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PubMed2002

Measuring the outputs of Australian nursing research published 1995-2000.

AIMS: To analyse the research published in refereed nursing journals by Australian authors from 1995 to 2000. BACKGROUND: Analysis of the research topics and types of methodologies used by Australian nurse researchers has not been recently undertaken. The study was similar to an analysis of United Kingdom (UK) nursing research between 1988 and 1995 to allow comparison between the two countries. DESIGN: A quantitative approach analysed the research abstracts for the topic researched, source of data, location of data collection, paradigm and methodology used and funding source. RESULTS: A total of 509 articles from 11 generalist Australian and UK nursing journals were analysed. The highest numbers of articles were published in Australian Journal of Advanced Nursing and Journal of Advanced Nursing. The most popular topics were education of nurses (18.7%, n=95) and practice issues relating to patient care (15.3%, n=78). However, scant attention was paid to major Australian health issues. Most research was undertaken in the hospital setting (55.8%, n=247). Data were most often drawn from nurses themselves (40.7%, n=206), followed by patients (25.5%, n=129). Both quantitative (41%, n=203) and qualitative approaches (47%, n=230) were employed. A minority of studies acknowledged any funding (14.9%, n=76). CONCLUSIONS: Research findings need to be applied in practice to improve patient care. Nurse researchers need to publish their findings and align their research interests to meet national health priorities. They need to be involved in setting these health priorities to ensure that nursing has a place in health research.

Australia↗
PubMed1977

Social goals, health policy and the dynamics of development as bases for health education.

Among the most powerful social forces in this century is self determination of nations and of people. The relatively recent phenomenon of community participation in health decisions in some countries is but one aspect of the larger societal value. We can assume that self care, mutual care and collaborative involvement between providers and citizens flow from the concept of self determination. Although the pace is uneven and varies greatly among different communities and in different countries, there is a global movement towards health by the people. This is reflected in the decline of professional dominance of the health field as people in communities assume greater responsiblity for tasks previously monopolized by the health professionals. At the macro level, communities are making decisions in the allocation of resources for health and setting health priorities. At the macro level, health education is increasingly concerned in assisting consumers to develop skills in self diagnosis, self help and self care. However, if health is a human right, it must also be appropriated responsibly by those who claim it. Many healthy problems have their roots in community life. Today, major reductions in death and disability cannot be expected from curative services; instead, future progress will have to result from changes in the environment and lifestyle. Environmental changes will require in turn the cooperation of non-health sectors. Traditionally, professionals and others in these sectors have been reluctant to touch health planning and health policy due to medical dominance and a general attitude that health care belongs to the health professions. A primary task in health education is therefore to build stable linkages with other workers and the public in order that health status may be improved by finding areas of common concern and by institutionalizing joint efforts in seeking solutions through multipurpose planning. In-service training and continuing education for professionals and decision-makers are important strategies in this connection. The fostering of community capabilities for health planning and citizen responsibility in health matters is a priority in health education. This represents an investment in health resource development since the basic resources for collaboration in health improvement are people themselves, both professional and lay. Through community participation, all of us become both shapers of societal goals and governmental policies concerning health and health care, and recipients of the fruits of those goals and policies.

Community Participation↗
PubMed1999

Positron emission tomography: establishing priorities for health technology assessment.

BACKGROUND: Positron emission tomography (PET) is an expensive diagnostic imaging technology. Despite the long history of PET development, the costs and effectiveness of its use in routine clinical practice remain unknown. Against this background of uncertainty regarding the clinical role of PET, the UK Standing Group on Health Technology requested a review of its current and potential role which would enable research priorities in this area to be established. OBJECTIVES: This 3-month project had two explicit objectives: (1) to review the state of knowledge regarding the clinical applications of PET; (2) to determine the key health technology assessment (HTA) research questions relating to the use of PET in the UK. METHODS: A literature review to ascertain the state of knowledge regarding the clinical applications of PET and a three-round Delphi study to inform the key HTA research questions relating to the use of PET in the UK were undertaken. The results of an earlier systematic review, published by the Veteran's Health Administration (VHA) in the USA in 1996, were used as the starting point for the literature review. The VHA review was updated and extended by means of MEDLINE and Cochrane Library database searches. Participants in the Delphi study were selected by discussion with five individuals in the UK with an interest in, and awareness of, developments in PET. As a result of their suggestions, 43 individuals were initially invited to participate, of whom two did not feel appropriately qualified. Questionnaires were sent by facsimile to all invited participants, who were asked to return the completed forms by facsimile within a week. The content and structure of the Delphi study was informed by the results of the literature review. The responses and comments of the participants were a major source of information for this report. RESULTS: Clinical applications for PET have been advocated in three broad disease groups: oncology, cardiology and neuropsychiatric disorders. There are currently four PET modalities that need to be considered when assessing its potential clinical role in the UK: full ring PET scanners operating in two or three dimensions (available at five sites); partial ring rotating PET scanners (one currently operating in the UK); coincidence imaging with modified gamma camera technology; and high-energy collimator imaging of 511 keV photons with modified gamma camera technology. There is a paucity of available evidence relating to the cost-effectiveness of the various PET modalities in all of the clinical indications for which the technology is currently being advocated. In addition, many existing reports on the diagnostic accuracy of PET are limited because they are liable to bias and often relate only to very small patient numbers. The results of the Delphi study indicated that the four most important research priorities for the NHS, in descending order of their importance, are: (1) the relative cost-effectiveness of (a) full ring PET, (b) gamma camera PET using coincidence imaging and (c) existing diagnostic strategies to determine staging prior to operative intervention for lung cancer; (2) partial ring PET compared with full ring PET in oncology (3) the relative cost-effectiveness of (a) full ring PET, (b) gamma camera PET using coincidence imaging and (c) existing diagnostic strategies to stage and monitor treatment response in breast cancer; (4) the relative cost-effectiveness of (a) gamma camera PET using coincidence imaging and (b) 511 keV collimated positron imaging for assessing myocardial viability when selecting patients for revascularisation surgery. Vignettes describing each of the research priorities are provided in the main report. CONCLUSIONS: The findings of this project, which was undertaken rapidly in order to inform HTA research prioritization in the UK, provide a contemporary overview of the potential clinical role for PET in the NHS. Evidence is needed that using PET as a diagnostic

Female↗
PubMed1989

Identifying health problems and health research priorities in developing countries.

When we were invited to prepare this background paper on the health problems of the developing countries for the Commission on Health Research for Development, our first thought was to compile and organize available data on the causes of morbidity and mortality affecting different age groups in various populations. It soon became clear that this would not be especially useful. There are major gaps in the available data, particularly from the poorer countries and for people above 5 years of age. The data that are available are often of poor or uncertain quality, collected from unrepresentative or undefined subpopulations, and not strictly comparable due to different definitions and data-collection methods. Additionally, in the absence of agreed definitions and analytical frameworks, it is not clear what could or should be done with the data on health problems so amassed. More fundamentally, we have come to doubt whether the current array of epidemiological concepts and tools is sufficient for the task. We therefore decided that, while giving an overview of current knowledge on levels and trends of morbidity and mortality, the emphasis of this paper should be more towards concepts, methods, and data deficiencies. In Section 1, we set out definitions and frameworks for considering health problems and health research; we review recent conceptual models for the analysis of the determinants of child survival; and we outline a framework, focusing on modifiable determinants of health and life-cycle health effects, which is used in subsequent sections. In Section 2, relationships between national and societal level determinants and health are reviewed and then set aside. In Section 3, we review available data on world patterns and trends of morbidity and mortality, highlighting the data deficiencies and lacunae. In Section 4, we follow the life of a woman in a developing country and examine the health problems, and their determinants, which she and her children face. In Section 5, we draw these strands together and, having reviewed current approaches to prioritizing health problems and suggested some ways in which they could be improved, in Section 6 identify several research priorities, emphasizing the need for methodological research. This paper was commissioned in March 1987; prepared in draft and presented to a meeting at Chateau de Bossey, Geneva, Switzerland during 15-17 July; and revised and completed in September 1987. It is in no sense definitive or final.(ABSTRACT TRUNCATED AT 400 WORDS)

Developing Countries↗
PubMed2001

Successful implementation of community water fluoridation via the community diagnosis process.

OBJECTIVES: This paper describes the community diagnosis process and how it was used to implement community water fluoridation in Tennessee. METHODS: Public health dental staff developed a survey instrument to collect community-specific data on the oral health status of schoolchildren. Key survey findings were presented to county health councils who were determining and prioritizing the health needs of their communities. RESULTS: Community-specific data showed higher caries levels in children without access to an optimally fluoridated community water supply. Presentation of local survey findings to county health councils resulted in fluoridation being a high-priority health issue in several counties. With health council support, opposition to fluoridation by utility district officials was overcome when decision makers were challenged with local survey findings. The community diagnosis process resulted in the successful fluoridation of six community water systems serving a total of 33,000 residents. CONCLUSIONS: The community diagnosis approach was successful in implementing community water fluoridation in geographic areas historically opposed to this public health measure. The success of these fluoridation initiatives was attributed to: (1) current, community-specific assessments of children's oral health; (2) identification of communities with disparate oral health needs, problems, and resources; and (3) effective presentation of community-specific oral health survey data to community leaders, stakeholders, and decision makers.

Attitude to Health↗
PubMed2003

Cost of diagnostic and therapeutic management of colorectal cancer according to stage at diagnosis in the Calvados Département, France.

Screening for colorectal cancer is a high priority of public health in France, as in other Western countries. In spite of its effectiveness, shown by randomized studies, no national program of colorectal screening using fecal occult blood test has yet implemented, due mainly to the low sensitivity of the screening test and to the weak participation of the target population. Economic studies can make a useful contribution to helping the decision makers of public health. One of the advantages to the organization of a screening program is a financial saving generated by advance in diagnosis. To investigate this hypothesis this study assessed the cost of the management of colorectal cancer according to its stage of extension using medical data from a specialized cancer registry and economic data from the national Social Security System. No significant decrease in the first-year costs of treating colorectal cancer was found with advance of diagnosis. The average cost for the first year of management of colorectal cancer after diagnosis was of Euro 21,918. According to the stage of diagnosis, the highest average cost was for the subjects with a cancer with lymph node involvement, with a cost of Euro 31,110. Cancers with an invasion limited to the submucosa or visceral metastases had an equivalent cost, respectively, of Euro 17,579 and of Euro 17,384. With a limited power due to low strength, these results suggest that the organization of a colorectal cancer screening program does not significantly reduce in the first year the total cost of management of this cancer. However, the organization of such screening remains a public health priority, prevention aiming only to allow subjects to live in good health as long as possible,and not to save money.

Journal Article↗