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PubMed2004

Taxonomy and environmental policy.

In 1992, with the United Nations Conference on Environment and Development in Rio de Janeiro and the subsequent Convention on Biological Diversity (CBD), the world changed for the science of taxonomy. Many taxonomists appear not to have noticed this change, but it has significantly altered the political climate in which taxonomic research is undertaken. By the late 1990s it was clear that effective implementation of the CBD needed the participation of and funding for the taxonomic community. In this paper, I chart the rise of the Global Taxonomy Initiative (GTI), review some of its goals and explore how it interacts with the CBD. The interactions of the GTI with the Global Environment Facility, a potential funding body, are explored, as are the possible synergies between the GTI and the many other global initiatives linking to taxonomy. Finally, I explore some of the challenges ahead as taxonomy begins to take a front seat in the implementation of environmental policy on the world stage.

Biodiversity↗

PubMed1996

Issues in casemix funding for acute inpatient psychiatric services and their relevance to mental health nursing.

With increased recognition by government, health administrators, and clinicians of the need to simultaneously contain health expenditure, improve the productivity and efficiency of health services and maintain quality of patient care, applications of casemix funding have been advocated as an alternative means of financing acute hospital care. Currently in Australia, the Commonwealth's casemix development program is encouraging the States and Territories to participate in certain casemix initiatives. Acute psychiatric hospital care and treatment have been excluded from the initial stages of the implementation of casemix in recognition of a number of inherent obstacles or challenges affecting the utility and accuracy of casemix in funding the psychiatric sector. Despite anecdotal claims that the reduced length of stay that often occurs under casemix payment systems may negatively impact upon the quality of care and patient outcomes, to date little empirical research has been directed towards measuring the potential impact of psychiatric casemix on the quality of patient care. Psychiatry cannot afford to ignore the casemix debate on account of its current exclusion from the early phases of implementation. To do so is to run the risk of having casemix imposed at some later stage in the absence of consultation. In the meantime it is vital that mental health professionals, including nurses, participate in the development and implementation of casemix, and contribute to research aimed at increasing or maximizing the relevance of casemix to the funding of psychiatric services.

Australia↗

PubMed2003

Challenges, benefits and pitfalls of the independent laboratory process.

During 1998 Sydney's drinking water supply system experienced three contamination events in quick succession. These events were revealed by routine monitoring, which indicated the presence of large numbers of Cryptosporidium and Giardia in raw and treated water. Questions were raised regarding the validity of the results produced by Sydney Water's laboratory, Australian Water Technology. In response to the incident a NSW Government Inquiry was carried out which made a range of recommendations, one of which was that "A suitably qualified independent laboratory should be established to provide accurate data for regulatory authorities." The NSW Department of Health (DOH) was given the responsibilty for interpretation and implementation of this recommendation. The role of Independent Laboratory was awarded to the Australian Water Quality Centre (AWQC) and monthly program of duplicate sample analysis was established. The implementation of the program and interpretation of the results have provided a challenge for all parties involved. A protocol was developed which defined conditions under which differences in results from the two laboratories were to be investigated. Over the time period of the Independent Laboratory process there has been only one occasion where a difference between results, as defined by the protocol, has been seen. The process has provided additional assurance of quality control procedures for the laboratories. The future role of the process will need to be readdressed in light of the results of the previous 18 months and as changes in the area of testing methodologies occur.

Animals↗

PubMedDate not supplied

Implementation of NANDA nursing diagnoses online. North American Nursing Diagnosis Association.

The authors describe the online implementation of the standardized nursing language of the North American Nursing Diagnosis Association (NANDA) nursing diagnoses at one 250-bed community hospital located in Chicago. A brief description of NANDA nursing diagnoses is provided along with a discussion of issues regarding implementation of these nursing diagnoses in a clinical information system. This system did not support online documentation of patient problems, therefore the challenge was to add documentation of patient problems to the system's software. This article focuses on the design and implementation of the nursing diagnoses computer screens, rather than focusing on the two problems we encountered during implementation--appropriate use of nursing diagnoses and the fit of nursing diagnoses with nursing interventions. Yet, the lessons learned in designing and implementing NANDA nursing diagnoses online may help others.

Chicago↗

PubMed2003

[The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure: the weapons are ready].

The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) has recently came to light in a short version. A complete version will soon be available. JNC 7 is the last attempt to bridge the big gap between the current availability of potent and well tolerated antihypertensive strategies and their poor implementation in the clinical practice. Some new and important features characterize the JNC 7 document. The aim of the new and challenging definition of pre-hypertension (BP 120-139/80-89 mmHg) is to sensitize the general population and health professionals to implement effective strategies for a healthier life in order to prevent hypertension and related cardiovascular disease as early as possible. Stage 3 hypertension has been deleted and merged with stage 2 (systolic > or = 160 or diastolic > or = 100 mmHg). BP levels to achieve with treatment (goals) are < 140/90 mmHg (< 130/80 mmHg in diabetics). To reach the goal, diuretics are recommended for initial treatment in most subjects with stage I hypertension. However, combination of at least 2 drugs is recommended if initial BP is 20/10 mmHg higher than goal BP. Apart from the definition of pre-hypertension and the advice to begin therapy with diuretics in most patients with stage 1 hypertension, JNC 7 shares several positions with the hypertension guidelines recently released by the European Society of Cardiology and European Society of Hypertension. JNC 7 seems to dedicate limited space to stratify the level of cardiovascular risk in the individual subjects on the basis of the different combinations between BP levels and concomitant risk factors. In summary, JNC 7 is an updated and well equipped arsenal of formidable weapons against hypertension and its complications. The stage is now set for an hard task: their effective implementation in the clinical practice with the aim to decrease cardiovascular morbidity and mortality.

Cardiovascular Diseases↗

PubMed2001

Gatekeeping: a challenge in the management of primary care physicians.

Assesses the degree of self-reported implementation of gatekeeping in clinical practice, and gains insight into primary care physicians' attitudes toward gatekeeping and their perceptions of necessary conditions for implementation of gatekeeping in daily practice. A self-administered questionnaire was mailed to a national sample of 800 primary care physicians in Israel, with a response rate of 86 per cent. Multivariate analysis indicated that sick fund affiliation was the main predictor of self-reported implementation of gatekeeping, while specialty training predicted primary care physicians' attitude toward this role. Close communication with specialists, continuous medical education, and management support of physician decisions were identified by respondents as being important conditions for gatekeeping. Discusses strategies to gain the cooperation of primary care physicians, which is necessary for implementing an effective gatekeeping system.

Adult↗

PubMed2006

Control of endemic methicillin-resistant Staphylococcus aureus--recent advances and future challenges.

Although the exact burden of disease caused by methicillin-resistant Staphylococcus aureus (MRSA) remains largely unknown, most experts agree that MRSA infections are an important clinical and public health problem. Thousands of reports have been published during the last four decades concerning epidemiological and microbiological aspects of MRSA, but uncertainty remains about the best approach to prevent and control this worldwide plague, especially endemic MRSA. Epidemiological methods, e.g., risk scores for targeted screening upon admission, rapid molecular tests and pre-emptive isolation of high-risk patients, new decontamination regimens and restriction of certain antibiotic classes, are all promising approaches that may decrease MRSA cross-transmission; however, further evidence is needed before these strategies can be implemented on a wide scale. Control of community MRSA is an additional challenge for the future, requiring improved surveillance and contact tracing, as well as education and treatment of both infected cases and colonised contacts. This review summarises recent advances and studies that address these issues. Overall, it seems that there is no level of MRSA prevalence for which active control measures are no longer warranted.

Anti-Bacterial Agents↗

PubMed2003

Telehealth in Western Australia: the challenge of evaluation.

Between 1996 and 2003, a network of 85 telehealth videoconference sites was implemented in Western Australia (WA), together with 19 teleradiology facilities. Telehealth services have been growing steadily, and in 2002 there were over 30,000 teleradiology transmissions and 1250 clinical occasions of service via videoconference. The funding bodies, and in particular the WA Department of Health, need to know whether the aims of the project have been achieved. They must also decide whether investment should continue. A process of progressive evaluation has been implemented to identify progress to date, the benefits achieved and the potential for further development. However, it is difficult to evaluate a broad range of programmes in rural and remote locations for such an embryonic service. These difficulties are compounded by the lack of a strategy at national level to ensure consistency and compatibility not only of infrastructure, equipment and standards but also of data capture and evaluation methodologies for telehealth. This would allow comparisons across regions and states, which in turn would provide opportunities to learn from others and thus improve health-care nationally.

Delivery of Health Care↗

PubMed2003

The challenge of negation in health care searches and queries.

This poster deals with exclusionary queries implemented using the database language SQL and the VA FileMan database system and the retrieval searches involving negated concepts in medical narratives. The poster describes and presents error patterns and designing database queries, underlying comprehension issues regarding negative statements and queries, strategies and software for avoiding false positives in searches, and makes practical recommendations on identifying potential sources of error and avoiding incorrect or misleading results.

Delivery of Health Care↗

PubMed1990

["Health care"--the care for complete quality, a challenge].

The report "Care for Health" of the Planning Office focused on the need to implement the principles of total quality assurance. The aim of the report was to reopen the discussion on the organisation of (public) health care in Belgium. Some topics were discussed in detail: definition of health (WHO), multicausal process thinking, team concept, management quality, organization models, preventive policy, financial policy, data management, legal aspects and last but not least the final responsibility for the health policy.

Belgium↗

PubMed2026

Genomics for precision surgical source control in anti-microbial resistant infections: A global review with focus on resource-limited settings.

BACKGROUND & OBJECTIVE: Antimicrobial resistance (AMR) critically threatens surgical safety, impairing perioperative prophylaxis and complicating infection management. Timely surgical source control is essential but relies on accurate microbiological diagnosis. Conventional culture-based methods are slow and insensitive, often leading to empirical broad-spectrum therapy. This review evaluates the role of advanced genomic diagnostics in enhancing surgical source control for AMR infections, with a focus on challenges and opportunities in low- and middle-income countries (LMICs) like Pakistan. METHODOLOGY: A narrative review was conducted via a structured search of PubMed, Google Scholar, and ScienceDirect (January 2015-October 2025). Studies involving genomic tools in the management of AMR-related surgical infections were included. Evidence was synthesized thematically, covering genomic platforms, clinical applications, implementation barriers, and LMIC specific perspectives. RESULTS: Genomic tools, particularly metagenomic next-generation sequencing (mNGS) and rapid multiplex PCR, demonstrate superior sensitivity (80.6-95.45%) and faster turnaround times (e.g., roughly 27 hours for mNGS) compared to culture. They improve pathogen detection in complex infections (e.g., prosthetic joints, necrotizing soft tissue), guide targeted antibiotic therapy, and can reduce broad-spectrum use. However, major implementation barriers exist, including high costs, need for specialized infrastructure and expertise, bioinformatic challenges, and ethical data concerns, which are especially pronounced in LMICs. CONCLUSION: Genomic diagnostics offer a powerful approach to accelerate and refine surgical source control in the era of AMR. Strategic investments in local capacity, affordable platforms, and integration with antimicrobial stewardship are needed to realize their potential for improving surgical outcomes, particularly in resource-limited settings.

Antimicrobial resistance↗

PubMed2003

Images of health technology in national and local strategies.

OBJECTIVES: This paper examines the potential of various models relating technology to society and institutional structures to inform health policy. Among the models discussed are various versions of technological determinism, social constructivism, actor network theory and critical theory. METHODS: The paper considers recent developments in policy and strategy that aim to shape the way the UK's National Health Service (NHS) integrates Information and Communication Technologies (ICTs) into health care and considers what these alternative models highlight or emphasise, and how they might influence the activities of setting local implementation strategies. RESULTS AND CONCLUSIONS: Contemporary ICTs are often presented as having a particular relevance and power in reforming or transforming the delivery of health care. Understanding how such technologies might be conceived of, implemented and become an integral part of some future health care system is an important and challenging task that requires innovative theoretical treatments.

Computer Communication Networks↗

PubMed2005

A discussion paper on challenges and limitations to water reuse and hygiene in the food industry.

Drinking water is becoming a scarce resource in many areas and both use of water and wastewater outlet are of major ecological and economical importance in many countries. Consumption and discharge may be considerably minimized by means of water reuse. The food industry has a large consumption of water, but until now very limited reuse has taken place due to legislations constraints and hygienic concerns. Legal space for use of water of qualities other than drinking water has been opened with the current legislation. This will, however, in many cases require careful analyses of individual cases based on a thorough understanding of the hazards involved in order to avoid compromising the safety of the food product and thereby the health of consumers. Implementation of water reuse practices in the food industry presents a great challenge for both companies and public health authorities regarding knowledge, technical expertise and documentation. Regulatory, technological, monitoring, verification and ethical aspects associated with microbiologically safe reuse of water in the food industry are discussed and some examples of the challenges ahead and possible approaches are given.

Conservation of Natural Resources↗

PubMed2000

The clinical guideline process within a managed care organization.

Clinical practice guidelines have been available to clinicians for almost two decades, but the consistency of their implementation in practice remains highly variable. This paper describes the various processes and mechanisms used by one managed care organization to develop clinical guidelines and promote their adoption. Some of these mechanisms include provision of individual physician report cards, financial incentives, and various documentation tools that serve as reminders of guideline recommendations and provide an easy format to document recommended services. There have been measurement challenges in evaluating the effectiveness of selected interventions designed to enhance guideline compliance. Most of these challenges relate to reliability and validity concerns regarding the three primary data sources used in the evaluation process: medical records, administrative claims data, and member survey data. Some of the interventions the health plan has implemented to address these measurement challenges include using hybrid methods of data collection and developing collaborative partnerships with outside organizations to enhance the accuracy and completeness of the available data. Outcomes of these efforts are described, as are physician response and recommendations for future enhancement of practice guidelines.

Documentation↗

PubMed2006

Recent developments in aluminium contamination of products used in parenteral nutrition.

PURPOSE OF REVIEW: This review evaluates recent developments concerning aluminium contamination of products used in the preparation of parenteral nutrition solutions and the failure of the pharmaceutical industry to respond to these concerns. The difficulty in meeting the intent of the recent US Food and Drug Administration mandate to reduce aluminium exposure with currently available parenteral nutrition additives is addressed. This review also summarizes the issues associated with aluminium toxicity, the patient populations at risk, treatment options, and compounding considerations. RECENT FINDINGS: Unfortunately, the published literature detailing the toxicities seen from aluminium exposure in the parenteral nutrition patient are primarily limited to those published in the 1980s and 1990s. Recent publications refer back to these classic papers and discuss the challenges that practitioners face when trying to apply the recommendations of the recently implemented Food and Drug Administration mandate with outdated literature. Few studies have been published to validate those earlier findings. SUMMARY: The issues surrounding aluminium toxicity are real and must be addressed. In order to make meaningful changes in clinical practice, low aluminium parenteral nutrition additives are needed and studies must be conducted using currently available products. It remains a challenge to optimize nutritional intake from parenteral nutrition and at the same time reduce aluminium exposure.

Aluminum↗

PubMed2004

[Nursing of tuberculosis patients--quality nursing to support patient's compliance to treatment].

Tuberculosis control program in Japan focuses more on completion of treatment. The activities for patients to complete treatment are being actively done with collaboration between nurses of hospitals and public health nurses of the health centers. In 2000, Ministry of Health Welfare announced DOTS program version Japan. As a result, health centers of big cities implemented DOTS for homeless tuberculosis patients and hospitals DOT for in-patients. In 2003, the government demonstrated the scheme of DOTS strategy Expansion Program version Japan, which includes community DOTS types to be selected depend upon the risk of default with an individual patient. It is necessary to develop and utilize social and human resources in the community to expand surely supporting system for patient's compliance. Mutual understanding and collaboration of the relevant organizations become very important. In this symposium, four panels from hospital, clinic and public health center discuss on the current situation and challenge of supporting system and the assessment of treatment outcome. 1. DOTS implementation with collaboration on nursing activities between hospital and public health center in Kyoto Prefecture: Ikuyo HIROHATA (National Hospital Organization Minami Kyoto National Hospital). 2. From standpoint of clinical practice: Hidenori MASUYAMA (Japan Anti-Tuberculosis Association Shibuya Clinic). 3. The activities for case support based on DOTS Program in Wakayama Prefecture: Kimiko KAWASAKI (Tanabe Public Health Center, Wakayama Prefecture). 4. Assessment of supporting activities for patient's compliance: Tomoko TAKANO (Uki Public Health Center, Kumamoto Prefecture). Three speakers gave additional comments and advice on quality supporting and nursing activities for patient's compliance through good coordination between hospitals and publics health centers.

Communicable Disease Control↗

PubMed2002

Contextualized behavioral support in early intervention for children with autism and their families.

Parent education programs have become an effective mode of treatment delivery for teaching families effective behavioral strategies to manage challenging behavior in young children with autism. Functional assessment and functional communication training (FCT) are empirically validated procedures that have recently been introduced into parent education programming to help resolve challenging behaviors. The success of these procedures, however, is contingent on family members' ability to integrate them into the specific contexts in which challenging behaviors occur. Consequently, the application of these procedures in home settings necessitates consideration of the family context in the assessment and treatment planning process. A study is presented that investigated the use of information on family context (i.e., caregiving demands, family support, patterns of social interaction) to direct the assessment and intervention planning process. More specifically, information on family context was used to individualize behavioral support plans designed to support family use of functional communication training within important family routines. Through parent-investigator collaboration we individualized the manner in which functional communication training procedures were taught and implemented so they were contextually relevant. Utilizing a multiple baseline design, the challenging behaviors and functional communication of three children with autism were monitored across baseline, intervention (i.e., FCT, and contextulized FCT), and follow-up phases. Multiple routines for each participant were selected and monitored across all phases to evaluate changes in the dependent measures within training and generalization routines. A self-report questionnaire was administered intermittently to parents to determine if consideration of family context improved the "goodness of fit" of the functional communication training treatment packages across FCT and contextualized FCT intervention phases. Results from the study indicate that consideration of family context in the assessment and intervention planning process does not jeopardize and may contribute to the stability and durability of reductions in challenging behavior achieved with functional assessment and functional communication training procedures.

Adolescent↗

PubMed2000

The global poliomyelitis eradication initiative: progress and challenges.

In 1988, The World Health Assembly committed WHO and its member states to the goal of poliomyelitis eradication by the year 2000. Global progress in implementation of strategies include routine and supplementary immunisation, AFP surveillance strategy and mopping up. Progress made in global polio eradication within 10 years has been dramatic. Challenges consist of tailoring and fine tuning strategies and sustaining adequate levels of findings. Although the intensified effort will increase needed resources in the short term, it will save costs in the long term.

Adolescent↗