and culturally and qualitatively appropriate instruments; (3) building effective management structures for interdisciplinary/intersectoral research partnerships; and (4) identifying, training and supporting qualified researchers to carry out a mental health study with older ethnically diverse adults. The paper concludes with strengths and limitations of the approach.

Anthropology, Cultural↗

PubMed1995

Health for all in the Republic of Korea: one country's experience with implementing universal health care.

Health care reforms in many countries face the twin challenges of providing universal coverage while controlling spiraling costs. Sixteen years ago the Republic of Korea had no national plan for health insurance, and only 8.8% of the population was covered. In 1975, health care accounted for 2.8% of GDP with government providing 12% of the finances. In 1977, Korea adopted a policy designed to achieve universal coverage while maintaining fee-for-service reimbursement. Korea incrementally established an employer based health care scheme by first mandating coverage for businesses, then government employees and teachers. Coverage was later extended to the poor, the self-employed, and residents of rural areas. Independent insurance societies manage each scheme, set premiums and co-payments, and are responsible for maintaining financial viability. By 1991, 30% of Korea's health care expenditures were from public funds, and health care costs had risen to 7.1% of GDP. Health care reform in Korea has been successful in achieving universal coverage, providing for a full range of services, and eliminating adverse selection. The system is financially solvent, costs are equitably distributed with the government providing subsidies when necessary, and small businesses have not been unduly burdened economically. Attempts to limit costs, however, have been unsuccessful. Patient demand for health care has remained surprisingly resistant to increasing co-payments. Providers have responded to lower physician and hospital fees by providing shorter, more frequent patient visits, relabeling services, and increasing hospital admissions. Competition between insurance societies has not materialized in a meaningful way to control costs.

Health Care Costs↗

PubMed2004

Implementing your privacy program: putting theory into practice.

Healthcare organizations across Canada are challenged with the new spectre of information privacy. While security and confidentiality have long been part of our culture in healthcare, privacy is a surprisingly new issue. With the introduction of privacy legislation and codes based on the CSA Model Code for the Protection of Personal Information (CSA Privacy Code), healthcare providers are subject to new obligations, and patients now enjoy new rights.

Awareness↗

PubMedDate not supplied

Challenging the future. Clinical laboratory automation: a paradigm shift.

Compared to other industries, implementation of automation in the health-care arena has been delayed. Changes in reimbursement methods are forcing hospitals and other health-care providers to provide more cost-effective services. Clinical laboratory services are essential to the support of newer medical technologies and therapies such as organ transplantation and chemotherapy. The current paradigm for clinical laboratory operations is based on a mix of batch and random access testing and is dependent on personnel. In this article, a new paradigm based on a factory automation model is described. Mechanisms to support the paradigm shift--including a proposal for the creation of a consortium to jointly fund a development operation--are also explored. A clinical laboratory platform prototype currently under development at the University of Nebraska Medical Center is also described.

Academic Medical Centers↗

PubMed1995

The social HMOs. Meeting the challenge of integrated team care coordination.

Four social health maintenance organizations (social HMOs) implemented care coordination programs in 1985 to integrate acute and long-term care for aged Medicare beneficiaries. The team approach to care coordination has been the key concept of the model at all four sites. Team members include the primary care physician, the care coordinator, inpatient and medical office staff, geriatric nurse practitioners, home care nurses and social workers, contracted community-based care staff, and, at three of the sites, volunteers. This article describes how care coordinators work with the health care teams in the social HMOs.

Aged↗

PubMed1997

Creating and implementing guidelines on caring for difficult patients: a research utilization project.

Difficult patients challenge the resourcefulness of nurses. Considering the results of a focus group study, guidelines are designed for the care of difficult patients. Four case studies present the use of the guidelines, including interventions and outcomes.

Adult↗

PubMed1995

An economic analysis of the resettlement of people with mild learning disabilities and challenging behaviour.

New models of care are needed following the closure of long-stay mental handicap hospitals. Based on an evaluation of a recently established assessment and treatment service in south-east England, this paper is concerned with the costs and likely benefits of different patterns of services for people with mild learning disabilities and severely challenging behaviour. Different models of provision are compared in terms of their costs and quality of life opportunities for clients. The assessment and treatment services provided a better understanding of the care needs, and achieved a reduction in challenging behaviours. It was therefore possible to give access to care settings closer to a normal life. For approximately 25% additional expenditure, 20 out of 34 clients who received the service moved to community placements, including three who had been referred following a breakdown in the community. If community care is to be implemented as a policy for clients with learning disabilities and serious challenging behaviours, it is necessary to recognise the financial implications. Better quality of life opportunities for this client group are associated with higher costs. When seen in the dynamic context of the costs and quality of life opportunities of the subsequent care, a high cost assessment and treatment service may be a good investment. On current evidence, the additional benefits of community homes, with a closer association with the local community, and greater freedom for clients is bought only at quite a high cost.

Adult↗

PubMedDate not supplied

From research to practice: one organisational model for promoting research based practice.

This paper describes a framework used by the National Institute for Nursing in Oxford to integrate research, development and practice. With the increasing attention given to the topic of how research findings are implemented into clinical practice, it was felt important to share the challenges that have arisen in attempting to combine traditional research activities with more practice based development work. The emerging conceptual framework, structures and functions are described highlighting the variety of partnerships to be established in order to achieve the goal of integrating research into practice. While the underpinning principles of the framework--generating knowledge, implementing research into practice and evaluating the effectiveness of programmes--are not new, it is the way they have been combined within an organisational structure that could be helpful to others considering such a strategy. Both the strengths and weaknesses of the model are discussed, a number of conclusions drawn as to its robustness and consideration given to its replication.

Diffusion of Innovation↗

PubMed2026

Artificial intelligence in molecular diagnostics for pandemic preparedness.

INTRODUCTION: Molecular diagnostics focusing on the detection and analysis of nucleic acids are indispensable tools for early pathogen identification, transmission monitoring, and genomic surveillance during pandemics. Recent technological advances have broadened the diagnostic landscape, incorporating PCR-based methods, isothermal amplification, high-CRISPR-based amplification detection, and sequencing. Despite their diagnostic potential, widespread implementation remains limited by high validation costs, time and logistical constraints, the need for specialized professional knowledge, and a lack of adaptability in resource-limited settings. Artificial intelligence (AI) is increasingly recognized as a promising but challenging approach, offering tools that streamline assay development, automate data interpretation, and optimize real-time diagnostic performance. AREAS COVERED: This review introduces recently published AI tools with potential to enhance the in-silico design validation process of oligonucleotides for molecular assays. These cover tools for initial assay design and optimization to validation and continuous assay updates. The limitations, including concerns regarding data accuracy, the lack of transparency in data processing ('black box' models), and unresolved licensing and regulatory issues, are highlighted for each tool and as expert opinion. EXPERT OPINION: Collectively, these challenges currently confine most AI-based approaches to research settings and prevent their routine implementation in clinical molecular diagnostics. Their widespread adoption depends on addressing remaining technical, regulatory, and practical challenges.

Humans↗

PubMed1981

Beliefs that foster physician avoidance of psychosocial aspects of health care.

Although training in family medicine emphasizes a biopsychosocial approach to patients, many residents experience difficulties in carrying out the appropriate psychosocial part of their diagnosis and treatment. Through teaching family medicine residents in a year-long Balint and Difficult Patient seminar, there has emerged a consistent set of core tacit beliefs which inhibit physicians from thinking psychosocially about their patients. These beliefs appear to be rigidly held but not examined or challenged. This paper presents the major of these beliefs and for each a more realistic therapeutic reply. They are grouped into three categories: (1) beliefs concerning physician's role (eg, I must rule out organic disease; only then can I focus on psychosocial problems), (2) beliefs concerning what the patient supposedly wants or does not want (eg, my patients want me to rule out organic problems), and (3) physicians" fears about approaching patients as people (eg, if the patient has the same problem I do, how can I help if I have not helped myself). By making overt these tacit assumptions, this paper attempts to highlight core barriers to the implementation of biopsychosocial care, increase understanding of effective alternatives, and challenge physicians to examine their hidden beliefs about patient care and their approach to patients.

Attitude of Health Personnel↗

PubMed2006

Universal influenza vaccination in the United States: are we ready? Report of a meeting.

Universal influenza vaccination has been proposed as one strategy to improve vaccination coverage and disease prevention. In October 2005, influenza and vaccination experts, public health practitioners, representatives from medical professional societies, influenza vaccine manufacturers, and managed care organizations met to assess whether current data were sufficient to support an expansion of universal influenza vaccination and to define information gaps and potential barriers to implementation. Presenters at the meeting documented the substantial burden of influenza disease among all age groups, the major role of children in transmission, and the effectiveness of vaccine, especially in healthy children and adults. Observational studies and a mathematical model suggested that indirect protection, or "herd immunity," resulting from vaccination of school-age children would substantially reduce the incidence of disease in other age groups. Economic analyses generally showed that vaccination of healthy children and adults is cost-effective and is sensitive to vaccine cost, population group, and season. Influenza vaccination received annually over several years is safe and effective, but data on long-term use are limited. Challenges to expanded recommendations include maintenance of the vaccine supply, implementation of a feasible and effective strategy for vaccine delivery, the burden on the public health infrastructure, public acceptability, and financing. Overall, meeting attendees favored incremental expansion of recommendations, potentially toward universal influenza vaccination. They preferred to expand recommendations among children first, because children have a higher risk of illness, compared with healthy adults; because there is greater feasibility of implementation of the recommendations among children; and because of the potential for herd immunity decreasing morbidity and mortality among adults.

Adolescent↗