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PubMedDate not supplied

Dancing with strangers: will U.S. substance abuse practice and research organizations build mutually productive relationships?

The scientific knowledge gained from research has not been extensively integrated into the U.S. substance abuse treatment system. A clear call to arms has been issued by the U.S. federal treatment and research agencies to bring research and practice together to create a better treatment system and a more responsive research agenda. The current federally sponsored initiatives to "close the gap" between research and practice are large and well funded. The field appears ready to change and realize the mutual benefits that can be achieved from the increased "bleeding" of research and practice. However, while the music has started and the partners seem willing, there are still many obstacles to a successful dance.

Ambulatory Care↗
PubMed1999

Emergency department-based telemedicine.

Although many studies have been published concerning clinical telemedicine, little information is available about emergency department (ED)-based telemedicine programs. An ED-based telemedicine program was initiated in April 1996 involving the National Cheng Kung University Hospital (NCKUH) and the Provincial Peng-Hu Hospital (PPHH) under a pilot project supported by the Department of Health. This is the first telemedicine program for remote offshore island service in Taiwan. The program is synchronous in nature to the practice of telemedicine. The role of the emergency physician includes giving initial suggestions, arranging consultations, coordination, and the organization of other medical tasks, such as accompanying some of the transfers. During the 12-month period, this system was used in 275 consultations, including 24 specialty and/or subspecialty department/sections, and more than 100 members of the medical staff have participated in this project since. In a survey, 89.4% of physicians in the PPHH and 82.2% of the physicians in NCKUH rated the system as very comfortable to work with and satisfactory. According to these observations, an ED-based telemedicine program is a feasible method for carrying out remote consultations. Successful development of the partnership and program of telemedicine is based on the active participation and coordination of the medical personnel and technicians between the cooperating hospitals.

Emergency Medicine↗
PubMed1995

Knowledge, know-how, and vascular surgeons.

Vascular surgeons know vascular disease and its treatment, yet uncertainties about the future of their specialty require an examination of its two basic components: knowledge and know-how. Knowledge, or understanding, flows from research efforts, and expands the scientific basis of our medical knowledge. It is imperative that new knowledge through funded research continues so that vascular surgical science progresses. Know-how, or skill, is a crucial component of the vascular surgeon's armamentarium and has been recognized through our history as a criterion of a surgeon's proficiency. The vascular fellowship program provides the vascular surgical trainee with the knowledge and know-how necessary to become accomplished and qualified for certification in this specialty. Future progress in vascular surgery depends on new knowledge and know-how and their innovative application to human vascular disease. This may involve a formal cooperative relationship between the two national vascular societies and our colleagues in interventional radiology to develop a comprehensive vascular health care program. The societies together must continually evaluate the forces for change that are prevalent in the health care environment to expand this program. This will ensure a healthy forecast for our dynamic specialty in the twenty-first century.

Clinical Competence↗
PubMed1996

Intersubjectivity, social microcosm, and the here-and-now in a support group for nurses.

Intersubjectivity, a concept from Watson's nursing model is interwoven with the group dynamics of social microcosm and the here-and-now. Examples from a graduate nursing student's clinical experience illustrate the application of a transpersonal dynamic, formerly associated with dyads, to interactions between a nurse and a support group. A psychiatric consultation liaison nurse specialist student facilitates a support group for registered nurses in a neurological intensive care unit, in response to a group-perceived need to improve communications between nurses, nurses and patients, and nurses and physicians. Discovery and processing of hidden anger and pain activates healing for these nurses.

Anger↗
PubMedDate not supplied

An interdisciplinary, interagency, primary care approach to case management of the dually diagnosed patient with HIV disease.

The epidemic of dually diagnosed patients with HIV disease (HIV disease coexisting with substance abuse and/or mental illness) has become increasingly recognized. This phenomenon poses potential threats to the effectiveness of HIV primary care, even when delivered by expert clinicians. This article describes implementation strategies for the provision, documentation, and third party billing of interdisciplinary, interagency HIV primary care case management within the context of an academic medical center. Our approach, which is specific to our setting, has evolved as we have attempted to define an active role for the primary care physician as a member of the case management team.

Academic Medical Centers↗
PubMed1998

The game may be the same but the rules have changed!

The job of a manager continues to be one of achieving outcomes through other people. However, in the current work environment, managers are finding that while their scope of responsibility is expanding, the traditional power base used to excourage high performance is shrinking. There are limited rewards a manager can use to gain commitment from their staff. Even if some of those rewards are available, many of the new employees do not see them as motivators. Employees come to the workplace with a different set of expectations. There seems to be a mismatch between the traditional management approach to getting the best from the worker and what the worker wants from their manager. In as much as the workplace and the worker are changing so too must manager's approach to "getting the job done."

Humans↗
PubMed2000

A collaborative approach to developing nursing skills to meet service needs.

Academics, educators and health service managers came together to explore, within their local area, the nature of the perceptions of beginning registered nurses (BRNs) and Nursing Unit Managers (NUMs) to the skills utilised by BRNs within the first six months of practice. A group of 71 BRNs and nine NUMs participated in a cross-sectional survey. BRNs were also asked to rate their preparedness in each particular skill, dependent on the method of teaching--theory/lectures, nursing laboratories and clinical experience. Some 21 skills, relating to medication/fluid administration and skin and wound care, were perceived by 95 per cent or more of the graduates as being used within the first six months. Similar perceptions existed for NUMs and BRNs for 52.4 per cent of the listed skills. Differences in perceptions have led to academics altering the scope of skills being taught and focusing assessment on critical skills for BRNs, and managers increasing awareness among NUMs as to the source of the differences and developing programs to improve clinical interpretation skills. Improvements in the experience of the BRN are likely to occur when all parties work together to bring about positive change. By Barbara Somerville,

Adult↗
PubMedDate not supplied

Telehealth and communication technologies in health: summary and action plan.

INTRODUCTION: Rapid innovations and improvements in communication technologies have opened many new channels for health education and delivery, as well as disaster management. Theme 2 examined the role and applicability of these technologies to Disaster Medicine and Management and the various issues involved in their use. METHODS: Details of the methods used are provided in the introductory paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The chairs then presided over a workshop that resulted in the generation of a set Action Plans that then were reported to the collective group of all delegates. RESULTS: Main points developed during the presentations and discussion included harnessing convergence, seeking interoperability, building partnerships and making it appropriate. This group identified four Principles of Action underlying its plan: (1) investigate possibilities, (2) identify stakeholders, (3) invite participation, and (4) involve discussants in activities. DISCUSSION: Action plans were categorized into three areas that included "thinking globally, acting regionally", forming a telehealth advisory group, and increasing corporate partnerships. CONCLUSIONS: Technology is opening many opportunities that have applications in disaster management. To optimize benefits, goals and standards must be agreed upon and implemented.

Cooperative Behavior↗
PubMedDate not supplied

The need for integrated linkages and long-term monitoring of mercury in Canada.

A nation-wide ecosystem science network for Canada was formed in 1994. At that time, mercury was a re-emerging issue in Canada and the Coordinating Office for the network sought collaboration to assess the issue. The key mechanisms by which the network has added value in addressing this issue are: 1) Information Dissemination, the network has organised, facilitated and co-hosted a number of regional. national and international mercury events (meetings, conferences and workshops) which have served to bring the expertise together, the network also disseminates information on it's web page. and the Coordinating Office hosts an annual National Science Conference: 2) Collaborative Mercury Monitoring, network partners advocated the need for a single hemispheric mercury network which resulted in the development of a compatible Canada-U.S. mercury deposition network, which may also be expanded into Mexico, and 3) Environmental Reporting, the network has collaborated with others to report on current mercury findings through initiatives such as the 1998 Northeast States and Eastern Canadian Mercury Study, a 1999 Mercury Case Study and is presently a partner in the University of Quebec's proposal to form a Collaborative Mercury Ecosystem Research Network in Canada.

Canada↗
PubMed2001

Evaluating palliative care: facilitating reflexive dialogues about an ambiguous concept.

Palliation is a relatively new concept that is used in connection with the integral care provided to those who are unable to recover from their illness. The specific meaning of the concept has not been clearly defined. This article explores the possibilities offered by a responsive approach to evaluation that can facilitate a reflexive dialogue on this ambiguous concept. In doing so it draws on a case study of a palliative care project in a Dutch health care authority. The article begins with an overview of the characteristics of a responsive approach to evaluation and addresses interpretative, representational and practical dilemmas. It goes on to present a series of dialogues between health professionals, informal caregivers, patients and evaluators. These dialogues take the form of juxtaposed stories, transcribed conversations and interpretations. Finally, the learning experiences are summarised and the appropriateness of the responsive approach to evaluate palliative care is discussed.

Ethics↗
PubMed2003

Environmental interventions to enhance student adjustment: implications for prevention.

School settings, often the sites for the prevention of adverse outcomes or the promotion of adjustment, are usually not the actual targets of such interventions. However, some interventions focus on modifying the school or classroom environments themselves. This review examines such approaches, and considers how school regularities that might undermine student adjustment are addressed. The environmental interventions are clustered in terms of focus: on student-student interactions, on teacher and peer influences, and on organizational function and structure. Reasons for the paucity of environmental change efforts and the inherent difficulties are discussed, and recommendations for creating ways to undertake future environmental interventions in schools are offered.

Child↗