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PubMed2000

Guideline development in Europe. An international comparison.

OBJECTIVES: To identify major differences and similarities in the development of clinical guidelines in different European countries. METHODS: A collaboration of researchers is funded by the European Commission to compare the approaches to guideline development in collaborators' countries. The program encompasses a series of tasks, the first being to identify and document current guideline procedures in the collaborating countries. A survey gathered information on guideline production, dissemination, and implementation in the 10 European countries involved in the project consortium: Denmark, England and Wales, Finland, France, Germany, Italy, the Netherlands, Scotland, Spain (both the Basque Country and Catalonia), and Switzerland. RESULTS: Seven countries have a national policy on guideline production, dissemination, and implementation, and three countries are discussing their policies. A majority of guidelines are currently produced at the national level in six of the countries and at the regional or local level in the other four. Central or national funding supports guideline production in six countries. Additional sources of funding include medical societies, pharmaceutical companies, and health insurance companies. Several of the countries have published or are preparing evaluations of their dissemination strategies. CONCLUSIONS: The survey highlighted wide variation in the methods and policies of guideline development in Europe. The Appraisal of Guidelines, Research, and Evaluation in Europe (AGREE) Collaboration research program will identify the characteristics of the "better" guideline programs and will provide the basis for more research-generated policy initiatives in the future, helping to ensure that guidelines play a major role in improving patient care in the millennium.

Cross-Cultural Comparison↗
PubMed1996

Health information services technologies.

Increasing demands for provider profiling have led to the growth of health information services units within payers and health plans. An important decision faced by these groups is whether to buy or build the information infrastructure necessary to support the activities of the department. The article offers an overview of a system that was collaboratively designed and built by Blue Cross and Blue Shield of Iowa and the Dartmouth Medical School. A case study illustrating the flexibility of the information system in adapting ambulatory care groups to the fee-for-service payer industry is reviewed.

Ambulatory Care↗
PubMed2005

Clinical competence in sharp debridement: an innovative course.

A quick and effective way of promoting wound healing is to carry out sharp debridement where indicated, but this procedure carries a high level of clinical risk. Minimizing risk is an essential feature of clinical governance. A new course in wound debridement was developed at King's College, London in response to local NHS trust demand which required assessment of competence for this high-risk procedure. This innovative development crossed traditional boundaries, and required high collaboration between education and practice.

Animals↗
PubMed1995

Multisite evaluation of four anti-HIV-1/HIV-2 enzyme immunoassays. Australian HIV Test Evaluation Group.

The performance of four enzyme immunoassays, manufactured by Abbott, Diagnostics Pasteur, Genetic Systems, and Organon Teknika, for the combined detection of anti-human immunodeficiency virus type 1 (HIV-1) and anti-HIV-2, was examined in a multisite evaluation. The collaborative efforts of 7 Australian Red Cross Blood Transfusion and 12 Australian Public Health Laboratories minimized potential biases in data by providing large numbers of anti-HIV-1-negative and -positive samples. Sensitivity was estimated using samples that were positive for anti-HIV-1 from individuals known to be infected and seroconversion samples. Sensitivity estimates in the four assays were 99.71, 99.94, 99.49, and 99.68%, respectively. Specificity was measured using fresh, sequential blood donations and samples with previous false-positive reactions in other assays. Specificity estimates from blood donations were 99.92, 99.46, 99.67, and 99.85%, respectively. The data were analyzed further using the delta statistic, which distinguishes the performance of assays of similar sensitivity and specificity by providing a measure of how well results in a population of positive or negative samples are removed from the assay's cutoff value.

Australia↗
PubMed1998

The primary/secondary interface. Cross-boundary teamwork--missing link for seamless care?

Factors for providing a seamless service are given and it is suggested that more collaborative interactions between organizational groups are needed to achieve this. It is argued that competitive philosophy within the NHS has been prohibitive to seamless care. Elements of the White Paper (DoH, 1997) are discussed in relation to this. Features of a collaborative organization are briefly discussed. Three current 'models' of cross-boundary interaction at the point of patient transfer are discussed. A fourth model involving enhanced inter-sector teamwork with multidisciplinary membership and shared professional, management and patient/carer responsibility is proposed.

Communication↗
PubMed2000

Obstacles to collaborative quality improvement: the case of ambulatory general medical care.

OBJECTIVE: To assess the effectiveness of inter-site collaboration and report-card style feedback of quality measures on quality improvement in the outpatient setting and to identify major barriers to improvement. DESIGN: A collaborative quality improvement effort consisting of a large cross-sectional data collection effort (chart reviews and patient surveys), feedback of comparative quality of care data to improvement teams, and collaboration between sites. SETTING: Eleven primary care sites in the Boston area. STUDY PARTICIPANTS: Quality improvement teams at each site with physician leaders. INTERVENTION: Education about techniques of rapid-cycle quality improvement, coaching of on-site teams, and report-card style feedback of comparative site-specific quality of care data. RESULTS: Multiple quality improvement projects were undertaken through this collaboration. However, though we were careful to educate teams on methods of continuous quality improvement and to name specific clinical leaders, the degree of collaboration and quality improvement fell short of expectations. Major impediments to improvement included lack of team members' time and resources, lack of incentives, and unempowered team leadership. The primary obstacle to collaboration was the diversity of sites and inability of teams to create interventions that were relevant to other sites. CONCLUSION: Despite ample quality of care data, quality improvement education, and a structured collaborative process, achieving quality improvement in the ambulatory setting is still a difficult challenge. Organizations need to find ways of overcoming the obstacles faced by improvement teams in order to maximize quality improvement.

Ambulatory Care↗
PubMed2004

Mild cognitive impairment: a cross-national comparison.

OBJECTIVE: The main aim of this collaborative study was to assess the comparability of the most commonly used criteria for mild cognitive impairment (MCI) by comparing the cognitive performance of patients with MCI from the Mayo Clinic (USA) and the Karolinska Institutet (Sweden). METHODS: Standardised neuropsychological test scores were used to compare the two samples from the two institutions with regard to the number of cognitive domains in which performance was below 1.5 SD. Possible predictors for the conversion from MCI to Alzheimer's disease (AD) were assessed. RESULTS: When the two institutions were considered together in the Cox proportional hazard model, the number of affected cognitive domains below 1.5 SD was a significant predictor of time to AD diagnosis with age, education, and APOE epsilon4 genotype entered into the same model as covariates. The number of affected cognitive areas remained as a significant predictor when the institutions were considered separately. The logistic regression model of conversion to AD showed that only tests assessing learning and retention were predictors of developing AD. CONCLUSIONS: Differences in population as well as in methodology of case ascertainment as well as other aspects may account for the observed variability between samples of patients with MCI. The number of impaired cognitive factors at baseline can predict the progression from MCI to AD. Furthermore, tests assessing learning and retention are the best predictors for progression to AD.

Aged↗
PubMed1984

Informed versus blind: the reliability of cross-sectional ratings of psychopathology.

Fifty subjects at the New York facility of the National Institute of Mental Health Clinical Research Branch Collaborative Program on the Psychobiology of Depression were evaluated for cross-sectional psychopathology and functional impairment at the 2-year followup by two professional raters, one blind and one with extensive knowledge of the subject's psychiatric history and course of illness and treatment (the cohort rater). Ratings were made on the change version of the Schedule for Affective Disorders and Schizophrenia. Interrater reliability, as tested using the intraclass correlation coefficient, was quite good for most of the symptom ratings and fair on measures of functional impairment and social functioning. However, there was a consistent tendency for the blind rater to score higher levels on symptoms of depression and anxiety than the informed cohort rater. Reasons for disagreement in different symptom areas are discussed. Using only the informed rater provides a very adequate picture of severity and patterns of psychopathology on a cross-sectional basis.

Adult↗
PubMed2005

Interagency collaboration between child protection and mental health services: practices, attitudes and barriers.

OBJECTIVE: The aim of this paper is to examine some of the factors that facilitate and hinder interagency collaboration between child protection services and mental health services in cases where there is a parent with a mental illness and there are protection concerns for the child(ren). The paper reports on agency practices, worker attitudes and experiences, and barriers to effective collaboration. METHOD: A self-administered, cross-sectional survey was developed and distributed via direct mail or via line supervisors to workers in statutory child protection services, adult mental health services, child and youth mental health services, and Suspected Child Abuse and Neglect (SCAN) Teams. There were 232 completed questionnaires returned, with an overall response rate of 21%. Thirty-eight percent of respondents were statutory child protection workers, 39% were adult mental health workers, 16% were child and youth mental health workers, and 4% were SCAN Team medical officers (with 3% missing data). RESULTS: Analysis revealed that workers were engaging in a moderate amount of interagency contact, but that they were unhappy with the support provided by their agency. Principle components analysis and multivariate analysis of variance (MANOVA) on items assessing attitudes toward other workers identified four factors, which differed in rates of endorsement: inadequate training, positive regard for child protection workers, positive regard for mental health workers, and mutual mistrust (from highest to lowest level of endorsement). The same procedure identified the relative endorsement of five factors extracted from items about potential barriers: inadequate resources, confidentiality, gaps in interagency processes, unrealistic expectations, and professional knowledge domains and boundaries. CONCLUSIONS: Mental health and child protection professionals believe that collaborative practice is necessary; however, their efforts are hindered by a lack of supportive structures and practices at the organizational level.

Adult↗
PubMed1996

Patient satisfaction with collaborative practice.

OBJECTIVE: To gather information on women's perceptions of the services delivered in collaborative obstetrics and gynecology practices and to determine whether patients perceive a difference in the delivery of services in a variety of practice settings. METHODS: A cross-sectional patient satisfaction survey was developed by the Collaborative Practice Advisory Group of ACOG. Ten collaborative practices were selected to participate: five in private offices, two in clinics, two in health maintenance organizations, and one in the military. Between April 15 and May 15, 1994, 3257 completed surveys were obtained for analysis. RESULTS: Between 71% and 92% of women, depending upon the practice setting, agreed with statements regarding the possible benefits from being cared for in a collaborative practice. The majority (75-92%) expected services provided in a collaborative practice to differ from those provided in a noncollaborative practice. Women making their first visit to a collaborative practice expected quicker appointments, more time with the provider, more health information, and more specific diet information than did women who had previously been seen in such a practice. There were minimal differences in comfort levels when discussing issues of sexuality and physical and sexual abuse in either public or private settings with physicians or non-physicians. CONCLUSIONS: Patients in this survey were accepting of the concept of collaborative practice and felt that it offered quicker appointments, more time with the provider, more health information, and more specific diet information than did physician-only practices.

Adult↗
PubMed1995

Health Emergencies in Large Populations (H.E.L.P.): a comprehensive training programme.

This article describes the training programme that the Medical Division of the International committee of the red cross has set up since 1986 in collaboration with the Geneva Medical School and WHO. It is meant primarily for health professionals who will have to deal with large populations in critical situations. The objectives and the organization of the course are described and the results of this training programme are analyzed in terms of number and distribution of participants as well as in terms of impact of the programme on coordination of aid agencies' work.

Emergency Medical Services↗
PubMed2007

Spirit of aging rising: cross-cutting thematic modules to enrich foundation graduate social work courses.

To enrich an urban generalist MSW program serving a diverse aging community, an innovative approach was initiated. A team of students, faculty and a field instructor collaborated in creating and evaluating 3 sets of cross-cutting thematic modules. An overview of the thematic modules (addressing elder abuse, family caregiving, and mental health), integrated across multiple curriculum areas (Human Behavior and the Social Environment, Macro/Policy, Practice and Research), is presented along with results of a faculty focus group evaluating the process of coordinating module content for one full week of class per foundation area (one topic per quarter).

Aged↗
PubMedDate not supplied

The preceptor--preceptee model for faculty "cross-training".

In the review of the literature, the author notes several discussions concerning collaboration between nursing education and service agencies for updating faculty clinical practice. This article addresses the Preceptor-Preceptee model for Faculty "Cross-training," including the permission process, method, needs analysis, and evaluation. A concluding statement by the author strongly recommends the utilization of the faculty practice model to enhance the faculty's competence in clinical nursing areas.

Clinical Competence↗
PubMed1989

WHO MONICA Project: risk factors.

The WHO MONICA Project was designed to measure trends and determinants in cardiovascular disease mortality and coronary heart disease and cerebrovascular disease morbidity, and to assess the extent to which these trends are related to changes in known risk factors in 39 collaborative centres in 26 countries. Results of the baseline population surveys are presented. Use of standardized methods allows cross-sectional comparisons to be made of data from the 39 collaborating centres. The proportion of smokers varied between 34-62% among men and 3-52% among women. The median systolic blood pressure (SBP) values varied from 121 mmHg to 145 mmHg in men and from 117 mmHg to 143 mmHg in women. Median diastolic blood pressure (DBP) values varied from 74 mmHg to 91 mmHg in men and from 72 mmHg to 89 mmHg in women. The prevalence of actual hypertension, defined as SBP and/or DBP greater than 159/94 mmHg, or on antihypertensive medication, varied between 8.4% and 45.3% in men and between 12.6% and 40.5% in women. Median serum total cholesterol values varied from 4.1 mmol/l to 6.4 mmol/l in men and from 4.2 mmol/l to 6.4 mmol/l in women. The results show that there is a large variability in the risk-factor patterns among the MONICA populations. They also indicate that populations with low levels of risk factors are in the minority.

Adult↗
PubMed1995

Empowerment meets narrative: listening to stories and creating settings.

Comments on and summarizes some of the themes of a special issue on empowerment. Extends empowerment theory with the suggestion that both research and practice would benefit from a narrative approach that links process to practice and attends to the voices of the people of interest. Narrative theory and method tends to open the field to a more inclusive attitude as to what counts as data and to cross-disciplinary insights as well as citizen collaboration. Communal narratives are defined at various levels of analysis, including the community, the organizational, and the cultural. A definition of empowerment that includes a concern with resources calls attention to the fact that communal narratives and personal stories are resources. Implications for personal and social change are suggested.

Community Networks↗
PubMed1984

Production and testing of an international reference standard of short ragweed pollen extract.

A lyophilized candidate International Reference Standard of short ragweed pollen extract was prepared by use of defined source material. In preliminary experiments, this extract was demonstrated by RAST inhibition and crossed radioimmunoelectrophoresis assays to contain several well-characterized ragweed allergens and to contain multiple antigenic bands by crossed immunoelectrophoresis analysis. In a subsequent multinational collaborative study involving 12 laboratories in five countries, the candidate extract was compared with existing national reference or commercial ragweed extracts by a variety of immunochemical, biochemical, and physicochemical procedures. The candidate extract could be used to assign relative orders of potency to the comparison-test extracts. In separate studies, the candidate extract was demonstrated to be stable when it was stored at either -20 degrees C or +5 degrees C for at least 2 yr. The candidate extract has been accepted as an International Reference Standard with an assigned arbitrary potency of 100,000 units per ampule .

Humans↗
PubMed1987

The depressed hyperthyroid patient.

The case of a person who developed episodic psychotic depression both during hypothyroid and hyperthyroid states is presented. This case illustrates the clinical interaction between an endocrine disorder and predisposing and concurrent psychologic risk factors for an affective disorder. The patient's troubled clinical course demonstrates the critical importance of expert clinical attention to both the psychologic and neuroendocrinologic factors involved. Successful management requires a collaborative interdisciplinary treatment plan as well as cross specialty knowledge. Finally, this case offers information about that complex interaction between the limbic and endocrine systems and their respective contributions to the development of affective disorders.

Adult↗