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PubMed2004

[Importance of the modern health management for the success of health reform in Lithuania].

Reform of the Lithuanian health system is a challenging process. The aim of this article is to assess the role of health managers in the process of health reform, evaluating the perception of health management and their training needs, as the possible determinants for the success of the reform. The results of several questionnaire surveys of Lithuanian health managers, particularly the one carried out in 2002 are used. The studies demonstrate great diversity in the conceptual understanding of health management, with prevailing rational and technical understanding. This might be associated with the rapid structural and organizational changes in the early stages of health reform and insufficient involvement of health managers in the planning and management of changes. General management, health policy, economic and law are considered as the most important study areas for health managers. The major lacking knowledge is in the subjects of law, economics and health financing. Health managers should act as mediators between politicians and health professionals. Enlargement of the area of competences, increasing autonomy in solving problems and meeting of the training needs of health managers is essential.

Attitude of Health Personnel↗

PubMed2004

Good healthcare innovation practice (GHIP)--a network-driven, knowledge-conscious approach for innovation in the (Dutch) healthcare sector.

In this article we describe why and how a new approach has been developed for innovation projects in the Dutch healthcare sector. There are three key aspects in the approach: Innovation should be seen as a (fair) process, the process is owned by all stakeholders (which calls for a Network approach) and, finally, the process should be knowledge-enabled, i.e. in each process step it should be clear what knowledge is needed, what knowledge becomes available and how the flow of knowledge should be managed.

Diffusion of Innovation↗

PubMed1977

Stress and cardiovascular disease.

Currently the role of stress as a potential factor in cardiovascular disease is receiving considerable attention. Accordingly, it is important to know how it is defined and identified, how it affects the cardiovascular system and how it can be managed with the knowledge presently available. An overview of the present body of knowledge on the relationship between stress and cardiovascular disease is presented for the reader's consideration.

Adrenergic beta-Antagonists↗

PubMed2005

Interdisciplinary conflict analysis and conflict mitigation in local resource management.

Within the Swedish research program SUCOZOMA (Sustainable Coastal Zone Management) several conflict studies have been carried out. Whereas the detailed results of these studies are published separately, this paper reviews important results from conflict research in combination with a summarizing and generalizing discussion of approaches and main results of SUCOZOMA's resource and conflicts studies. After an analysis of interdisciplinary and theoretical research about environmental and resource use conflicts, the methodology used in SUCOZOMA is presented, a combined stakeholder and conflict analysis. It can be summarized in four main points: i) to map the stakeholders and their interests; i) to analyse the conflicts; iii) to develop methods for conflict mitigation and cooperation with stakeholders; iv) to integrate these components in a system for the management of natural resources. Exemplary case studies of resource use conflicts have been carried out at the Swedish west and east coast including coastal fishery, mussel culture, coastal planning and specific conflicts such as between species protection (seals) and coastal fishery. Researchers are involved as experts and as conflicting parties, and the role of scientists as stakeholders deserves special attention in conflict research. Conflict management is not only for the solution of present conflicts, but part of integrated resource management systems where knowledge transfer, institutional development, collective learning of scientific, political and administrative actors, and cooperation between scientists and resource users can occur.

Animals↗

PubMed2005

The Grid as a healthcare provision tool.

OBJECTIVES: This paper presents a survey on HealthGrid technologies, describing the current status of Grid and eHealth and analyzing them in the medium-term future. The objective is to analyze the key points, barriers and driving forces for the take-up of HealthGrids. METHODS: The article considers the procedures from other Grid disciplines such as high energy physics or biomolecular engineering and discusses the differences with respect to healthcare. It analyzes the status of the basic technology, the needs of the eHealth environment and the successes of current projects in health and other relevant disciplines. RESULTS: Information and communication technology (ICT) in healthcare is a promising area for the use of the Grid. There are many driving forces that are fostering the application of the secure, pervasive, ubiquitous and transparent access to information and computing resources that Grid technologies can provide. However, there are many barriers that must be solved. Many technical problems that arise in eHealth (standardization of data, federation of databases, content-based knowledge extraction, and management of personal data ...) can be solved with Grid technologies. CONCLUSIONS: The article presents the development of successful and demonstrative applications as the key for the take-up of HealthGrids, where short-term future medical applications will surely be biocomputing-oriented, and the future of Grid technologies on medical imaging seems promising. Finally, exploitation of HealthGrid is analyzed considering the curve of the adoption of ICT solutions and the definition of business models, which are far more complex than in other e-business technologies such ASP.

Data Collection↗

PubMed2005

[The evaluation and treatment of acute anterior shoulder dislocation].

Anterior shoulder dislocation is the most common dislocation in the human body with a high recurrence rate and thus, has been one of the interesting subjects in orthopaedics and traumatology. There is still controversy about its evaluation and treatment. In particular, the type and duration of immobilization after reduction of the shoulder vary among centers. Another matter of debate is the indication of acute repair of the capsulolabral structures to prevent late instability. This review aims to provide an outline of current knowledge about the management and treatment alternatives of anterior shoulder dislocation.

Acute Disease↗

PubMed2006

Medicare Part D drug benefit and HIV/AIDS: questions and answers.

This newly enacted legislation has the potential to expand access to needed medications for persons with HIV/AIDS and actually improve care by making medication more affordable. This is particularly true for patients who are currently enrolled in ADAPs with limited or restricted formularies. The benefit of the Part D program in states with more generous ADAP formularies, such as New York and California, is not as clear. Choosing a drug plan can also be complex. Providers and case managers should have knowledge of the plans that are offered in their areas. While a program such as this has the potential to improve access to drugs, providers should expect the unexpected, especially with a newly implemented program that is wide in scope and subject to change over time. In the end, we need to work to avoid interruptions in treatment for our patients.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Clinical implications of diabetes on the foot.

OBJECTIVE: Athletic trainers must understand the clinical implications of diabetes on the athletic foot in order to promote proper foot care and footwear and to adapt protocols for treatment and exercise of the affected athlete. DATA SOURCES: The MEDLINE and CINAHL databases were searched for the years 1984 to 1996 with the terms "diabetes and foot," "neuropathy," and "Charcot joint." DATA SYNTHESIS: As more athletes with diabetes participate in sports, athletic trainers must develop the skills and knowledge necessary to manage this metabolic illness. Although the need to keep blood glucose levels carefully controlled is well known, the impact of diabetes on the foot is not as well recognized. Peripheral vascular disease, soft tissue neuropathy, and neuropathic arthropathy are the most common complications of diabetes affecting the foot. However, with proper management, these complications can be minimized, allowing diabetic athletes and nonathletes to lead more normal and functional lives. CONCLUSIONS/RECOMMENDATIONS: The athletic trainer can assist the diabetic athlete by promoting proper foot care and footwear and adapting protocols for treatment and exercise.

Journal Article↗

PubMed2006

[Guidelines concerning insulin dosage in children and adolescents with type 1 diabetes on continuous subcutaneous insulin infusion].

The treatment of diabetes mellitus with a continuous subcutaneous insulin infusion (CSII) has become very popular and is well accepted by diabetic patients. Pump therapy mimics the physiological insulin secretion and has been shown to be a safe and effective method of insulin administration alternative to the method of multiple injections. Continuous insulin infusion provides greater flexibility in the timing of meals and snacks with higher treatment satisfaction. Programmed basal rates improve nocturnal glycemic control and help to minimize a pre-breakfast increase of blood glucose level (the dawn phenomenon). Moreover, CSII can reduce exercise-induced and nocturnal hypoglycemia. Insulin pump therapy is effective in lowering glycated hemoglobin levels without higher risk of severe hypoglycaemia and ketoacidosis. To achieve a proper metabolic control with this method of treatment, the patient and his family requires appropriate education including knowledge of diet management, insulin therapy and manual competence of pump device. Here we present general guidelines for patients education concerning insulin dosage, programming of basal insulin rates and meal boluses based on carbohydrates and protein-fat exchanges.

Child↗

PubMed1991

Clinical decision making and pain.

Pain management is intimately linked to decision making. Nurses play a key role in making decisions regarding pain and its management. This paper presents data from a preliminary study (N = 53) extending the investigators' pain research into the areas of clinical decision making and ethical dilemmas related to pain management. Nurses completed surveys focused on actual experiences of caring for patients in pain. The results identify common clinical decisions related to pain, barriers to providing optimum pain relief, and ethical/professional conflicts in pain management. Decisions related to the amount of pain intensity, when to give medications, and choice of analgesics. Nurses identified verbal and nonverbal cues central to their decisions regarding pain assessment. Barriers to effective pain management included physician knowledge and cooperation, patient/family knowledge and cooperation, as well as nursing knowledge and time. Respondents identified ethical dilemmas about overmedication or undermedication, conflicts with physicians or patients, and concern over opioid side effects. A tentative model of decision making related to pain is presented.

Adult↗

PubMed1991

The role of the veterinarian in the education and health of pre-school children.

Two surveys conducted in pre-schools (n = 156) located in advantaged areas and disadvantaged areas in Pretoria, indicated that animals had social and psychological as well as educational value for pre-school children. All schools (n = 156) utilised animals in some way for the education of pre-school children. Nineteen of the pre-schools in advantaged areas kept animals permanently at the school. All of these schools utilised the zoo. Only 3 of the schools in disadvantaged areas (n = 106) were able to keep animals permanently on the premises although 69 would have liked to keep animals and 77 of the schools visited the zoo at least once a year. Limiting factors included lack of finances and facilities, lack of knowledge on animal management and anxiety about zoonoses. No cases of zoonotic disease in children were recorded. The species of animals utilised at the pre-schools differed from those found most commonly as household pets. Pre-schools favoured rodents, fish and birds rather than carnivores. The role of the veterinarian may include clinical treatment of the animals from the pre-school, advice on management and zoonosis prevention, pet-care counselling, communication with children and their parents in the consulting room, public health aspects and promotion of environmental education.

Animals↗

PubMed1991

Curricula of doctoral programs in nursing.

Each doctoral program possesses unique features that reflect the special characteristics of the faculty, the environment, and the students of its respective institution. This study focused more narrowly on the formalized structure of programs of study available in printed literature which does not fully capture the richness of doctoral education. While most doctoral programs in this country appear to possess curricular elements of quality previously identified by AACN with respect to curricular issues in the areas of research, theory construction, and philosophy, there was much more variation in the curricular content focusing on areas of substantive nursing knowledge, and data management, tools, and technology.

Curriculum↗

PubMed1991

Disturbances of balance in the elderly.

Dizziness and falls are a common cause of morbidity and mortality in the elderly. The pathophysiological mechanisms leading to these symptoms are legion and such patients may present in a multiplicity of medical and surgical outpatient departments. A working knowledge of the management of these disorders is therefore of value to every clinician.

Aged↗

PubMed1991

Medical treatment of malaria.

Eleven patients with 14 episodes of malaria have been admitted to Kaohsiung Medical College Hospital in the past 10 years and have been evaluated in this study. All of the patients were male and had traveling history to Africa or Southeast Asia. Eight of them were suffering from falciparum malaria and three vivax malaria. Initially they were treated with chloroquine (900 mg + 300 mg x 2 d) and primaquine (15 mg x 14 d). Quinine (650 mg q8h x 7-10 d) was used in one severe and another reinfected case of falciparum malaria. Cerebral malaria was noted in two falciparum cases with good response to treatment. One severe patient who also suffered from black water fever died of acute renal failure, even though quinine had been given immediately. It is concluded that chloroquine combined with primaquine is effective and safe in the treatment of vivax and falciparum malaria in Taiwan. Quinine should be given as soon as possible in a severe case of falciparum malaria. Supportive management and basic knowledge of epidemiology is also very important in the medical treatment of malaria.

Adult↗

PubMed1989

[Non vascular interventional radiology--general].

Since last about 20 years, invasive diagnostic procedures have gradually changed the conception to interventional radiology (IVR). Non vascular IVR has been developing steadily by suitable instruments and excellent techniques as well as vascular IVR. The fields of non-vascular IVR is becoming wider and wider in various regions in the body. Non-vascular IVR contains many kinds of drainage and forming inner fistula in the biliary and urinary tracts, for example, occlusive jaundice or hydronephrosis. Drainage for abscess in the thoracic or abdominal cavity is a good indication except peri-pancreatic abscess. In addition, IVR means time saving and cost saving in the aspiration biopsy for malignant neoplasms this is fast decision for reasonable therapies. In the earlier period, aspiration biopsy was considered as dangerous method because of bleeding and dissemination of malignant seeds along the route of aspiration needles. By using fluoroscopic image amplifier and ultrasonic unit, non-vascular IVR has many indications that radiologist's specialty demonstrated. Therefore, radiologist should have heavy responsibility based on understanding of right knowledge and good management for non-vascular IVR.

Abscess↗

PubMed1989

Complications of acute pancreatitis.

In 1925, Sir Berkeley Moynihan stated that "acute pancreatitis is the most terrible of all the calamities that occur in connection with the abdominal viscera." The case of M.H. clearly reflects the accuracy of that statement. It should be pointed out that through the exceptional, dedicated care provided by all members of the health care team, a young woman whose predicted mortality approached 100 percent was restored to her previous state of good health, and has since delivered a healthy baby girl by cesarean section. This illustrates that the nurse who possesses a sound understanding of the complications of acute pancreatitis and the pathophysiologic processes responsible, can integrate this knowledge into the management of the patient and improve the quality of care.

Acute Disease↗

PubMed1989

[Thoracic outlet syndrome].

The thoracic outlet-syndrome (TOS) results from compression of the brachial plexus at the superior thoracic aperture. Sometimes it is accompanied by vascular symptoms. Every non typical peripheral compression syndrome, recurrent compression symptomatology or the presence of several irritable nerve segments should let TOS enter into the diagnostic considerations. Diagnosis is not simple and requires a synoptic approach using several investigations. Initial therapy is conservative. Surgical management implies good knowledge of anatomy and possible anomalies of the upper thoracic aperture.

Adult↗

PubMedDate not supplied

[Diagnosis of dementia in primary care].

We studied the level of knowledge that a group of general practitioners (N = 40), selected by means of conglomerate sampling, had about dementias. To perform this study we used a five-question open questionnaire. Our conclusions were: 1) In our sample, 80% of the GP's were not familiar with the initial symptoms of dementia; 2) The full clinical picture of dementia was well recognized; 3) There was little knowledge about the management of a possible case of dementia, the most usual procedure being to remit it to a specialist; 4) In general, they did not know what the possible causes for dementia are, arteriosclerosis being the most frequently mentioned; 5) A considerable number of doctors (40%) believed dementia to be curable.

Adult↗