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Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

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PubMed1994

Implementing the Boston Healthy Start Initiative: a case study of community empowerment and public health.

This article examines the efforts on the part of a city health department, in partnership with a broad-based coalition of community-based, government, and social service agencies, to plan and implement, using principles of empowerment and community participation, a federally funded infant mortality reduction program. It examines the social and institutional dynamics of sharing power in an environment highly charged politically. Infant mortality in Boston is much more than a public health problem. It is the focal point of complex racial, political, and institutional factors. This case study illustrates how empowerment moves from rhetoric to reality and the challenge to both traditional public health practice and traditional community mobilization. The article describes the federal Healthy Start Initiative and its community participation mandate, the background on infant mortality in Boston, a case study of the development of the Healthy Start program from the perspective of community empowerment, and finally, the lessons learned in the first 2 years of the program. It describes the controversies encountered, some of the mistakes made, and the ways found that government must be reinvented if empowerment is to be a real public health tool.

Black or African American↗
PubMed1992

Shared information could revolutionize healthcare.

Hospitals soon may learn the value of shared information technology. The idea of "community health information networks" is picking up steam as payers and policymakers look for ways to control costs and measure the quality of care. Backing from the federal government is likely to make the transition speedier and perhaps less painful than it was for other industries.

Community Health Services↗
PubMedDate not supplied

Preventive medicine: notes toward an agenda for change.

Preventive medicine is an exciting specialty that is often blocked in its progress by internal conflicts and external obstacles. We can all change this state of affairs. I present and compare definitions of important terms to clarify the discussion. Structural problems of the specialty include, among others, fragmentary representation, unfocused academic departments, lack of control over professionalization, and specialty identification, particularly with respect to occupational medicine. A set of suggested solutions to these problems include these actions: (1) federate the leading organizations into a coalition for organizational strength, without sacrificing their individual identities; (2) define the core content of the specialty once and for all by the mechanism of consensus-driven competency-based learning objectives; (3) build stronger bridges to clinical specialties other than family medicine, particularly to internal medicine; (4) restructure academic departments to form a preventive medicine unit as such, encouraging health care research and community medicine to connect principally with family medicine departments; (5) rethink specialty certification, including a model defining a knowledge and skills set in defined modules, which would be combined in various ways to support flexible specialty certification; and (6) integrate occupational medicine with preventive medicine generally by exploring issues of common interest and building closer institutional ties when the opportunity arises. These and other ideas might be discussed by the leadership of the principal public health and prevention organizations at a "summit" meeting, but some group must take the initiative to champion the cause. Medical Subject Headings (MeSH): preventive medicine, future, definitions, specialty certification, community medicine, population medicine.

Certification↗
PubMed1976

[Disabled children in the federal republic of Germany in 1974 (author's transl)].

Within the scope of an additional micro-census inquiry--carried out in 1974--the Federal Statistical Office in Wiesbaden assessed the number of physically, mentally and psychologically impaired children. The results are differentiated according to the types of disability and therapy, age, in-patient treatment and special school attendance. Furthermore, the estimated results are compared with earlier surveys of the Federal Statistical Office and other estimates.

Adolescent↗
PubMed2006

Improvements on flood alleviation in Germany: lessons learned from the Elbe flood in August 2002.

The increase in damage due to natural disasters is directly related to the number of people who live and work in hazardous areas and continuously accumulate assets. Therefore, land use planning authorities have to manage effectively the establishment and development of settlements in flood-prone areas in order to avoid the further increase of vulnerable assets. Germany faced major destruction during the flood in August 2002 in the Elbe and Danube catchments, and many changes have been suggested in the existing German water and planning regulations. This article presents some findings of a "Lessons Learned" study that was carried out in the aftermath of the flood and discusses the following topics: 1) the establishment of comprehensive hazard maps and flood protection concepts, 2) the harmonization of regulations of flood protection at the federal level, 3) the communication of the flood hazard and awareness strategies, and 4) how damage potential can be minimized through measures of area precaution such as resettlement and risk-adapted land use. Although attempts towards a coordinated and harmonized creation of flood hazard maps and concepts have been made, there is still no uniform strategy at all planning levels and for all states (Laender) of the Federal Republic of Germany. The development and communication of possible mitigation strategies for "unthinkable extreme events" beyond the common safety level of a 100-year flood are needed. In order to establish a sustainable and integrated flood risk management, interdisciplinary and catchment-based approaches are needed.

Disaster Planning↗
PubMed2000

Reimbursement issues in advanced practice nursing: an overview.

In this era of rapid change and restructuring of the health care delivery system, APNs are faced with many new opportunities and challenges. This implies that APNs should know the federal and state laws, rules, and regulations that clearly define their scope of practice and prescriptive authority. They should familiarize themselves with Medicare and Medicaid payment policies, and the state laws related to the private insurance practices. By learning the basic language of third-party payers, APNs will find themselves in a better position of understanding the process that ensures reimbursement for the services rendered. Thus, APNs should keep up with the new demand for their expertise by having close ties with new knowledge and new technologies. In addition, APNs should have the skills, credentials, and the knowledge of computer technology for communication, distance learning, diagnosis, and treatment. The ultimate goal is to provide high-quality and cost-effective care.

Forecasting↗
PubMedDate not supplied

Medical privacy: from the 4th Amendment to HIPAA. Right to privacy vs. public health: showdown looms over patient genetic information.

Newly adopted federal privacy regulations set a high standard for control of medical information that all medical offices and clinics must meet. Yet, the federal government can't even secure its own database of medical information. We have less than two years to come into full compliance with regulations that may well change over the coming months, making compliance a moving target. Learn the history of our privacy rights and regulations. And preview the privacy debates and dilemmas that await our digital society.

Confidentiality↗
PubMed1981

Evaluation of the effects of SOMPA measures on classification of students as mildly mentally retarded.

Recent suggestions for changes in classification criteria for mild mental retardation, advocated in the literature and by the courts and Federal agencies, were investigated with samples of children from four sociocultural groups. Application of the requirements of sociocultural background and broadly conceived adaptive behavior, using the System of Multicultural Pluralistic Assessment Adaptive Behavior Inventory for Children and Estimated Learning Potential measures, sharply reduced the number and percentages of children eligible for mild mental retardation classification in all sociocultural groups. Implications for the diagnostic construct of mild mental retardation and for the concept of bias in assessment were discussed.

Child↗
PubMedDate not supplied

Medicare and the financing of nursing education: implications of Board of Trustees v Sullivan.

In 1991 a federal court decided a case of first impression about the appropriateness of reimbursement to programs of nursing education under Medicare. The court confirmed that the University of Mississippi could continue receiving Medicare reimbursement for a proportionate share of the costs of clinical education for nurses in its affiliated hospital. However, it ruled that the $2 million in costs for classroom nursing education incurred by the School of Nursing would not be reimbursed despite the fact that both the hospital and nursing school were controlled by the same entity, the university system. This article reviews the court's decision in Board of Trustees of State Institutions of Higher Learning v Sullivan within the context of the available nursing literature on this topic. It describes the provisions of the Medicare statute, which allow for reimbursement of programs of nursing education, and the implications of the court's decision for nursing education. Finally, it suggests directions for additional research and discussion about the availability of an additional source of federal funding.

Education, Nursing↗
PubMed2006

Impacts of a participatory approach to developing national level sustainable development indicators in Finland.

The paper explores the role of a participatory approach in the outcome of the Finnish sustainable development indicator (SDI) exercise in 1998-2002. The process is analysed through three main objectives: to achieve stronger democracy, better quality of the end product and a more effective process. The analysis is further structured by a set of criteria needed for successful participation and differentiation of types of participants. The criteria comprise three main aspects: fairness, competence and social learning. In addition to the normally mentioned stakeholders (e.g. citizens and interest groups) participants also include experts and civil servants. Using the set of criteria above the participatory approach of the Finnish SDI process is then evaluated, and in the light of this evaluation the paper also discusses the specifications needed as evaluation criteria for national level policy programme processes like developing the SDIs. The results are based on documentation of the indicator task force meetings, written comments and a study of the putative end-users conducted after the publication of the indicators. The results show that the intense and broad participation of experts and civil servants increased the competence of the outcome and led to greater efficiency in working methods. However, this led to technocratic participation, absence of democratic participation and absence of social learning. Thus the ultimate goal of SDIs to contribute to achieving sustainability was not reached.

Conservation of Natural Resources↗
PubMed2005

SOR guidelines for concomitant chemoradiotherapy for patients with uterine cervical cancers: evidence update bulletin 2004.

BACKGROUND: In 1993 the French National Federation of Cancer Centres (FNCLCC) initiated the Standards, Options and Recommendations (SOR) project. This is a collaboration between the FNCLCC, the 20 French cancer centres, and specialists from French public universities, general hospitals and private clinics, and some specialists learned societies. The main objective is to develop clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. MATERIALS AND METHODS: The SORs are developed using a methodology based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. RESULTS: In 1999, the initial SORs for the management of women with cervical cancer were published. At that time the use of chemoradiotherapy was considered as an option. Since this original publication, five randomised trials comparing chemoradiotherapy with radiotherapy have been published, as well as a systematic review and two other clinical practice guidelines. In the light of this additional evidence, it was decided to update the guidelines on chemoradiotherapy in women with cervical cancer. CONCLUSION: After selection, critical analysis and integration of new evidence, chemoradiotherapy has become a standard for women with cervical cancer.

Clinical Trials as Topic↗
PubMedDate not supplied

Patient Education Corner. Accessing and evaluating the Internet for patient and family education.

In the last decade, the Internet has become a vast resource for healthcare information. Multiple Web sites, produced by the federal government, healthcare institutions, and individual healthcare providers, give Americans a wealth of useful information sources. Nurses recognize that more Americans than ever before are using the Internet and that nurses are in an excellent position to help patients learn how to search for healthcare topics and evaluate the information found. This article will focus on seeking information, judging the quality of the information, and listing specific Web sites.

Advertising↗
PubMedDate not supplied

Putting a price tag on training new doctors.

The nation's teaching hospitals depend heavily on $5.2 billion in annual federal payments for graduate medical education, but few of them know what portion pays for patient care and what portion supports teaching activities. Because hospitals and medical schools will continue to confront funding cutbacks under health reform, they must learn how to quantify the revenue and expenses associated with each activity to receive adequate compensation.

Costs and Cost Analysis↗
PubMedDate not supplied

Communicate skillfully, successfully, and confidently. A ten-step process.

To compete successfully in the 1990s, professionals must be good oral communicators. The opportunities are many: to persuade customers/clients, motivate employees, influence funders, explain to federal regulators, or to inform community groups. Unfortunately, most people have no formal training in presentational skills. This paper outlines three phases--complete with key steps--of effective public speaking: 1) fine-tuning your oral communication skills, 2) learning about audience and setting, and 3) tailoring content and delivery strategies accordingly.

Administrative Personnel↗
PubMed2005

[Preparedness for terrorist attack in the United States--the role of forensic pathologists and medical examiners].

Long distance airplanes hijacked by terrorists suddenly struck the World Trade Center in New York City on September 11, 2001. The city responded with efficient emergency service and there were a number of learning points for future planning. Early activation of the Disaster Mortuary Operation Response Team (DMORT) provided efficient family assistance by setting up a comprehensive Information Database Center and assisted the Medical Examiner in identifying the deceased. DMORT is a federally funded emergency service, made up of volunteer medical examiners and mortuary personnel, which responds to assist the local medical examiners in just such overwhelming emergency situations. We had been warned that Los Angeles was targeted as a probable site for similar attacks by terrorist groups. In response, Los Angeles has setup a far more advanced response system, the Coroner's Special Operation Response Team (SORT). SORT consists of over ten specialized units, one of which is the Weapons of Mass Destruction (WMD) Unit, staffed by qualified personnel, which provide continuing training, using standard procedures, drills and maintenance of many specialized protective equipment. Current urgent preparedness training includes the plans for maintaining government business continuity, safe keeping of electronic records, handling of multiple, widely spread fatalities through wrap, tag and hold program at multiple sites, using body bag, tag and hold procedure. Staff recruitment and training, development of equipment with the newly designed mobile facility for long range storage and field operation is an ongoing process in order to be able to respond effectively to any disaster. We still need expansion of training and equipment for handling cases of exposure to chemicals, biologic agents, radiation and nuclear energy. Plans in process are to have integration with DMORT and establish advance geographic information system, accomplished through the internet, and provide field reporting, commands and resource coordination in real time.

Coroners and Medical Examiners↗
PubMed2003

An ESID case study at the federal level.

The D (dissemination) phase of the ESID model has been often overlooked in our efforts to create innovative and widespread social change. The process of replicating successful social innovations is both a prerequisite for dissemination (in order to assess the consistency of effects) and an obvious outcome of a successful dissemination effort. Fidelity, the extent to which a replicated program is implemented in a manner consistent with the original program model, is an important dimension of replication. This study was designed to provide empirical data related to three questions. Can complex social programs be implemented with fidelity? How much fidelity is appropriate or desired? What are the organizational dynamics of adoption with fidelity? Data were collected from grantees of a national replication initiative funded by the Center for Substance Abuse Prevention. Data suggest that high fidelity can be achieved, at least in the context in which programs are mandated to do so as part of the funding agreement and are given technical assistance in achieving fidelity. Secondly, programs perceived high fidelity as having positive effects on the program and its participants, a finding consistent with a limited assessment of the relationship of program outcomes and fidelity. Finally, much was learned about the human and organizational dynamics of replicating with fidelity. Implications for policy and direction regarding replication are discussed.

Diffusion of Innovation↗
PubMedDate not supplied

Leveraging healthcare for the greater good: lessons learned from the National Centers of Excellence in Women's Health.

The creation of the National Centers of Excellence in Women's Health (CoE) program in 1996 by the Office on Women's Health, Department of Health and Human Services, included the stipulation that each institution awarded a CoE contribute at least a 25% match for the federal funds. Even the combination of these two sources of monies was insufficient for each CoE to accomplish its goals, however, so leveraging funds became necessary for each CoE to function effectively. The forms of leveraging varied from CoE to CoE, in part as a result of the institutional environment and the unique possibilities each permitted and in part as a result of the creativity of the leaders of the CoEs. This paper describes the concepts and some applications of leveraging in the setting of the CoEs, which might be applicable to other settings as well.

Academic Medical Centers↗