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PubMed2003

Landform classification for land use planning in developed areas: an example in Segovia Province (central Spain).

Landform-based physiographic maps, also called land systems inventories, have been widely and successfully used in undeveloped/rural areas in several locations, such as Australia, the western United States, Canada, and the British ex-colonies. This paper presents a case study of their application in a developed semi-urban/suburban area (Segovia, Spain) for land use planning purposes. The paper focuses in the information transfer process, showing how land use decision-makers, such as governments, planners, town managers, etc., can use the information developed from these maps to assist them. The paper also addresses several issues important to the development and use of this information, such as the goals of modern physiography, the types of landform-based mapping products, the problem of data management in developed areas, and the distinctions among data, interpretations, and decisions.

Conservation of Natural Resources↗
PubMed1995

A pay-for-performance system for civil service doctors: the Indonesian experiment.

In 1980 the Government of Indonesia proposed the introduction of a pay-for-performance system, the Functional Position System (FPS), for certain occupational categories of civil servants to provide a career development path and stimulate productivity (Government of Indonesia. Government Ordinance No. 3, 1980 Concerning Appointment to Civil Service Rank. Jakarta, 1980). The FPS, a bold pay concept in the civil service, links pay to skills and performance. In 1987, instructions were issued for doctors to be included in the system (Government of Indonesia, Credit Scores for Doctors. Circular Issued by the Ministry of Health and the Agency for Administration of the Civil Service No. 614/MENKES/E/VIII/1987 and No. 16/SE/1987). In this paper we evaluate how well the system-which in principle could be applicable to both developed and developing economies--can meet its stated objectives for Indonesian doctors working in the community, and for Indonesian health policy objectives as stated in the country's last five-year development plan "Repelita V" (Government of Indonesia. The Fifth Five-year Development Plan (Repelita V) 1989-1994. Jakarta, Indonesia, 1989). The FPS is particularly innovative in the Indonesian environment where wages are low and comparatively uniform, reflecting a philosophy of 'shared poverty', and vary primarily by seniority. The FPS has, however, several conceptual and practical shortcomings. The design of the reward system disregards effort or time inputs, as well as other inputs needed per unit of reward. Consequently, the FPS can not be used as an effective incentive system promoting professional excellence and health policy objectives. Practically, the system hardly provides an effective alternative for career development among community physicians.(ABSTRACT TRUNCATED AT 250 WORDS)

Career Mobility↗
PubMed1991

A new approach to postanesthesia care unit documentation.

Documentation demonstrates that nursing standards of care have been met. To be an effective tool, a record must be complete and concise. A request to develop PACU care plans became the impetus to revise the PACU record. Perioperative information and physical assessments are data required to formulate individualized plans. Development and implementation of a comprehensive record was a positive outcome of a lengthy but interesting and worthwhile project.

Hospitals, Veterans↗
PubMedDate not supplied

[Sports for the elderly in a sports active aging society].

The number of elderly people is growing. The next generation will grow older taking a more active part in sport than the present one. The halving of the number of younger members of the population, and thus the declining number of people participating in sport is furthering the interest of sports clubs in the elderly. At present the programmes of sport for the elderly run by sports associations are still at an initial stage. Sports clubs and the planning of the development of sports facilities in towns and villages are confronted by a new situation-that of the growing number of elderly people taking an active part in sport. In 1988/89 the Institute for Development Planning and Structural Research at the University of Hanover carried out five regional case studies into the sports behaviour of the elderly and into their motives and expectations with regard to sport. More than 10,000 people participated in the representative surveys. They came from towns and villages with a rural character in the Federal Republic of Germany. Structures and development perspectives on the subject of "Sport by Elderly" are outlined from a social science aspect.

Aged↗
PubMed1992

Epidemiology's contribution to health service management and planning in developing countries: a missing link.

Two hypotheses are examined in the light of experience and the literature: (1) health service planning requires little epidemiological information, and (2) health services rarely get useful answers to relevant epidemiological questions. In the first hypothesis, the theoretical robustness of the concept of a minimum package of activities common to all facilities belonging to the same level of the system and the extent to which it is unaffected by variations in the frequencies of most diseases are examined. Semi-quantitative analyses and analysis of routine entries and participation suffice to adapt this package to the local context. Some of the methods which give a fundamental role to epidemiological information are criticized. With regard to the second hypothesis, the pertinent contributions epidemiology may make to health service organization are reviewed. These include identification of diseases that justify special activities (health maps and interepidemic surveillance), determination of the activities that should be added to the health centres, the political usefulness of rare impact assessments, and the relevant demographic elements. Finally an epidemiological agenda is proposed for specialized centres, districts, universities, and the central decision-making level of health ministries in developing countries.

Adult↗
PubMed1998

Nursing manpower development and strategic planning in Greece.

PURPOSE: A national study to register all working nursing personnel and nursing students; to estimate the nursing needs of the Greek population beyond the year 2000; to design a nursing resource master plan for the nursing needs of Greece. DESIGN: First, a questionnaire was distributed to register all nursing personnel. Second, required personnel were estimated according to the population of each of the country's regions. Third, a master plan for developing nursing personnel to the year 2010 was developed. RESULTS: The number of nursing personnel was found to be 35,715 which included 11,497 RNs and health visitors, 22,318 assistant nurses, 1,900 midwives. The number of students was 9,252. The majority of nursing personnel work in areas with the highest population. The need for nursing personnel was estimated to be 62,000: 36,300 RNs, 21,700 assistant nurses and 4,000 midwives. CONCLUSIONS: There is a serious shortage of RNs in the Greek health services resulting in a downgrading of nursing care quality.

Education, Nursing↗
PubMed2003

"A planning guide": Developing a consensus document for palliative care service provision.

Over the past 30 years, palliative care services have developed in an ad-hoc way in Australia and around the world. Community expectations for palliative care have grown in recent years. As palliative care has evolved, the World Health Organization definition of palliative care has changed substantially. The changes challenge those who are involved in planning, funding and provision of services to meet new expectations. Many services have not attracted adequate nursing, medical and allied health resources to provide interdisciplinary palliative care. A national consensus document ("a planning guide") has been developed in consultation with key stakeholders and organisations. It outlines the minimum needs for service provision, independent of fundholders and models of service delivery.

Australia↗
PubMed2005

Towards an RTS,S-based, multi-stage, multi-antigen vaccine against falciparum malaria: progress at the Walter Reed Army Institute of Research.

The goal of the Malaria Vaccine Program at the Walter Reed Army Institute of Research (WRAIR) is to develop a licensed multi-antigen, multi-stage vaccine against Plasmodium falciparum able to prevent all symptomatic manifestations of malaria by preventing parasitemia. A secondary goal is to limit disease in vaccinees that do develop malaria. Malaria prevention will be achieved by inducing humoral and cellular immunity against the pre-erythrocytic circumsporozoite protein (CSP) and the liver stage antigen-1 (LSA-1). The strategy to limit disease will target immune responses against one or more blood stage antigens, merozoite surface protein-1 (MSP-1) and apical merozoite antigen-1 (AMA-1). The induction of T- and B-cell memory to achieve a sustained vaccine response may additionally require immunization with an adenovirus vector such as adenovirus serotype 35. RTS,S, a CSP-derived antigen developed by GlaxoSmithKline Biologicals in collaboration with the Walter Reed Army Institute of Research over the past 17 years, is the cornerstone of our program. RTS,S formulated in AS02A (a GSK proprietary formulation) is the only vaccine candidate shown in field trials to prevent malaria and, in one instance, to limit disease severity. Our vaccine development plan requires proof of an individual antigen's efficacy in a Phase 2 laboratory challenge or field trial prior to its integration into an RTS,S-based, multi-antigen vaccine. Progress has been accelerated through extensive partnerships with industrial, academic, governmental, and non-governmental organizations. Recent safety, immunogenicity, and efficacy trials in the US and Africa are presented, as well as plans for the development of a multi-antigen vaccine.

Academies and Institutes↗
PubMed1999

The lack of integration of clinical audit and the maintenance of medical dominance within British hospital trusts.

Concerns have been expressed repeatedly about the effectiveness of clinical audit. Some have argued that this is limited by the lack of integration within day-to-day practice and with other NHS policy initiatives. We aimed to explore what mechanisms were being used to develop annual clinical audit programmes within NHS Trusts, and to describe the influence of other initiatives on this; to understand how such influences are exerted; and to understand the role of key players, in order to inform future programme development. Semi-structured face-to-face interviews were performed with Chairs of Clinical Audit Committees, Clinical Audit Managers and Co-ordinators (N = 15) in the former Yorkshire Region of the NHS in England. Concerns about the development, planning and integration of clinical audit focused upon an almost exclusive medical dominance and upon how audit leadership could be delivered within the context of hospital management structures. The lack of an overall plan for the development of clinical audit in most sites was seen as enabling the doctors' agenda to dominate. Purchasing authorities were recognized as being important, but often with limited influence. Other influences on the audit agenda, such as research and development (R&D) and clinical risk management, were rarely well co-ordinated. These findings concur with previous studies in identifying a wide range of constraints on the progress of audit. Several of these constraints operate within the internal environment, for example the doctors' agenda, and concerns about management involvement. Such constraints require resolution in order to facilitate the integration of audit with other initiatives and to achieve the goals of audit effectively. Clinical effectiveness and clinical governance may offer a means of facilitating this integration.

Health Policy↗
PubMed2001

The role of job-related rewards in retirement planning.

The authors used data from the first wave of the Health and Retirement Study ( F. Juster and R. Suzman 1995) to evaluate whether certain job-related gratifications might reduce retirement planning. Three definitions of retirement planning were evaluated and then regressed separately on a set of variables that included 3 types of job-related satisfactions (intrinsic gratification, positive social relations, and ascendance in the workplace) and 7 covariates: education, age, sex, health, marital status, race, and pension eligibility. Findings indicated that jobs high in ascendance were related to an increase in certain types of retirement planning, but jobs high in intrinsic rewards and positive social relations were related to less planning, regardless of how planning was defined. The findings suggest that information about work-related rewards may be useful in targeting individuals who might benefit from retirement planning programs, in developing planning programs to help workers realize more complex retirement plans, and in assisting employers who hope to retain older workers.

Career Mobility↗
PubMed2005

Lessons learned in preparing to receive large numbers of contaminated individuals.

Traditionally, medical radiation emergency plans have provided for the receipt and care of a limited number of individuals, usually no more than two or three at any given time. Large numbers of contaminated, uninjured individuals cannot be effectively handled in the emergency departments (EDs) of hospitals as they present a risk of forcing the ED to close because of contamination and they divert ED personnel away from patients needing medical attention. Alternative locations and plans for handling large numbers of contaminated but otherwise uninjured patients must be considered. Such plans developed at the Penn State Hershey Medical Center (HMC) during the 1979 accident at the Three Mile Island Nuclear Power Plant (TMI) were resurrected post 9/11 and used there in developing and upgrading plans and capabilities for handling large numbers of contaminated, uninjured individuals.

Disaster Planning↗
PubMed1999

The Medicare Critical Access Hospital program: the first year.

The Medicare Critical Access Hospital (CAH) program, part of the Balanced Budget Act of 1997, is a nationwide limited service hospital program. Structured interviews were conducted in August and September 1998 with key people in state offices of rural health, state hospital associations, departments of health or departments of facility licensing in all 50 states to assess their progress in the development of the CAH program. The majority of states expressed interest in the CAH program. Twenty-one states were moving formally toward involvement in the program. States that had developed or were in the process of developing a state plan estimated that between 183 to 227 hospitals would convert to CAHs in the next one to two years. States that were the most successful with plan development appeared to be states that participated in the Essential Access Community Hospital/Rural Primary Care Hospital program, states where there was dialogue about the possibility of a limited service hospital program and states with widespread support in the state. A pressing need for most states is for reliable fiscal consulting or analysis that could be applied to individual hospitals that are considering conversion to CAHs. The CAH program shows promise for successful implementation based on its early results.

Budgets↗