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Practice guidelines are proliferating in the era of managed care. Hospital epidemiologists frequently are asked to author guidelines of infection control. The greatest challenge in the process is not writing the guidelines but implementing them. This article offers practical advice on which topic to select and on how to develop and implement guidelines.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Road traffic is a diffuse source of heavy metals and oil that leads to pollution of verges and surface water in areas immediately surrounding roads. The Commission for Integrated Water Management (CIW) has drawn up a policy document addressing methods for managing this type of pollution. The document is based on results from numerous studies in The Netherlands targeting pollution caused by traffic. The Commission concludes that measures at the source are the only way to realise sustainable solutions. For example, attention should be devoted to the issue of zinc emissions from car tyres and crash barriers. The concept of controlled infiltration is recommended for combating pollution caused by spray and runoff from roads. This includes periodic chemical inspection of verge pollution and, where necessary, replacement of the verge's top layer. The application of porous asphalt on highways in The Netherlands has also proven highly effective in limiting pollution caused by traffic, with far less pollution caused by spray from the highway and runoff as compared to traditional asphalt.
"This article reviews the experience of two pilot projects in Bangladesh that have addressed the question of how [operations] research can be designed to foster its utilization. In a rural field experiment [begun in 1972] in Matlab subdistrict, research has demonstrated that contraceptive services, if carefully designed and properly implemented, can influence demographic dynamics even where social and economic circumstances are not conducive to fertility change. Despite the success that Matlab represents, the project was not systematically utilized for policy until a second study [begun in 1981] was launched to address government questions concerning its replicability in the public sector programme. Results suggest that pilot projects, if fielded in conjunction with research systems for testing their replicability, can foster organizational development in contexts that are not conducive to bureaucratic change."
UNLABELLED: The aim of the study was to assess the changes in healthy life expectancy of the Lithuanian population between the years 1997 and 2001 and to explore the differentials of this combined mortality and subjective health measure in males and females. MATERIAL AND METHODS: The data about the Lithuanian population and the deceased were available from the Lithuanian Department of Statistics, life tables for 1997 and 2001 were created and life expectancy estimated. The method presented first by D. F. Sullivan was applied for the assessment of healthy life expectancy. The data on self-perceived health of the Lithuanian population were acquired from the surveys of the health behavior of a randomly selected sample of the adult population of Lithuania, carried out by the Lithuanian Center for Health Education. RESULTS: Healthy life expectancy at birth increased from 52.7 in males and 52.6 in females in 1997 up to 53.7 in males and 55.3 in females in 2001. The proportion of healthy life expectancy in the total life expectancy at birth increased both in males and in females. Though the total life expectancy of males is 10-11 years shorter, females are expected to spend considerably more years in poor health, even though some positive changes were observed. CONCLUSION: Increasing healthy life expectancy reflects improving health of Lithuanian population. This integrated health indicator should be periodically assessed and used for development health strategies to promote health in Lithuania.
"The various studies focussing on human settlements in Senegal show that the share of population living in cities is ever increasing because of the massive and continuous flow from rural areas. The persistance of such migration trends from the country to cities deepens regional disparities, compounds the difficulties and cost of city management and development, specially in the case of Dakar, and runs counter to the goals of social and economic development plans.... The growing importance of such phenomena calls for the designing of corrective measures in favour of rural areas and small towns in order to settle rural populations and halt the inordinate and chaotic geographical growth of large cities. Failing this, development efforts may well be compromised." (SUMMARY IN ENG)
Although radical changes in drug regulation are rare (e.g., the Federal Food, Drug and Cosmetic Act of 1938 and the 1962 amendment to the Act creating an effectiveness requirement), regulations and guidance do evolve significantly in the face of new problems and accumulating experience. Recent changes have been driven by the Food and Drug Administration Modernization Act (FDAMA), user fee legislation, the International Conference on Harmonization, recent safety related drug withdrawals, and concerns about trial ethics and investigator conflict of interest. FDAMA and guidance developed in response to it has helped circumstances in which FDA would rely on a single study to support effectiveness and the circumstances in which surrogate endpoints could support approval. An ICH Document 'Choice of control group and related design issues in clinical trials' focussed attention on the ethics of placebo controls (acceptable, even if there is existing therapy, when the placebo-treated patient will suffer no irreversible injury) and the design of 'equivalence' or 'non-inferiority' trials. There has been greatly increased attention to obtaining good dose-response information and to assessing need for modifying treatment in demographic (age, gender, race) and concomitant disease (renal or hepatic function abnormalities) subgroups, and in assessing drug-drug interactions. Other important trends are increasing reliance on non-U.S. data, increasing numbers of FDA-industry meetings during drug development, and new focus on risk assessment and risk management.
The release of Australia's National Action Plan for Dementia Care in 1992 was the culmination of more than a decade of policy development over which the federal government assumed an increasing role, and the participatory approach fostered under its Social Justice Strategy promoted collectivist and political attempts to address the issues of dementia care. This article begins with an account of four phases of policy development, with the transition from one to the next marked by changes in thinking about dementia care being incorporated into policy and then expressed in programmes and in care practices. In the second part of the article, the goals and structure of the National Action Plan are outlined and its implementation and outcomes discussed. Continuation of the policy climate in which the National Action Plan was formulated is a crucial, but uncertain, factor for future development.
The author examines how, as part of a reform of Wisconsin's public mental health system, a workgroup of system stakeholders defined and operationalized the concept of recovery. Based on participant observation, document analysis, and interviews, with an analytic framework drawn from symbolic interactionism, the author finds that although individual members held a range of definitions of recovery, the workgroup was able to reach consensus in its policy recommendations through processual means and by tacitly agreeing on a set of overarching values that were flexible enough to accommodate many definitions.
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The implementation of certain therapies within clinical practice is dependent on nurses taking the initiative and expanding their scope of practice. In incorporating therapies within nursing practice it is hoped that a more holistic approach to care can be achieved.
The implementation of certain therapies within clinical practice is dependent on nurses taking the initiative and expanding their scope of practice. In incorporating therapies within nursing practice it is hoped that a more holistic approach to care can be achieved.
The Program of All-Inclusive Care for the Elderly (PACE) offers a unique model of comprehensive care for frail, elderly people. To date, all of the PACE programs have been located in urban areas. Rural advocates and policymakers, however, believe the program may hold great promise for use in rural areas, which have higher percentages of elderly residents than urban areas. In 2002, the National Rural Health Association and the National PACE Association convened a meeting that brought together PACE experts, policymakers, and rural health care providers to examine PACE and its applicability for rural communities. The meeting participants concluded that there were many rural communities where the PACE model might not only be appropriate but also highly successful in caring for rural, frail, elderly people. This article examines the notion of expanding the PACE model to rural communities, including some of the barriers and some of the possible solutions that might make PACE a viable part of the rural health care delivery system.
Risk taking is a concommitant of life--inescapable beyond the inert, sessile state. Accordingly, risk assessment is implicit for almost all human activities, from daily actions, such as crossing a trafficked street to esoteric ones such as landing on the moon.
"The paper brings out the role of political economy in influencing the process of urbanisation and [the] structure of settlement network. This is demonstrated through an empirical study of Hungary during the twentieth century. Three phases get easily distinguished: pre-1949 or the period of changes in the state boundaries; 1949-89 or the period of state socialism; and post-1989 or the period of institutional reform. An interesting finding is that there was a bias in favour of large cities and county seats in allocation of development funds under all the regimes."