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PubMedDate not supplied

[Management programs for elderly patients with chronic heart failure].

PURPOSE: Most patients with heart failure are elderly with multiple coexisting diseases and heart failure is the most common discharge diagnosis in elderly hospitalized patients. Despite major advances in the pharmacotherapy of heart failure, hospitalization rates remain high, owing in large part to a multitude of psychosocial, behavioral, and financial factors that serve as barriers to effective compliance with prescribed treatment. In the last decade, several models have been proposed in order to optimise the long-term management of elderly patients with heart failure. DESIGN: A review of most significant and recent models available was performed. RESULTS: Several studies have documented the efficacy of specialized multidisciplinary heart failure disease management programs in terms of reducing hospital utilization, improving quality of life, functional capacity, patient satisfaction, compliance with diet and medications and decreasing cost of care. CONCLUSIONS: At present, the greatest challenge in managing elderly heart failure patients is to more effectively implement proven treatments and disease management systems.

Age Factors↗

PubMed1992

The provision of speech, language and hearing services in a rural district of South Africa.

In this paper the delivery of a speech, language and hearing therapy (SLHT) service in a rural area is discussed. In the light of the need to relate the delivery of this service to principles of primary health care (PHC) and community based rehabilitation (CBR), a brief theoretical background is given. Obstacles to service delivery are then presented, followed by a description of some attempts to implement principles of PHC and CBR. The author concludes that many challenges need to be faced in providing SLHT services that will benefit the majority of the population of South Africa.

Community Health Services↗

PubMed2003

Modeling interdependencies between business and communication processes in hospitals.

The optimization and redesign of business processes in hospitals is an important challenge for the hospital information management who has to design and implement a suitable HIS architecture. Nevertheless, there are no tools available specializing in modeling information-driven business processes and the consequences on the communication between information processing, tools. Therefore, we will present an approach which facilitates the representation and analysis of business processes and resulting communication processes between application components and their interdependencies. This approach aims not only to visualize those processes, but to also to evaluate if there are weaknesses concerning the information processing infrastructure which hinder the smooth implementation of the business processes.

Commerce↗

PubMed2003

Emergency implementation of knowledge management system to support a bioterrorism response.

In a public health emergency, it becomes necessary for public health agencies to provide timely, accurate and useful information to the community. During the anthrax attacks, the Public Health Practice Program Office in the Centers for Disease Control and Prevention implemented a knowledge management (KM) system to respond to an increased number of inquiries from public health officials, first responders, and health care professionals as well as the general public. While it is possible to successfully implement a knowledge management system quickly in a crisis situation, additional challenges to sustainability may result from shortchanging the normal decision-making channels.

Anthrax↗

PubMed2004

Outcome of low birth weight neonates in a tertiary health care centre in Lagos, Nigeria.

The records of all low birth weight (LBW) neonates admitted into the Neonatal Unit of the Lagos University Teaching Hospital (LUTH) from January 1997 to December 2001 were retrospectively analysed in order to determine the outcome and risk factors associated with mortality. There were 535 LBW admissions of which 411(76.8%) survived while 124(23.2%) died. The birth weight specific mortality rate for the < 1000g neonates was 818 per 1000, 451 per 1000 for the 1000-1499g, 216 per 1000 for the 1500-1999g, and 67 per 1000 for the 2000-2499g neonates (X2 = 127.70, p = 0.0001). Primary indications for admission were neonatal sepsis (25.2%), perinatal asphyxia (23.0%) and neonatal jaundice (19.6%) with case fatality rates of 20.0%, 34.1% and 10.5% respectively (X2 = 34.24, p = 0.00001). Death occurred within 48 hours of admission in 45.2% of subjects and by the 7th day, 72.6% had died (X2 = 70.07, p = 0.0001). Significant risk factors associated with mortality were birth weight [OR 4.24, 95% CI = 3.14-5.72] and category of LBW [OR 2.79, 95% CI = 1.65-4.69]. Sex, twinning, booking status and mode of delivery had no significant influence on mortality. Since the provision of adequate intensive care for these vulnerable infants remains a major challenge in countries with poor resources, efforts should be intensified to implement effective strategies for the reduction of low birth weight deliveries.

Asphyxia Neonatorum↗

PubMedDate not supplied

The axis and nexus of e-health alliances in 2020.

Strategic partnerships between the health care and Information Communication Technology (ICT) sectors are the wave of the future, as e-health systems are implemented. Divergent perspectives between ICT and health care executives impose central challenges in forging productive strategic alliances. Bridging these perceptual differences requires strong leadership and vision, financial resources, and care provider support. Together these form the axis upon which tomorrow's e-health alliances will rest. The growth of e-health systems is inexorable. The strength of governance leadership continues to influence its rate of growth and positive impact on health care systems. The extent to which strategic partnerships with the ICT sector will evolve into dynamic e-health alliances is directly related to the quality of national and regional governance leadership--the ultimate nexus of evolving e-health systems of 2020.

Biomedical Technology↗

PubMed2006

[Cervix uteri cancer in Poland--epidemiological opening balance and perspectives].

Cancer is one of the main causes of death among young and middle-aged females. In case of some cancer sites there is a possibility of undertaking an intervention, which would diminish the risk of death--to this group belongs first of all malignant neoplasm of cervix uteri. The date of beginning first cervix uteri cancer screening in Poland is approaching, therefore presenting epidemiological opening balance and possible scenarios of changes it worthwhile. This work uses data on morbidity and mortality due to malignant neoplasm of cervix uteri cancer in Polish population. Time trends analysis was based on so-called "breakpoint" (joinpoint analysis). Cervix uteri cancer mortality trend is characterized by two breakpoints (1971 and 1993). In the period of 1963-1970 there was an increase of mortality and then after the trend reversed: percentage decline was estimated at the level of 0.8% yearly in 1971-1992 and 2.4% yearly in 1993-2002. Hypothetical scenarios of changes in cervix uteri cancer mortality show, that lack of intervention will cause mortality among Polish females at the level recorded in Finland 25 years ago. Optimistic variant would allow on diminishing mortality in Poland down to the level observed currently in Finland, in around 30 years. Implementing preventive cervix uteri cancer screening is currently the most urgent challenge of public health. If the preventive screening program will still be in the phase of plans and projects, then in 30 years time Poland will be in the point which Finland reached in the end of 1970s, and our civilizing underdevelopment will reach half a century.

Cause of Death↗

PubMed1984

Current and future pharmacy initiatives in institutional and corporate practice.

The future of pharmacy in organized health-care settings is discussed in light of changes in the health-care industry. The shift of health-care financing from cost-based reimbursement to prospective pricing provides pharmacists with the challenge of providing high-quality, cost-effective pharmaceutical services. Implementation of clinical pharmacy services will be a key factor in containing costs and improving patient care. The consolidation and corporate restructuring of hospitals will permit diversified services to develop in a highly competitive market. The formulary system, within which the medical staff may authorize and place conditions on the use of therapeutic equivalent drug products, will continue to play an important role in hospitals. Changes in the health-care industry will offer institutional pharmacists opportunities to enhance their roles as health professionals and as providers of economical quality care.

Formularies, Hospital as Topic↗

PubMed2005

Hypertension.

For primary care physicians, managing hypertension is a challenging undertaking because it is a good example of the balance be-tween implementing evidence and working with patients' beliefs, ideas, and resources to help them improve their health. In this article the authors review the evidence supporting aggressive recommendations on prevention and treatment of hypertension to decrease cardiovascular, cerebrovascular, and renal disease. They review the public health implications of hypertension, but focus on the challenges clinicians face in working with patients to optimize their health with the financial and personal resources they have available.

Antihypertensive Agents↗

PubMed2005

Transcriptional control of B cell activation.

The developmental program that commits a hematopoietic stem cell to the B lymphocyte lineage employs transcriptional regulators to enable the assembly of an antigen receptor complex with a useful specificity and with signalling competence. Once a naive IgM+ B cell is generated, it must correctly integrate signals from the antigen receptor with those from cytokine receptors and co-receptors delivering T cell help. The B cell responds through the regulated expression of genes that implement specific cell expansion and differentiation, secretion of high levels of high-affinity antibody, and generation of long-term memory. The transcriptional regulators highlighted in this chapter are those for which genetic evidence of function in IgM+ B cells in vivo has been provided, often in the form of mutant mice generated by conventional or conditional gene targeting. A critical developmental step is the maturation of bone marrow emigrant "transitional" B cells into the mature, long-lived cells of the periphery, and a number of the transcription factors discussed here impact on this process, yielding B cells with poor mitogenic responses in vitro. For mature B cells, it is clear that not only the nature, but the duration and amplitude of an activating signal are major determinants of the transcription factor activities enlisted, and so the ultimate outcome. The current challenge is the identification of the target genes that are activated to implement the correct response, so that we may more precisely and safely manipulate B cell behavior to predictably and positively influence humoral immune responses.

Animals↗

PubMedDate not supplied

Veterans Health Administration Office of Nursing Services exploration of positive patient care synergies fueled by consumer demand: care coordination, advanced clinic access, and patient self-management.

The consumers who utilize the Veterans Health Administration healthcare system are older, and most are learning to live with chronic diseases. Their desires and needs have driven changes within the Veterans Health Administration. Through patient satisfaction initiatives and other feedback sources, consumers have made it clear that they do not want to wait for their care, they want a say in what care is provided to them, and they want to remain as independent as possible. Two interdisciplinary processes/models of healthcare are being implemented on the national level to address these issues: advanced clinic access and care coordination. These programs have a synergistic relationship and are integrated with patient self-management initiatives. Positive outcomes of these programs also meet the needs of our staff. As these new processes and programs are implemented nationwide, skills of both patients and nursing staff who provide their care need to be enhanced to meet the challenges of providing nursing care now and into the 21st century. Veterans Health Administration Office of Nursing Services Strategic Planning Work Group is defining and implementing processes/programs to ensure nurses have the knowledge, information, and skills to meet these patient care demands at all levels within the organization.

Clinical Competence↗

PubMed2000

Pan-European research challenges in toxicology and epidemiology: twinning for the better.

At the Third Ministerial Conference on Environment and Health held in London in June 1999, a document on environment and health research for Europe was discussed and endorsed. This initiative - developed by the European Science Foundation, the European Commission and the WHO European Region - will be one of the largest of its kind in Europe. The programme described in particular an analysis of the more than 80 research recommendations which served as the basis for the high priority research questions presented in London. The need for an integrated multi-disciplinary approach is emphasised. The ultimate aim is to provide risk managers with tools to implement remediation and prevention effectively and efficiently in a prioritised fashion. Related research challenges in toxicology for the new millennium are described.

Congresses as Topic↗

PubMed2003

Road map and principles for built environment sustainability.

The built environment, defined by the facilities and civil infrastructure systems that people use, is the fundamental foundation upon which a society exists, develops, and survives. As the main provider and the life cycle custodian of the built environment, the Architecture, Engineering, and Construction (AEC) industry plays a critical role in determining the quality, integrity, and longevity of this foundation. In the execution of these two roles, provider and custodian, the AEC industry has had a major direct and indirect impact on the natural environment, contributing both directly and indirectly to natural resource depletion and degradation, waste generation and accumulation, and environmental impact and degradation. These impacts are not unique to the AEC industry. Other industries face similar challenges, and for many years, a wide range of constituencies within them have been attempting the implementation of the concept of sustainability within what these industries do, how they do it, and with what as a possible mechanism to slow, reduce, eliminate these impacts, and even restore conditions to a better state. In the pursuit of sustainability, the AEC industry faces challenges posed by the unique attributes and characteristics nature of facilities and civil infrastructure systems, the complexities of the current processes for their delivery and use, and the diverse set of resources required for both their delivery and their use. This paper offers a road map and an initial set of principles to implement built environment sustainability as a starting point for an ongoing, industry-wide dialogue and debate.

Conservation of Natural Resources↗

PubMed2006

Technical challenges in totally endoscopic robotic coronary artery bypass grafting.

OBJECTIVE: Robotic technology is a prerequisite for performance of totally endoscopic coronary artery bypass grafting. During the implementation phase of totally endoscopic coronary artery bypass, surgeon-related technical difficulties might be encountered. It was the aim of this study to assess the incidence of these challenges, to find risk factors, and to describe clinical results associated with technical errors. METHODS: From October 2001 through October 2004, 40 patients received robotically assisted totally endoscopic left internal thoracic artery grafts to the left anterior descending coronary artery system with the da Vinci telemanipulation device. All patients underwent remote access cardiopulmonary bypass perfusion through groin access, and all anastomoses were performed on the arrested heart. RESULTS: Undesirable technical events of various grades occurred in 20 (50%) of 40 patients: bleeding from a port hole in 3 (8%), left internal thoracic artery damage in 3 (8%), epicardial lesion in 3 (8%), remote access perfusion problems in 9 (23%), bleeding from the anastomosis in 4 (10%), and anastomotic stenosis in 2 (5%). There was no hospital mortality. The following differences were noted between patients without technical difficulties (group 1) and those in whom problems occurred (group 2): total operative time of 314 minutes (260-540 minutes) versus 418 minutes (270-690 minutes; P = .007), ventilation time of 6 hours (0-26 hours) versus 14 hours (0-278 hours; P = .004), intensive care unit stay of 20 hours (11-70 hours) versus 44 hours (16-336 hours; P=.183), hospital stay of 7 days (4-13 days) versus 8 days (5-21 days; P = .038), and cumulative freedom from angina at 36 months of 93% versus 100% (P = .317). CONCLUSION: We conclude that technical difficulties during totally endoscopic coronary artery bypass grafting translate into markedly increased operative time, moderately prolonged postoperative ventilation time, and slightly increased hospital stay. Short-term survival and freedom from angina, however, do not seem to be compromised.

Adult↗

PubMed2002

Developing a systemwide approach to patient safety: the first year.

BACKGROUND: Health care organizations face an imperative to ensure that care is provided to patients in the safest manner possible. In 2000 INTEGRIS Health, an Oklahoma City-based health system including ten acute care organizations, developed a patient safety framework that was built on the foundation of a culture of patient safety and began implementation in January 2001. IMPORTANCE OF LEADERSHIP IN PATIENT SAFETY: The first step in establishing a culture of safety was to ensure that leadership and the entire organization understand the rationale for a focus on patient safety. The traditional blaming approach will not prevent human error; staff need to speak freely, to talk about errors that happen and those that almost happen, and to identify where mistakes are likely and where systems allow mistakes to get through. Systems and processes should make it difficult for staff to make mistakes and easy for them to do things correctly. EXPERIENCE TO DATE: Since our efforts began, staff have helped identify multiple accidents waiting to happen. For example, an anesthesiologist, the service chief at one of our large hospitals, prepared a list of safety issues immediately after hearing a presentation to the Medical Executive Committee. Many system flaws have been identified as a result of our discussions; some of the solutions are easy and some much more complex. CHALLENGES: Challenges include keeping patient safety highly visible and demonstrating progress in our implementation, developing effective mechanisms for communicating safety solutions and ensuring that they are implemented in all the facilities, and figuring out how to measure success in a meaningful way.

Communication↗

PubMed2000

How to implement dietary changes to prevent the development of metabolic syndrome.

Changing dietary intake is a major challenge to individuals, households and the general public. Promoting the consumption of diets that are low in fat and high in fruits, vegetables and starchy carbohydrate, and managing overweight and central obesity, are important dietary strategies for the prevention of metabolic syndrome. Educational, behavioural and motivational tactics are required to help people achieve overall dietary change. These strategies might usefully be based on intervention models which incorporate behavioural theories and goals through personal, multiple contact with individuals or in small groups, using active involvement and specific behaviour-change strategies. Two particular aspects, namely the impact of computer-generated, personalized nutrition education and social support networks (e.g. family, health centre and community) provide useful adjuncts to traditional dietary counselling and might usefully be incorporated into diet- and lifestyle-change programmes for community-based and individualized approaches for disease prevention. The use of moderate energy-deficit diets, modest targets for weight loss (and maintenance) which can be sustained over the long term, and increased physical activity probably offers the most feasible approach for intervention aimed at reducing overall body weight.

Diet↗

PubMed1990

Implementing nutrition into the medical curriculum: a user's guide.

The medical profession is facing the challenges of the 1990s with a shift to outpatient care and preventive services. Medical schools will need to respond to these forces by reevaluating their curricula and setting new objectives. Nutrition is an essential element in the process of curriculum change. The nutrition educator will be expected to take a leading role in integrating nutrition into the medical school curriculum. This report presents steps and strategies to initiate the process.

Curriculum↗

PubMedDate not supplied

Implementation of medical-surgical nurse extern and student nurse aide programs in critical care.

In an effort to deal with the critical nursing shortage, new graduate nurses are entering highly specialized areas that once were available only to experienced nurses. A critical challenge exists for the new graduate when faced with the application of intensive theoretical knowledge in practice, and implementation of high-technology interventions, to meet the needs of patients and families. Innovative strategies are required to prepare the new graduate for this high-acuity practice environment and lessen the impact of reality shock. This article describes the implementation of medical-surgical nurse extern and student nurse aide programs that expanded to critical care. Program outcomes included positive feedback from participants about increased clinical experience, RN role perception, and comfort in the clinical practice setting. Program components are detailed, outcomes discussed, and implications for practice presented.

Attitude of Health Personnel↗