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PubMed2005

Mentoring for nurses in general practice: national issues and challenges.

This paper reports the findings of a research project designed to identify national issues impacting on the development of a mentoring framework for nurses in general practice in Australia. The project comprised the first phase of a three-phase study commissioned by the Australian Government Department of Health and Ageing to develop a contemporary, flexible and sustainable mentoring framework that enhances the capacity of nurses to contribute to general practice outcomes. Key stakeholders and influential informants from around Australia were brought together via a national teleconference to identify issues surrounding the development of such a framework. Outcomes focussed on major themes concerning choice, relationships, structures and resources. Here, we consider the issues and challenges identified in light of some contemporary case studies from outside the field of nursing in the hope of sparking new ideas and strategies. A case study from an Australian practice nurse is included. No research has been conducted on mentoring for nurses in general practice in Australia to date, highlighting an urgent need for new models and their evaluation.

Australia↗
PubMed2004

The North Carolina experience with the diabetes health disparities collaboratives.

BACKGROUND: The Bureau of Primary Health Care (BPHC) adopted a collaborative approach that used the Chronic Care Model and quality improvement methods. The North Carolina Diabetes Prevention and Control Branch has partnered with the 12 participating community health centers since early 2000. METHODS: Team leaders of the first four centers that participated in the collaboratives were interviewed. Information obtained included previous diabetes efforts, benefits of the collaborative, success factors, and barriers to sustainability. CASE STUDY: In one of two case studies, a nonprofit community health center made Chronic Care Model-based changes to the organization of health care, clinical information systems, and delivery system design. RESULTS: Centers tracked used the electronic registry to establish a baseline, trend key process and outcome measures, and raise the standard of care. Success factors included senior leadership support, physician champions, multidisciplinary teams, and priority of collaborative activities. Barriers included staff turnover and low priority in strategic planning. Glycohemoglobin (A1C) values from aggregated reports demonstrated improvement. DISCUSSION: Useful strategies for future collaboratives may include providing provider-specific data, imparting vision to new team members, ensuring that leadership provides collaborative structure and resources, and pairing veteran and new participating sites.

Community Health Centers↗
PubMed2003

[Care of children and adolescents with asthma by primary care physicians: current situation and proposals for improvement].

INTRODUCTION: To provide good asthma care to children and adolescents the following conditions are required: well-trained health professionals with the structure and resources necessary to perform their work efficiently, and client satisfaction as a measure of compliance and self-management. The aims of this study were to determine the current situation of asthma management by primary care pediatricians and to promote improvement of the healthcare and quality of life of these children and their families. MATERIAL AND METHODS: We performed a descriptive study. A questionnaire was completed by primary care pediatricians attending asthma courses given by the Respiratory Team of the Spanish Association of Primary Care Pediatrics in 2001. RESULTS: Three hundred twenty-three questionnaires were completed. The mean age of the pediatricians was 42 years and 70.6 % were women. A total of 7.4 % referred all patients to the pediatric pneumologist and 21.3 % referred all patients to the pediatric allergy clinic; 61.9 % referred only patients with moderate-severe persistent asthma. Concerning items registered in medical records, 32.5 % recorded a codified asthma diagnosis and 61 % included severity classification. Spirometers were available to 48.6 % and peak flow meters to 45.5 %. With regard to lung function measurement, 17.3 % performed spirometry and 33.2 % performed peak expiratory flow. Concerning asthma educational issues, 90.4 % had received education on environmental factors, 81.7 % had received training in the proper use of medication inhalers and 41.2 % had received training in written self-management plans. CONCLUSIONS: This is the first study to present results on the current situation of asthma management by primary care pediatricians in Spain. The results show the need to improve record-keeping, facilitate the resources required for diagnosis and follow-up and prioritize education in order to achieve an optimal level of self-management by patients and their families.

Adolescent↗
PubMed2003

A high concentration of glucose inhibits Tuber borchii mycelium growth: a biochemical investigation.

Tuber borchii mycelium (strain 1BO) is able to utilise glucose, fructose or mannitol in the culture medium as a carbohydrate source. Since sugars not only function as a metabolic resource and structural constituent of cells, but also act as important regulators of various processes, we investigated if high sugar concentrations could influence fungal growth and development. The studies performed in this paper revealed that fructose or mannitol used at high concentration (50 g l-1) in the culture medium do not influence the growth and the biochemical responses of fungus but the growth of T. borchii mycelium is subject to glucose repression. In experiments with a high glucose concentration (50 g l-1) and with 2-deoxyglucose, a non-metabolisable glucose analogue, the growth of T. borchii was halved with respect to the control (10 g l-1 of glucose). The morphological and biochemical analyses revealed that the hyphae were metabolically and functionally active, but the activity of mannitol dehydrogenase was reduced to one-third in the high glucose treatment. This is the first evidence of glucose repression of growth and activity in the ascomycetous ectomycorrhizal fungus T. borchii.

Ascomycota↗
PubMed2000

Baltimore's consumer ombudsman and assistance program: an emerging public health service in Medicaid Managed Care.

OBJECTIVES: To present Baltimore City Health Department's (BCHD) experience in developing and operating an ombudsprogram for Maryland's Medicaid Managed Care HealthChoice Program as an innovative public health response to its MCH Title V assurance functions. METHODS: This paper presents a case study that 1) describes Baltimore City's Consumer Ombudsman and Assistance Program (COAP) in terms of development, function, structure, and resources; 2) provides a summary of its first 30 months' experiences, both quantitatively and qualitatively; and 3) describes COAP's successes, value, and limitations with respect to its three essential roles--a) conflict resolution for individuals, b) education for consumers, providers and advocates, and c) catalyst for quality improvement. OUTCOMES: Over 1300 cases (involving enrollment, access, billing, and treatment issues) were referred to COAP by the State's Complaint Resolution Section during the first 2 1/2 years of HealthChoice. Ombudsman interventions resulted in conflict resolution for enrollees using a continuum of education, mediation and advocacy, and in generating systematic data for systems change through collaboration with state and community public health, managed care organization, provider, consumer, and advocacy officials and groups. CONCLUSIONS: Public health ombudsprograms can effectively assist and educate enrollees; and provide concurrent, or real-time, information for consumer, provider, health plan, and advocacy groups, as well as public policymakers and legislators to better inform systems improvement and innovation. The community-based ombudsman role is an effective mechanism to ensure appropriate care for MCH populations and others with special needs. Such efforts can be funded by federal/state Medicaid administrative funds and are a sound investment in assuring access to comprehensive care for vulnerable populations.

Adolescent↗
PubMed1987

Characterizing attentional resources.

Other studies have found that it is easier to divide attention when messages can be discriminated on the basis of stimulus and response features. The present study extended these results and explored whether dual-task performance is a function of similarity of central processing and, more specifically, the semantic similarity of the competing messages. In a dichotic listening task, subjects detected targets in concurrent messages that either differed semantically and required different central processing (the mixed condition) or were semantically similar and required similar central processing (the same condition). Three criteria are developed to determine whether the tasks in the mixed condition call upon distinct resources. The results are discussed in terms of three metaphors for resources: fuel, structure, and skills.

Attention↗
PubMed2002

Communication: principal barrier to nurse-consumer partnerships.

An 8-month pilot study conducted in urban, rural and remote areas of Australia sought to identify barriers to nurse-consumer partnerships, as well as strategies to overcome these barriers. One hundred and ninety-nine Registered Nurses (RNs) and 36 consumers participated across 14 workshops to collect data for the pilot study. Analysis of these data found that nurses' perceptions of partnership with consumers were diverse. Nevertheless, participants in the workshops identified 'communication' as the principal barrier to nurse-consumer partnerships. Contexts in which communication barriers occur grouped easily under the themes of information transfer, documentation, education, personal and interpersonal situations, guidelines and policy, organizational structures, politics, resources and time. Workshop participants also worked together to identify/recommend strategies through which the most important barriers to communication in nurse-consumer partnerships could be addressed.

Communication Barriers↗
PubMed2002

Whither the drug specialist? The work-force development needs of drug specialist staff and agencies.

Drug specialist staff and agencies have been identified as having a critical role in responding to alcohol and other drug-related harm. This role must be seen in the context of the broad needs of people affected by drug use and the services that they utilize. Unfortunately, as in generic mainstream services, skill development, expertise, organizational structures and resources do not always support the demands of the drug specialist role. In order to develop the drug specialist work-force we must first review the evidence about the factors that influence effective practice. The available research indicates that a range of strategies is required and that these should not only focus on building the capacity of individuals, but also on organizations and systems. Substantial effort in capacity building is required in order to fulfil the expectations created by the title "drug specialist".

Australia↗
PubMed2001

A new bicoumarin from Stellera chamaejasme L.

Thirteen compounds were isolated from roots of Stellera chamaejasme L. (Thymelaeaceae). They are 3-sitosterol (2), simplexin (3), pimelea factor P2 (4), daucosterol (5), (+)-3-hydroxy-1,5-diphenyl-1-pentanone (6), 4-ethoxy-benzoic acid (7), 2,4,6-Trimethoxy-benzoic acid (8), (+)-afzelechin (9), fumaric acid (10), N,N-dimethyl-L-aspartic acid (11), umbelliferone (12), daphniretin (13) and a novel bicoumarin named bicoumastechamin (1). Among the known compounds, 7, 8, 9, 10 and 11 were first isolated from this plant, and 6 was first isolated from the natural resources. Their structures have been elucidated on the basis of spectral data. In vitro bioassays showed that 4 inhibited cancer cell growth, 13 exhibited immunomodulatory activity, and 6 exhibited both immunomodulatory and anti-tumor activity.

Chromatography, Gel↗
PubMed2006

Improving patient safety: resource availability and application for reducing the incidence of healthcare-associated infection.

OBJECTIVE: VHA Mountain States conducted a survey and analysis of infection control (IC) staffing resources, organizational structures, and clinical processes related to reducing the incidence of healthcare-associated infections (HAIs) in community healthcare facilities. METHODS: Member participation was solicited for 2 study components. The first was a survey of demographic characteristics regarding the type and size of the facility and the structure and functions of IC departments. The second was an observational study of infection prevention practices related to general hand hygiene (GHH), ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI), and catheter-related urinary tract infection (CRUTI). RESULTS: A total of 31 not-for-profit community healthcare facilities submitted data; the number of beds in participating centers ranged from less than 50 beds (1 facility) to more than 500 beds (7 facilities). IC department staffing ranged from 0.3 to 5.0 full-time equivalents. There was a positive correlation between average daily census and IC staffing (r = .879; P < .001). Observational studies revealed that compliance with the use of alcohol-based hand rubs (77%) was significantly better than compliance with the use of soap and water (64%; P < .001). Seven (30%) of 23 organizations observed 90% or better compliance with VAP process measures; 7 of 27 (26%) observed 90% or better compliance with guidelines for preventing CRBSI; and 14 (56%) demonstrated proper placement of urinary drainage bags at least 90% of the time. CONCLUSIONS: There was variation in IC department structure and processes among the participating organizations. Infection prevention practices were inconsistent. These findings emphasize the need for more-effective implementation of current evidence-based recommendations for preventing HAIs and reducing the risk of harm to patients.

Catheterization↗
PubMed2001

Functional and structural genomics using PEDANT.

MOTIVATION: Enormous demand for fast and accurate analysis of biological sequences is fuelled by the pace of genome analysis efforts. There is also an acute need in reliable up-to-date genomic databases integrating both functional and structural information. Here we describe the current status of the PEDANT software system for high-throughput analysis of large biological sequence sets and the genome analysis server associated with it. RESULTS: The principal features of PEDANT are: (i) completely automatic processing of data using a wide range of bioinformatics methods, (ii) manual refinement of annotation, (iii) automatic and manual assignment of gene products to a number of functional and structural categories, (iv) extensive hyperlinked protein reports, and (v) advanced DNA and protein viewers. The system is easily extensible and allows to include custom methods, databases, and categories with minimal or no programming effort. PEDANT is actively used as a collaborative environment to support several on-going genome sequencing projects. The main purpose of the PEDANT genome database is to quickly disseminate well-organized information on completely sequenced and unfinished genomes. It currently includes 80 genomic sequences and in many cases serves as the only source of exhaustive information on a given genome. The database also acts as a vehicle for a number of research projects in bioinformatics. Using SQL queries, it is possible to correlate a large variety of pre-computed properties of gene products encoded in complete genomes with each other and compare them with data sets of special scientific interest. In particular, the availability of structural predictions for over 300 000 genomic proteins makes PEDANT the most extensive structural genomics resource available on the web.

Arabidopsis↗
PubMed2002

A molecular cytogenetic map of sorghum chromosome 1. Fluorescence in situ hybridization analysis with mapped bacterial artificial chromosomes.

We used structural genomic resources for Sorghum bicolor (L.) Moench to target and develop multiple molecular cytogenetic probes that would provide extensive coverage for a specific chromosome of sorghum. Bacterial artificial chromosome (BAC) clones containing molecular markers mapped across sorghum linkage group A were labeled as probes for fluorescence in situ hybridization (FISH). Signals from single-, dual-, and multiprobe BAC-FISH to spreads of mitotic chromosomes and pachytene bivalents were associated with the largest sorghum chromosome, which bears the nucleolus organizing region (NOR). The order of individual BAC-FISH loci along the chromosome was fully concordant to that of marker loci along the linkage map. In addition, the order of several tightly linked molecular markers was clarified by FISH analysis. The FISH results indicate that markers from the linkage map positions 0.0-81.8 cM reside in the short arm of chromosome 1 whereas markers from 81.8-242.9 cM are located in the long arm of chromosome 1. The centromere and NOR were located in a large heterochromatic region that spans approximately 60% of chromosome 1. In contrast, this region represents only 0.7% of the total genetic map distance of this chromosome. Variation in recombination frequency among euchromatic chromosomal regions also was apparent. The integrated data underscore the value of cytological data, because minor errors and uncertainties in linkage maps can involve huge physical regions. The successful development of multiprobe FISH cocktails suggests that it is feasible to develop chromosome-specific "paints" from genomic resources rather than flow sorting or microdissection and that when applied to pachytene chromatin, such cocktails provide an especially powerful framework for mapping. Such a molecular cytogenetic infrastructure would be inherently cross-linked with other genomic tools and thereby establish a cytogenomics system with extensive utility in development and application of genomic resources, cloning, transgene localization, development of plant "chromonomics," germplasm introgression, and marker-assisted breeding. In combination with previously reported work, the results indicate that a sorghum cytogenomics system would be partially applicable to other gramineous genera.

Chromosome Mapping↗
PubMed2000

Unbalanced social exchanges and living arrangement transitions among older adults.

Using an elaborated person-environment perspective, this research clarifies the role unbalanced social exchanges play in older adults' living arrangement transitions. Data from the National Survey of Families and Households (NSFH) are used to estimate destination-specific hazard models that include measures of baseline living arrangements, demographic characteristics, financial resources, family structure, and social exchanges. Distinctions are made between transitions that occur within the community and transitions into an institution or death. The results indicate that unbalanced exchange relationships are an integral part of the living arrangement transition process in later life.

Activities of Daily Living↗
PubMed2002

Linking private and public sectors in tuberculosis treatment in Kathmandu Valley, Nepal.

Tuberculosis (TB) is a major public health problem and the world's foremost cause of death from a single infectious agent. Despite the increasing number of TB patients who seek help in the private sector, there are few practical examples of how to create a public/private linkage of TB services. The paper presents a pilot service-linkage project between the public and private sector in TB control in Kathmandu Valley, Nepal. The study documents and examines the process of the service-linkage project through the undertaking of a longitudinal analytical case study. A detailed description of the project from formulation to a short-term evaluation is given. The analysis relates the activities and early outcomes of the service-linkage project to the context, characteristics and interactions of the organizations involved. The study reveals that although the involved organizations initially agreed on the objective of the service-linkage project, differences in capacity, motivation, environment and needs had implications for the implementation and short-term success of the project. The public sector, despite the will, did not have the structure or resources to engage with the private sector. The private sector lacked interest in public health aspects of TB treatment and trust in the public sector. The study points to two different organizations that have the potential capacities to act as mediators between the public and private sectors: international research institutions and non-governmental organizations.

Antitubercular Agents↗
PubMed2002

YPL.db: the Yeast Protein Localization database.

The Yeast Protein Localization database (YPL.db) contains information about the localization patterns of yeast proteins resulting from microscopic analyses. The data and parameters of the experiments to obtain the localization information, together with images from confocal or video microscopy, are stored in a relational database, building an archive of, and the documentation for, all experiments. The database can be queried based on gene name, protein localization, growth conditions and a number of additional parameters. All experiment parameters are selectable from predefined lists to ensure database integrity and conformity across different investigators. The database provides a structure reference resource to allow for better characterization of unknown or ambiguous localization patterns. Links to MIPS, YPD and SGD databases are provided to allow fast access to further information not contained in the localization database itself. YPL.db is available at http://ypl.tugraz.at.

Computer Graphics↗
PubMed2006

Flexible Structural Neighborhood--a database of protein structural similarities and alignments.

Protein structures are flexible, changing their shapes not only upon substrate binding, but also during evolution as a collective effect of mutations, deletions and insertions. A new generation of protein structure comparison algorithms allows for such flexibility; they go beyond identifying the largest common part between two proteins and find hinge regions and patterns of flexibility in protein families. Here we present a Flexible Structural Neighborhood (FSN), a database of structural neighbors of proteins deposited in PDB as seen by a flexible protein structure alignment program FATCAT, developed previously in our group. The database, searchable by a protein PDB code, provides lists of proteins with statistically significant structural similarity and on lower menu levels provides detailed alignments, interactive superposition of structures and positions of hinges that were identified in the comparison. While superficially similar to other structural protein alignment resources, FSN provides a unique resource to study not only protein structural similarity, but also how protein structures change. FSN is available from a server http://fatcat.burnham.org/fatcat/struct_neighbor and by direct links from the PDB database.

Databases, Protein↗
PubMed1996

Social support networks of confidants to people with AIDS.

AIDS has a devastating impact on the social support networks of those most closely involved with the person with AIDS (PWA). This qualitative study of the social support networks of confidants to PWAs reports the findings of intensive, semistructured interviews with 11 confidants. Numerous changes were observed in the confidants' supportive resources, network structure, and functioning. Implications for social work practice are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Medical students as patients: a pilot study of their health care needs, practices, and concerns.

BACKGROUND: The personal health experiences of medical students may contribute in important but previously unacknowledged ways to their well-being and education. This pilot study surveyed medical students about their health care needs, practices, insurance status, and concerns about seeking care. METHOD: A questionnaire was developed and distributed to 151 students at the University of New Mexico School of Medicine in 1993-94. Participant privacy was protected. Responses were compiled and analyzed using logistic regression models and odds ratios. RESULTS: A total of 112 students responded. Most reported health care needs and half routinely received care at their training institution. One-third had informally requested prescriptions or diagnostic tests from medical school faculty and housestaff; one-fourth used such informal consultation as their "usual" method of obtaining care. Eighteen students were uninsured. The students reported that they had not sought care for several reasons, and many had experienced difficulty in obtaining care. The students indicated concern about confidentiality and about the dual role as both student and patient at the training institution. They believed that their academic standing would be jeopardized if they developed certain health problems. When asked about hypothetical scenarios, a majority preferred to avoid the dual role of medical-student-patient. When asked about scenarios in which medical student peers exhibited suicidal depression or severe drug abuse, the students overwhelmingly preferred not to notify the medical school administration. Significant differences in responses were found with respect to gender and training level. CONCLUSION: This pilot study examined the health care needs, practices (including the use of informal consultation), insurance status, and concerns of students at one medical school. The findings highlight the students' perceptions of illness and vulnerability during medical school training. Constructive implications for academic medicine are discussed regarding initiatives in the areas of policy, research, and the resources and structure of student health care services.

Adult↗