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Nursing home utilization patterns: implications for policy.

Nursing homes represent the fastest growing component of health care expenditures, over half of which come from public funds. This paper reviews research on nursing home utilization with regard to several policy issues concerning the subsidization of long-term care by Medicaid. As a background, the paper defines and contrasts three concepts; need, demand, and utilization. It then indicates how Medicaid policies regarding reimbursement of homes and eligibility for support can result in a chronic shortage of beds and describes the estimated effects on utilization of eight variables: Medicaid generosity, age structure, family resources, racial composition, residence, financial capability of the elderly, price of nursing home care and alternative sources of care. The paper concludes that there is a need for: subsidization of a more comprehensive set of long-term care services, a review of reimbursement policies, and improved methods of allocating existing nursing home beds among persons desiring care.

Aged↗

The healthcare manager as catalyst for evidence-based practice: changing the healthcare environment and changing experience.

This thoughtful essay conveys a logically ordered series of concepts that may help develop a process to more fully integrate evidence into healthcare management decisions. In responding to this article we have tried to think broadly about what might be discovered if the ideas of Browman, Snider and Ellis were put into practice. We have chosen to focus on factors that could confound the five-point plan suggested by the authors. Browman, Snider and Ellis provide an interesting overview and advocacy for evidence-based medicine and its application. The authors recognize that the area under investigation, oncology, may lend itself more readily than others to the facilitation of evidence-based practice. They introduce the concept of healthcare as a negotiating environment and the healthcare manager as a potential catalyst for change. In their conclusions the authors offer healthcare managers a five-point plan: 1. Express the value that knowledge is a core resource. 2. Structure decision-making to involve the stewards of knowledge and stimulate negotiation while encouraging the parties to express shared goals. 3. Invest in strategies that support knowledge management, including arbitration. 4. Demonstrate leadership and develop organizational metaphors to encourage participation. 5. Share the results and experiences of evidence-based decision-making.

Decision Making, Organizational↗

Cytotoxic chemotherapy in the home: a study of community nurses' attitudes and concerns.

Cytotoxic chemotherapy initiated in a hospital setting and continued in the home is an expanding service. The evolution of such a service received a boost with the publication of the NHS Cancer Plan (Department of Health (DH), 2000a) and the NHS Manual of Cancer Service Standards (DH, 2000b). The literature claims a range of benefits of such a service including enhanced standards of care and cost savings. Effective care depends on a number of key factors including assessment, management of risk and support, i.e. appropriate policies and the availability of adequate resources. This study among community nurses reveals a number of key findings including the incremental nature of the development of policy and practice, the general acceptance that changes in community practice are inevitable and welcome where the changes enhance the care of patients, and a level of concern about the availability of appropriate resources and structures necessary for safe and effective practice.

Antineoplastic Agents↗

Negotiating multiple identities in a queer Vietnamese support group.

My participant-observation with O-Môi, a support group for Vietnamese lesbians, bisexual women and female-to-male transgenders, and interviews with members, focusing on how different identity issues are negotiated, suggest that despite O-Môi's claim of supporting its members' multiple marginalized identities, group processes in everyday pragmatic interactions construct a hierarchy that centers and normalizes experiences of bilingual Vietnamese lesbians. This renders the marginalization of bisexual women, transgender men, and Vietnamese/English monolingual members. Using the concept of "identity work" to examine the intersection of race/ethnicity, class, and gender/sexuality as everyday (counter)hegemonic processes, I discuss how organizational structure, discourse resources, and personal politics orient and mold members' talk and interactions leading to normalization and/or marginalization of certain groups' experiences.

Female↗

Teaching medical informatics a la carte: a curriculum for the professional palate.

Health professionals as well as students vary greatly in their appetite for medical informatics and evidence-based medicine. The information professional is challenged by the need for instructional programs that support the use of medical informatics to a diverse audience. For teaching programs to be successfully received, the information professional must be able to offer an adaptable curriculum that can be arranged to meet the differing needs of a wide range of health professionals. The Educational Services Department at New York University Medical Center has designed and implemented a multidisciplinary curriculum that serves as a model for health and information professionals to meet a variety of goals and objectives. This paper describes how the curriculum evolved. It is presented as a menu of offerings that may be coordinated and adapted to meet the varying skills and needs of clinicians, basic scientists, residency training programs, medical student clerkships, and nursing and allied health programs. Informatics programs that may include workshops in basic computer skills, identification of information resources, the structure of information, developing search strategies in support of evidence-based medicine, identifying qualitative journal literature, and critical appraisal of the literature, are easily adapted to any audience and schedule.

Academic Medical Centers↗

Telepresence.

Telepresence, the perception of presence within a physically remote or simulated site, has been identified as a design ideal for synthetic environments. However, confusion exists within the literature about the precise definition of telepresence. Furthermore, there is a need for a plausible and parsimonious model of telepresence. This paper identifies three types of telepresence extant in the literature: simple telepresence, cybernetic telepresence, and experiential telepresence. The third definition is the most interesting. This paper reviews the origins of experiential telepresence and the theoretical approaches commonly used to explain it. One can term these technological approaches, which emphasize the role of control/display technology, and psychological approaches, which identify experiential telepresence with known psychological phenomena. Finally, the paper presents and discusses an integrative approach to telepresence featuring a structured attentional resource model. Actual or potential applications of this research include the design of future human-machine interfaces for teleoperated robots and virtual reality systems.

Cybernetics↗

Privatisation of veterinary services in Jamaica: a case study.

Clinical veterinary services were privatised in Jamaica in September 1992. Using the limited official data, the authors briefly examine the premise and logistics behind transferring the responsibility for clinical services, which may be regarded as 'a private good', to private veterinary practitioners. There are indications that this privatisation model can work for farmers, despite financial problems in the livestock industry and a decline in production, caused by trade liberalisation policies and the substitution of cheaper imports. In addition, other national fiscal problems, such as a downturn in the economy, have left veterinarians attempting to boost production in a livestock industry which lacks adequate financial structuring and resources. The authors express concern that various unpublished projections since the last official agricultural survey in 1996 indicate that the livestock industry in Jamaica is diminishing. It is possible that valuable genetic breeding stock may never recover. A comprehensive study of the future of the livestock industry and its associated services is strongly urged. Ten years after the event, the authors reflect on the privatisation of clinical veterinary services in Jamaica and offer some suggestions to improve on the quality of the services offered by private veterinary practitioners.

Animal Husbandry↗

Objective criteria for evaluating occupational health programs.

An objective scoring system is proposed as a single and flexible method of evaluating occupational health programs to appraise the extent to which existing programs approach a basic standard of excellence as defined by a theoretical model based on published and professionally acceptable guidelines and standards. This proposed system emphasizes the importance of an interdependent relationship between four program components: (1) guiding philosophy and policy; (2) organizational structure; (3) resources; (4) occupational health services, and it stresses the importance of long range health commitments to employee health status in contrasts to short range health commitments aimed primarily at an economic payoff to a sponsoring agency, institution, or company. The proposed evaluation scheme should enable self-evaluation by individual programs. Additionally, programs can utilize this evaluative tool to examine their influence on such important questions as employee hospital utilization and other specific elements of employee health in an objective, relatively simple manner.

Evaluation Studies as Topic↗

The development of worker-controlled occupational health centers in Canada.

Over the past decade worker-controlled occupational health centers have been established in three Canadian provinces. This development has been a response to the slowness in recognizing occupational medicine in the Canadian medical community, the limited availability and questionable acceptability of existing services, as well as the growth of worker control in occupational health matters generally. The history, funding, organizational structure, personnel, resources, and programs of these worker-controlled centers are outlined, illustrating the extensive programs that can be provided despite small budgets of these operations. Advantages to workers include direct access to resources as well as expert professional advice with the focus on work place hazards. Furthermore, the centers provide for extensive interaction among workers on their common concerns. Disadvantages of the model include restricted access to work places associated with frequent distrust of employers. Employer-based and university-based models are compared to worker-controlled centers, and it is suggested that the latter may influence the pattern of practice of occupational health as well as the ability of workers and their unions to promote improved occupational health and safety conditions.

Canada↗

Artificial Intelligence for Natural Products Discovery and Development.

Natural products (NPs) remain a cornerstone of modern drug discovery, offering stereochemical complexity and diverse bioactivities that precisely modulate therapeutic targets, refined through billions of years of evolution. However, their research has long been hindered by inefficient, empirical workflows, high resource consumption, structural complexity, and the "multicomponent, multi-target" nature of their mechanisms. The exponential growth of genomic, metabolomic, and spectral data has overwhelmed conventional analytical methods, exposing critical bottlenecks in handling high-dimensional, heterogeneous datasets that exceed human interpretive capacity. Artificial intelligence (AI) is emerging as a transformative paradigm to address these challenges, integrating multi-omics and chemical data to shift NP research from fragmented empiricism toward mechanism-driven, precision-oriented development. By leveraging deep learning architectures- including graph neural networks, Transformers, and diffusion-based generative models-AI enables systematic decoding of NP biosynthesis, automated structure elucidation, rational target identification, knowledge extraction from vast unstructured scientific literature, and de novo molecular design. This review comprehensively surveys recent advances in AI applications across the full NP discovery and development pipeline, encompassing genome mining, structure-based and ligand-based virtual screening, multimodal structural characterization, lead optimization, and biosynthetic pathway engineering. We further examine the emerging roles of protein-centric, molecule- centric, and multimodal foundation models, as well as large language models, in bridging genotype-to-chemotype gaps and unlocking unstructured scientific knowledge. Finally, we discuss critical challenges including data scarcity, representational limitations for complex stereochemistry, physical plausibility in generative models, and the urgent need for experimental validation, while outlining future directions toward autonomous experimentation, closed-loop optimization, and human-AI collaborative discovery.

Artificial intelligence↗

Emotional intelligence skills for maintaining social networks in healthcare organizations.

For healthcare organizations to survive in these increasingly challenging times, leadership and management must face mounting interpersonal concerns. The authors present the boundaries of internal and external social networks with respect to leadership and managerial functions: Social networks within the organization are stretched by reductions in available resources and structural ambiguity, whereas external social networks are stressed by interorganizational competitive pressures. The authors present the development of emotional intelligence skills in employees as a strategic training objective that can strengthen the internal and external social networks of healthcare organizations. The authors delineate the unique functions of leadership and management with respect to the application of emotional intelligence skills and discuss training and future research implications for emotional intelligence skill sets and social networks.

Emotions↗

Creating mosaics: the interrelationships of knowledge and context.

This qualitative interpretivist study analyzed the interrelationships between the knowledge gained through continuing nursing education programs and the context of nurses' clinical practice. The content of nursing continuing education programs offered 9-12 months previously was reviewed. Forty semi-structured, tape-recorded interviews were conducted with nurses from hospitals, nursing homes and home care agencies to determine their use of this new knowledge. Findings indicate that nurses used information from continuing education programs to construct a knowledge base and that this process was affected by the structural, human resources, political and symbolic frames of the context in which nurses practice.

Attitude of Health Personnel↗

Bacterial infections among patients with diabetes in Papua New Guinea.

This study reports the morbidity that resulted from bacterial infections in Melanesian patients with non-insulin-dependent diabetes who attended the Port Moresby General Hospital, Papua New Guinea, between January 1, 1982 and June 30, 1984. Fifty-three of 160 patients with diabetes experienced 66 episodes of infection, 48 of which required inpatient hospital treatment. The average length of stay in hospital was 37.6 days per episode of infection. Of 88 patients who were newly-diagnosed as diabetic during this period, 30 patients initially had presented with a bacterial infection. The lower limb was the site that was infected most frequently, and Staphylococcus aureus and Klebsiella pneumoniae were the usual causative organisms. Eleven patients had bacterial gangrene of the foot; two of these patients were less than 23 years of age, and five patients were not known to have had diabetes previously. Five patients were suffering from pulmonary tuberculosis; the annual incidence of tuberculosis in this study group (12.5 cases/1000 patients) was about 11-times higher than that which has been reported for the general population. Thirteen patients with diabetes died in hospital during the study period. Infection was the cause of death in nine patients and three of these patients were less than 25 years of age. The morbidity of infection can be controlled if diabetes is sought more frequently in patients with infections, and if glycaemia can be controlled. This will have to be achieved through existing primary health-care structures, as resources for diabetes-specific preventive programmes in developing countries will be limited.

Adult↗

An ounce of prevention.

Hospitals that see financial trouble coming should do a candid assessment of their resources and structure as the first step in preventing a slide toward an emergency turnaround situation. That's the advice of Michael Rindler and Anthony Chirchirillo.

Hospital Administration↗

Preparing stewards for tomorrow. A healthcare system's intern program provides mentors for potential trustees.

Mentors can provide support essential to a person's advancement and growth in a new business or position. Because of the complex and rapidly changing nature of healthcare, mentors can be particularly valuable to persons interested in becoming healthcare facility trustees. Since 1987, the Sisters of Mercy Health System (SMHS), St. Louis, has implemented a comprehensive intern program for potential trustees. Each intern is assigned to a board and a board member mentor at an SMHS facility. The program lasts for two years and includes a didactic component, independent study, clinical experience, regularly scheduled meetings, and issuance of a certificate on completion. Thus far, the interns have been sisters from education, healthcare, social service, or other ministries. They must show abilities crucial for successful trustees (such as listening skills), an appreciation of and strong support for the ministry, and a willingness to commit the time and energy to the program. Mentors chosen for the program also must devote time to orientation and meetings and must assist interns in integrating mission and values into board activities. In addition, mentors help interns identify the focus of present structures and resources and their appropriateness and discuss the trustee's role and responsibilities and dynamics for quality decision making.

Catholicism↗

Concept on health promotion about the unemployed in Switzerland.

Unemployment is a relatively new phenomena for Switzerland. Compared with other countries our unemployment rate of approximately 4% is rather low. Among the unemployed we found similar health problems as in other countries. The health situation of the unemployed forces us to take more notice of their problems. In our federalist country many national, cantonal and local institutions are treating social and health questions, but no one is responsible for the health problems of the unemployed, resulting in ineffective interventions. In order to change this situation we have developed a national concept of health promotion for the unemployed and are seeking to implement it. Three areas of health promotion for the unemployed and their families: Services within existing, and if need, newly created institutions, which can range from counselling to triage and further referral; Health modules in existing occupational programs and formation courses as an introduction to the health problems of the unemployed; Special health courses for the unemployed with in depth treatment of health questions. Realisation steps of the concept: Sensitisation of the responsible institutions and persons; Systematic documentation of existing resources and structures; Elaboration of the course concepts and documents; Carrying out of pilot projects; Set-up of an infrastructure on the national, cantonal and local level.

Health Promotion↗

Minimal requirements in prostate cancer irradiation: a consensus document by the AIRO Lombardia Cooperative Group.

PURPOSE: With the aim of establishing clinical and technical criteria to homogenize radiotherapy practice, a working group of AIRO-Lombardia (Associazione Italiana di Radioterapia Oncologica--Gruppo regionale della Lombardia) has tried to define minimal requirements for radical and postoperative irradiation in prostate cancer. The document has been structured in such a way as to be also of interest to the urological and medical oncology communities. METHODS: The working group, composed of representatives of most of the regional radiotherapy departments in the Lombardy region, had monthly meetings during 1996 and 1997. The document on minimal requirements has been derived from the participants' combined experience and knowledge, from review of the literature, and from a 1995 regional survey on current practice of prostate irradiation. RESULTS: Minimal requirements for radical and postoperative irradiation of prostate cancer have been defined with respect to treatment strategies, pre-treatment diagnostic evaluation and staging, treatment prescription, preparation and execution, and quality assurance procedures. CONCLUSION: Standards of reference for minimal requirements in prostate cancer irradiation adapted to the regional structures and resources have been defined.

Humans↗