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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."
Health is a sensitive mirror of social circumstances. This paper looks at the situation of women's health in Lithuania in the context of the social, political and economic transition in the country following independence in 1990, and reforms to the health system. Data since 1990 show that considerable social and demographic inequalities in the health of women exist in Lithuania, with low-educated women and those living in rural areas in the most unfavourable situation, including in relation to reproductive health. Reproductive health issues have received some recognition in recent years, with the main attention and resources directed to the development of a Maternal and Child Health Programme, especially perinatal care and the organisation of neonatology services, which has resulted in a notable decrease in maternal, perinatal and infant mortality. Services for family planning, abortion, infertility, cervical and breast cancer, and violence against women are under-developed. Non-governmental organizations are beginning to be formed to advocate for increased resources and services for reproductive health. Improvements in the health status of Lithuanian women can be expected if attention is paid to social determinants of health.
Policies and procedures (P&P) constitute the mechanism for planning, standardizing, and documenting the provision of clinical services. Upon approval by hospital management, the P&P is an official statement of hospital rules and regulations. Each P&P establishes organizational responsibility for providing services. P&P are a mechanism for communicating standard operating procedures to hospital and medical staff. P&P serve as a reference document for unusual events, as well as routine procedures. P&P are often reviewed by inspection teams from the Joint Commission on Accreditation of Hospital Organizations (JCAHO) to determine whether the hospital has documented systematic practices. A picture archival and communications system (PACS) provides a new vehicle for providing radiology services. P&P that were designed for conventional film-based imaging are often not appropriate for electronic imaging. Because PACS is new and not yet widespread, good examples of PACS P&P are not yet available. JCAHO has no official requirements for PACS: PACS is viewed only as a means for the hospital to accomplish its work. Successful P&P development is a team effort, drafted by personnel responsible for executing the procedure, assisted by staff proficient in PACS technology, and tested in the field. The P&P should be reviewed and approved by management personnel knowledgeable about hospital and imaging operations. P&P should be written in clear and concise language. Successful P&P development is an ongoing effort. P&P must be periodically reviewed and updated to reflect changes in PACS technology and changes in clinical operations. New P&P must be developed when a deficit is noted. PACS security is a good example of a topic worthy of P&P development, especially in the face of the Health Insurance Portability and Accountability Act (HIPAA) legislation of 1996. What are the provisions for access control? Does the system include a feature for automatic shut-off of the software? Are there "generic" passwords and log-ins shared by a community of users? How are passwords assigned and how frequently are they changed? What security measures are in place to assure passwords are given to the appropriate user? Who grants and denies access? Service calls are another topic for P&P. Who initiates a service call? What is the process for escalating a service call from the operator level to the vendor? What immediate actions are expected by the operator in order to restore PACS services? How are service events documented? Who is responsible for determining when "downtime" procedures should be initiated or suspended? When our hospital's total electrical system had to be shut down for an extended period, we found that a P&P was lacking for a task as mundane as shutting down and restarting our PACS components. What is the sequence for the shutdown? Who is responsible for shutting down and restarting? How long can the devices operate on uninteruptible power supplies (UPS)? What components are on emergency power? Should we expect the components to survive the switchover to generator power? Developing this P&P was worth the effort: it made the PACS more fault-tolerant and served as a reference document 3 years later when expansion of our physical plant required two more power outages.
International mental health economics is emerging as a significant field in the increasingly intricate and interactive world in which we live. In line with this, the conceptualisation and gathering of pertinent data for international studies such as WHO's Atlas Project pose considerable methodological challenges. This paper outlines the need for broader conceptual models and partnerships and discusses some promising endeavours.
Sexual violence is among the foremost problems that our society faces today. Addressing this problem will require more direct public education, effective and accessible resources for victims, punishment for offenders, and treatment of offenders to prevent recidivism. Although the 74th Texas legislative session began a concentrated approach to addressing this problem, further legislation is needed to provide a cost-effective method to increase public safety from sexual violence over the long term.
The objective of this article is to focus on the challenges and opportunities the Palestinian health care system is currently facing in a 'transitional period', which started subsequent to the Oslo Agreement in 1993. The characteristics of 'transition' have to be highlighted in order to understand the context and peculiarities in which the Palestinian health care system is operating. A descriptive analysis is provided of the historical, political, economic and socio-demographic elements to gain an insight into the complex context of the Occupied Palestinian Territories, a country in 'transition'.
Ideally, computer networks should help raise the quality of health care, reduce its cost, and enable consumers and providers to make smarter decisions. But government and the private sector have failed to resolve such critical problems as the protection of medical privacy and production of reliable comparative data on plans and providers. While individual enterprises are building information networks, community networks serving public purposes have lagged. An information revolution in health care is the making, but the hope that it will allow consumers and providers to make smarter choices is still far from being realized.
Terms such as coke babies and crack babies are appearing with increased frequency in the popular literature. Although the number of babies exposed to cocaine in utero has increased, synthesis of the literature to help determine the manifestations of cocaine exposure or to direct research on the problems experienced by cocaine-exposed infants and their care givers has yet to occur. In this analysis a synthesis of the literature related to the effects of perinatal cocaine exposure is provided. The manifestations, effects, and sequelae of cocaine exposure are explicated and a model is proposed to explain the mechanisms underlying physiologic and psychosocial expressions of exposure. Both time of exposure during gestation and dose relationships were identified as major predictor variables. Recommendations include the need for (1) an individualized intervention protocol and (2) prevention programs directed at pregnant women and women of childbearing age.
Economic forces are changing Canadian medicine. There are four hospitals in Manitoba with CT services and eight were planning to add services based on public subscription, internal transfer of resources and expected growth. The Ministry of Health requested an in depth report and review. Analysis of clinical activity for 287 disease categories from 13,996,240 physician claims and 149,480 hospital discharges reveal that 33,552 CT examinations are reasonable for 1.1 million people. The cost of operating each scanner is one million dollars per year. A formal review process of the report by the 12 hospitals and 7 selected experts was conducted. An advisory committee of all interested parties recommended that no further resources be allocated without proven clinical need and that a strong management committee be reactivated. MRI growth for nervous disease is expected to replace much CT activity in the next five years.
The replacement of old radiologic contrast media with supposedly safer but more expensive media has created a dilemma for radiologists and hospital administrators. To quantitate the nature of this trade-off we performed a cost-utility analysis using optimistic assumptions that favoured the new media. A complete conversion to the new media would result in an incremental cost of at least $65,000 to gain 1 quality-adjusted life-year (QALY). For a selective strategy in which only high-risk patients would receive the new media the cost would be about $23,000 per QALY gained. However, the incremental cost for low-risk patients is over $220,000 per QALY gained. Conversion to the new contrast media, although not necessarily the most efficient use of scarce resources, has already occurred in Ontario, primarily because of press publicity, pressure from insurers and a political unwillingness of policymakers to decide the fate of identifiable victims. We found that funding of a new intervention associated with a high cost-utility ratio rather than interventions with lower ratios might save some identifiable victims at the expense of a larger number of unidentifiable ones.
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This paper describes select results of a pilot test of automated speed enforcement devices (ASEDs) in Michigan. A mail response survey of drivers (1,209 respondents) showed the general public favors use of ASEDs in select situations, particularly in school zones, in areas where traffic enforcement is dangerous for police, for heavy trucks, and in construction zones. The survey also showed opposition to ASED use on freeways, on bridges, and on "all roads." In general, observed speeders and persons who reported having multiple citations in the previous two years were in greater opposition to the use of ASEDs than the general population.
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Explore the source record for details and available documents.