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PubMedDate not supplied

Organizational effectiveness: the key to accountability for collegiate schools of nursing.

This study describes the organizational effectiveness of collegiate nursing programs in terms of their ability to interact with their external environment. Nursing education administrators from 401 institutions were surveyed concerning their ability to secure resources and the degree of their system's openness and community interaction. Overall, with a response rate of 76.8 per cent, the administrators considered the availability of resources to be adequate and perceived their programs to be moderately successful in procuring resources. A categorical comparison of responses indicated that administrators in specialized/professional institutions identified a greater degree of richness in the availability of resources and perceived their programs to be more successful in procuring resources. However, a second categorical comparison found no statistically significant differences among administrators in their perception of system openness and community interaction. All administrators considered their environments cooperative, accepting, predictable, and stable.

Adult↗
PubMed1993

QALYs (Quality Adjusted Life Years): a nurse's view.

Examines the political and ideological significance of measures of quality of life, specifically Quality Adjusted Life Years (QALYs). Briefly reviews recent developments in the debate surrounding the economic and political functions of quality of life measures. The dialectic between conceptions of the quality of life and the implicit realpolitik of socio-economic pressures, ecological conditions, political ethos and cultural norms and expectations, is conceived as a powerful means for the critique of our aspirations concerning health. Argues that existing approaches to assessing quality of life, in denying this dialectic, have jeopardized their potential contribution to the planning, implementation and evaluation of health are policy. Resource allocation challenges us to develop openly ideological strategies and measures.

Australia↗
PubMed2006

Drowning or thirsting: the extremes of availability of medical information.

The March 2006 issue of PLoS Medicine contains the following editorial and a thoughtful debate on the issue of direct-to-consumer advertising of prescription drugs. The same issue contains a fascinating article on a "low tech" approach to information management, the blue trunk approach. This electronic journal is one of several published by the non-profit Public Library of Science (PLoS), a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. PLoS Medicine is an open-access, on-line journal that contains timely discussions and new findings on a broad range of medically-related topics. Readers are referred to the PLoS Medicine website: http://www/plosmedicne.org to read the full pro and con debate mentioned in this paper and to learn more about this valuable intellectual resource.

Advertising↗
PubMed1999

Patterns of morbidity and resource consumption associated with laparoscopic cholecystectomy in a VA medical center.

BACKGROUND: The generally low incidence of morbidity and reduced rate of health care resource consumption commonly associated with laparoscopic cholecystectomy (LC) have been established from studies of patient populations which are distinct from that served by the Department of Veterans Affairs (VA) health care system. We sought to assess the outcomes of this procedure when performed on VA beneficiaries. MATERIALS AND METHODS: Demographic and perioperative data for all patients undergoing attempted LC in our facility were recorded in a prospective database beginning 1 January 1993. The information in this registry was analyzed to determine the demographics of the treated population, the spectrum of biliary tract disease encountered, and patterns of morbidity and resource consumption. RESULTS: LC was attempted in 141 cases. Median patient age was 62 years. The indication for surgery was either acute cholecystitis or biliary pancreatitis in 63 cases (45%). Thirteen patients (9%) developed major complications. These patients were significantly older (mean age 68 vs 59 years) than patients whose course was uncomplicated. Twenty-seven cases (19%) required conversion to an open procedure, most commonly for acute cholecystitis. Progressive cholecystitis was associated with a conversion rate of 64%. Both conversion and the development of a major complication produced significant increases in length of stay. CONCLUSIONS: The population undergoing attempted LC in the VA system is characterized by relatively advanced age and high incidences of comorbid illness and complicated biliary tract disease. These attributes increase the frequency of major morbidity and of conversion to open cholecystectomy, which in turn increase resource consumption. Comparisons between the outcomes of attempted LC in VA centers and "benchmark" results obtained in other settings should be controlled for these factors.

Acute Disease↗
PubMed1998

Information system for clinical resource management in a regional setting.

The Hospital District of Varsinais-Suomi consists of five hospitals for non-psychiatric diseases to deliver specialised health care for the population of 440,000 inhabitants in South-western Finland. We have applied an open regional information system to aid clinical resource management in such a complex expert organisation. The main areas of application have been assessment of inpatient care usage in different communities and in different diagnosis-related-groups (DRG), measurement of length of hospital stay in different DRGs and comparison of DRG unit weight costs of different hospitals. The open structure of the data base and its distribution to all parties of health care professionals has resulted in mutual decisions on structural changes and increased cost containment activities.

Aged↗
PubMedDate not supplied

Does condom availability make a difference? An evaluation of Philadelphia's health resource centers.

In 1992, nine Philadelphia high schools opened drop-in centers where students could receive reproductive health information, condoms and general health referrals. Analyses of survey data collected in 1991 and 1993 suggest that the presence of the condom availability program did not increase the level of sexual activity among students in these schools and may have contributed to safer sex practices. The proportion of students who had used a condom at last intercourse increased from 52% to 58%; although the change was not statistically significant, it exceeded the increase in a group of comparison schools. Changes in the proportions of students who had ever had intercourse, who had had sex in the previous four weeks, who had used a condom at last intercourse and who had recently had unprotected sex were greatest in schools with higher levels of program usage; however, only the decline in recent unprotected intercourse among students in high-use schools (from 14% to 6%) approached statistical significance.

Adolescent↗
PubMed1994

Evaluation of the cost of laparoscopic and open cholecystectomy.

Despite the rapid growth of laparoscopic cholecystectomy, the comparative costs of this new procedure and open cholecystectomy remain unknown. In this study the costs have been evaluated of a consecutive series of patients undergoing these procedures in a district general hospital with an established resource management centre. Fifty consecutive patients undergoing open cholecystectomy between June 1988 and July 1990 immediately before the introduction of laparoscopic cholecystectomy and 100 patients undergoing laparoscopic cholecystectomy between August 1990 and June 1992 were studied. Costs estimated prospectively for each patient were compared. The mean cost per patient of open cholecystectomy was estimated at 2102 pounds compared with 2026 pounds for the first 50 patients undergoing the laparoscopic procedure. The mean cost (1744 pounds) for the second 50 patients undergoing laparoscopic cholecystectomy was less than that for either open cholecystectomy (P < 0.005) or the initial 50 laparoscopic operations (P < 0.03). Operating theatre costs and equipment costs were higher in both laparoscopic groups. These were offset by the higher nursing and ward costs of open cholecystectomy. For the laparoscopic procedure the operating theatre times and duration of hospital stay were both less in the second 50 patients than in the first 50. After the initial learning period, laparoscopic cholecystectomy is less expensive than the open operation and represents a cost-effective method for treatment of the patient with gallstones.

Adult↗
PubMed2005

Ontology driven dynamic linking of biology resources.

Biologists were early adopters of the Web and continue to use it as the primary means of delivering data, tools and knowledge to their community. The Web is made by the links between pages, yet these links have many limitations: they are static and maintained by hand; they can only link one lexical item to another single resource; ownership is necessary for the placement of link anchors and the link mechanism is essentially inflexible. Dynamic linking services, supported by ontologies, offer a mechanism to overcome such restrictions. The Conceptual Open Hypermedia Service (COHSE) system enhances web resources through the dynamic addition of hypertext links. These links are derived through the use of an ontology and associated lexicon along with a mapping from concepts to possible link targets. We describe an application of COHSE to Bioinformatics, using the Gene Ontology (GO) as an ontology and associated keyword mappings and GO associations as link targets. The resulting demonstrator (referred to here as GOHSE) provides both glossary functionality and the possibility of building knowledge based hypertext structures linking bioinformatics resources.

Animals↗
PubMedDate not supplied

Qualitative outcome assessment of a medical ethics program for clinical clerkships: a pilot study.

This study assessed the usefulness of an open-ended case analysis test instrument for evaluating the effects of a 1-year ethics course on medical students' decision-making skills. Through case-oriented seminars in gynecology, internal medicine, obstetrics, pediatrics, psychiatry, and surgery, third-year medical students were taught a structured analytic framework for analyzing clinical ethical problems stressing the interactive relationships among medical indications, patient preferences, quality of life, and contextual (social, legal, economic) matters. At precourse, the students were given a test case and asked to provide a line of reasoning for their clinical decisions. At postcourse, the students were given the same case. Content analysis of pre- and postcourse responses of a random student sample revealed increases in student awareness in the following areas: 1) consideration of informed consent, 2) professional liability, 3) physician-assisted suicide, and 4) resource utilization. With some modifications, open-ended case analysis holds promise for evaluating medical ethics courses. The authors make recommendations for future research in evaluating the true impact of clinical ethics courses in medical education.

Clinical Clerkship↗
PubMed2003

Open access echocardiography: a prospective audit of referral patterns from primary care.

Following recently published recommendations and guidelines, a prospective audit of 222 consecutive patients referred for open access echocardiography was conducted over a period of three months in a large district general hospital in the UK. Our study demonstrated the waiting time for an open access echocardiogram to be shorter than the waiting time for the outpatient clinic, which allowed identification of clinically significant cardiac disease sooner, leading to early advice on patient management. Specialist referral was avoided by the inclusion of management comments by a cardiologist in the technical echocardiogram report. We showed that open access echocardiography for detection of left ventricular systolic function, should be performed only if the ECG is abnormal, confirming previous reports. ECG interpretation in primary care is unreliable. In view of limited resources, hospitals should vigorously screen referrals for open access echocardiography.

Atrial Fibrillation↗
PubMedDate not supplied

A study of factors related to the use of online resources by nurse educators.

A descriptive cross-sectional survey was used to collect data from nurse educators related to the use of online electronic resources for scholarly pursuits. The 35-question survey was divided into 4 sections, Environment, Stressor, Utilization, and Demographics information. Two open-ended questions were also included to allow respondents to elaborate on factors that they believed facilitated or detracted from use of online resources but were not adequately covered in the survey. Data were received from 489 respondents who were faculty members currently teaching in 1 of 38 colleges or universities located in the 6 New England states offering a minimum of a baccalaureate degree in nursing. Quantitative and qualitative data analysis revealed that many of the same issues, previously reported as deterrents to the use of computers, also play a significant role in preventing the use of online resources. The two open-ended questions provided clarification of facilitators and detractors to use of online resources and were used to understand better the quantitative results. Based on the findings of this study, recommendations for administrators, educators, staff developers, and technical support personnel are discussed.

Attitude to Computers↗
PubMed1999

The treatment of newly diagnosed patients with glaucoma or with ocular hypertension in The Netherlands: an observational study of costs and initial treatment success based on retrospective chart review.

To determine the health care resource use and costs of patients with glaucoma or ocular hypertension in the Netherlands during the first 2 years after primary diagnosis, we performed a study based on retrospective chart review. Data of 200 patients and their health care resource use were collected in five hospitals. Unit-prices were calculated using micro costing in two hospitals. The mean 2-year costs per patient were estimated to be US$ 877. Outpatient visits to the ophthalmologist and medications were the cost-driving factors, and were responsible for 40 and 30% of total costs, respectively. Total costs were considered to be low, when compared to the estimated costs per patient in Sweden and the USA. In multiple least-squares regression only baseline IOP-value, the change in IOP-value between baseline and the next visit and the hospital of treatment were significantly related with total costs. The variation in costs between patients largely depended on whether or not a patient had undergone surgery.

Adrenergic beta-Antagonists↗
PubMed2003

Finding Canadian cancer clinical trials on the Internet: an exploratory evaluation of online resources.

BACKGROUND: Online information about the availability of clinical trials promises to enhance the accrual of patients into trials. The primary objective of our study was to assess the completeness of online databases of breast cancer clinical trials available in Canada. METHODS: Eligible online resources were identified through a search of MEDLINE (articles published from 1966 to January 2002), an Internet search with Google, examination of Web sites of cancer organizations and information from experts. Resources were included if they contained information about open, active cancer clinical trials available in Canada. Web sites reviewed were not limited to those based in Canada. For each eligible resource, the number of listed trials and the proportion of trials identified were calculated. RESULTS: Of 30 Web sites identified, 8 met all of the inclusion criteria; 3 were based in Canada and 5 in the United States. The total number of breast cancer trials identified as being available in Canada was 28. The Physician Data Query (PDQ) Clinical Trials Database of the US National Cancer Institute (cancer.gov/search/clinical_trials) identified 86% (24/28). The database of the National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) (ctg.queensu.ca) identified 29% (8/28) of the available breast cancer trials. CenterWatch Clinical Trials Listing Service (centerwatch.com) identified 4% (1/28). INTERPRETATION: If the PDQ database included all of the NCIC CTG trials, it would become the most complete database of breast cancer clinical trials currently available in Canada. Online cancer data sources should strive to make access to clinical trials simpler and more reliable, particularly for residents of the country where the trial is to be conducted.

Canada↗
PubMed2026

A scalable HPC framework for bioinformatics in resource-limited settings: design principles, implementation, and sustainability from the UVRI experience.

MOTIVATION: Building and sustaining High-Performance Computing (HPC) infrastructure for bioinformatics research in resource-limited settings presents significant technical, financial and operational challenges. Institutions in low-and middle-income regions often face constraints such as limited technical expertise, unstable infrastructure and restricted funding which can hinder the deployment of large-scale computational platforms necessary for modern genomics and bioinformatics analyses. RESULTS: We present a scalable and modular HPC framework developed at the Uganda Virus Research Institute (UVRI) to support large-scale genomics and other omics data analyses in resource-limited settings. The framework integrates open-source HPC management tools, infrastructure automation, and reproducible configuration management to enable reliable deployment and maintenance. Optimized storage and networking configurations combined with a phased capacity-building strategy support high-throughput genomic workflows while strengthening local technical expertise. From our implementation experience, we derive ten practical design and operational rules that provide a transferable methodology for establishing and sustaining in-house HPC infrastructure. These rules emphasize strategic investment in human capacity, structured planning, leveraging collaborations, adoption of open-source technologies and service management practices to improve operational resilience and long-term sustainability. AVAILABILITY: The design principles, automation strategies and implementation guidelines described in this work are applicable to institutions seeking to establish sustainable HPC resources for bioinformatics research in resource-constrained environments.

Computational Biology↗
PubMed2002

Ethical decision-making in prenatal diagnosis and termination of pregnancy: a qualitative survey among physicians and midwives.

OBJECTIVES: This study was aimed at exploring the conflicts and ethical problems experienced by professionals involved in prenatal diagnosis and termination of pregnancy (TOP) in order to improve the understanding of decision-making processes and medical practices in the field of prenatal diagnosis. METHODS: Qualitative study with in-depth tape-recorded interviews conducted in three tertiary care maternity units in France, between May 1999 and March 2000. All full-time obstetricians and half of the full-time midwives were contacted. Seventeen obstetricians and 30 midwives participated (three refusals, five missing). Interviews were transcribed and analysed successively by two different researchers. RESULTS: All respondents stated that prenatal diagnosis and TOP raised important ethical dilemmas, the most frequent being request for abortion in case of minor anomalies. They pointed out the inability of our society to appropriately care for disabled children and the risk of eugenic pressures. The decisions and practices in prenatal diagnosis should be debated throughout society. All respondents reported that their unit did not have protocols for deciding when a TOP was justifiable. The transmission of information to the women appeared to be a problematic area. Moral conflicts and emotional distress were frequently expressed, especially by midwives who mentioned the need for more discussions and support groups in their department. CONCLUSION: Health professionals involved in prenatal diagnosis face complex ethical dilemmas which raise important personal conflicts. A need for more resources for counselling women and for open debate about the consequences of the current practices clearly emerged.

Abortion, Eugenic↗
PubMed2005

[What does the language of Alzheimer patients have to do with the language of Paul Celan?].

Being in touch with severely demented patients requires a fundamental transformation in communication habits in medicine and in nursing. There is a need of reorientation away from an interpreting and often deficit-oriented aspect of communication towards attentive observance of unusual verbal and nonverbal signals and resources of the patient. Spontaneous and open communication with the patient outweighs the importance of a goal-oriented exchange of information and poses a significant challenge for all health and social professions. The well-being of persons with dementia depends mainly on the quality of communication and on the design of the milieu and the quality of everyday life. Interaction in nursing seems to be the crucial issue, including both spontaneity and creativity in the interaction partners, while respecting the personal boundaries of both the patient and the nurse in the necessary intimacy of the care environment. This essay shows important aspects and strategies of adequate communication with people with dementia from the perspective of medicine and of nursing. Ways to improve communication skills are shown, referring, among others, to the approaches by Kate Allan and John Killick (research fellows at Dementia Services Development Centre, University of Stirling).

Aged↗