Residents must develop a plan for addressing overweight in children.
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Child↗
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Results for “Development Planning”
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Development and results of a Case Coordination Activity Tracking tool.
This study describes the development of a tool used to track the who, what, when, and how much of case coordination for elderly, community-based clients. The Case Coordination Activity Tracking Form measures phase of coordination (assessment, plan development, plan implementation, monitoring reassessient, and discharge), type of activity (in-person, telephone, documentation, research, travel, case conference), with whom contact took place (client, family, client/family together, supervisor/colleague, service provider, physician, program access committee), and special circumstances (e.g., infection control). Over a 6-month span, we used the tool to study case coordination of services for elderly, community-based clients. The average amount of coordination time was 5.15 hours (n = 234), with 71% of the clients requiring between 2 and 6hours of coordination, and 26% of the clients accounting for 49% of the total coordination time. Frequency and average amount of coordination declined greatly after the first month. Not all clients required coordination each month, and monitoring was the most common activity in later months. The tool was found to be reliable and easy to use, and of benefit to decision makers, managers, and case coordinators in measuring, analyzing, and describing case coordination. This tool could be readily used with other client groups.
Aged↗
Fiscal planning in developing psychiatric emergency services.
Two actual budgets are highlighted here to emphasize their worth as models for other programs to copy. Their deficiencies are also discussed so that more attention to headings and content might be paid by administrators facing similar budgetting processes. The need for programs to expand considerable more effort initially to plan fiscally for their emergency psychiatry service is emphasized. With a proper needs assessment and statistical forecasting, resource planning and allocation can be estimated more accurately. Even with the wild fluctuations of case load which all emergency psychiatric services experience, trends do become obvious with scrutiny. Ongoing statistical data can further define future budgets more accurately. More attention to the standard expense categories will clarify where the money is expected to go. More care in identifying income generation through better billing procedures, bill itemization, community fund identification, governmental supplement requests can be clearly documented by an income budget. Without it a program looks like an errant stepchild--spending everyone else's hard earned money and not contributing to the fiscal stability of the parent organization.
Budgets↗
Electronic fetal heart rate monitoring: research guidelines for interpretation. The National Institute of Child Health and Human Development Research Planning Workshop.
The purpose of the National Institutes of Health (NIH) research planning workshops are to assess the research status of clinically important areas. This article reports on a workshop, whose meetings were held between May 1995 and November 1996, in Bethesda, MD, and Chicago, IL. Its specific purpose was to develop standardized and unambiguous definitions for fetal heart rate (FHR) tracings. Their recommendations for interpreting FHR patterns are being published here, in JOGNN, and simultaneously by the American Journal of Obstetrics and Gynecology.
Cardiotocography↗
Electronic fetal heart rate monitoring: research guidelines for interpretation. National Institute of Child Health and Human Development Research Planning Workshop.
The purpose of the National Institutes of Health research planning workshops is to assess the research status of clinically important areas. This article reports on a workshop whose meetings were held between May 1995 and November 1996 in Bethesda, Maryland, and Chicago, Illinois. Its specific purpose was to develop standardized and unambiguous definitions for fetal heart rate tracings. The recommendations for interpreting fetal heart rate patterns are being published here and simultaneously by the Journal of Obstetric, Gynecologic, and Neonatal Nursing.
Female↗
Reducing dose calculation time for accurate iterative IMRT planning.
A time-consuming component of IMRT optimization is the dose computation required in each iteration for the evaluation of the objective function. Accurate superposition/convolution (SC) and Monte Carlo (MC) dose calculations are currently considered too time-consuming for iterative IMRT dose calculation. Thus, fast, but less accurate algorithms such as pencil beam (PB) algorithms are typically used in most current IMRT systems. This paper describes two hybrid methods that utilize the speed of fast PB algorithms yet achieve the accuracy of optimizing based upon SC algorithms via the application of dose correction matrices. In one method, the ratio method, an infrequently computed voxel-by-voxel dose ratio matrix (R = D(SC)/D(PB)) is applied for each beam to the dose distributions calculated with the PB method during the optimization. That is, D(PB) x R is used for the dose calculation during the optimization. The optimization proceeds until both the IMRT beam intensities and the dose correction ratio matrix converge. In the second method, the correction method, a periodically computed voxel-by-voxel correction matrix for each beam, defined to be the difference between the SC and PB dose computations, is used to correct PB dose distributions. To validate the methods, IMRT treatment plans developed with the hybrid methods are compared with those obtained when the SC algorithm is used for all optimization iterations and with those obtained when PB-based optimization is followed by SC-based optimization. In the 12 patient cases studied, no clinically significant differences exist in the final treatment plans developed with each of the dose computation methodologies. However, the number of time-consuming SC iterations is reduced from 6-32 for pure SC optimization to four or less for the ratio matrix method and five or less for the correction method. Because the PB algorithm is faster at computing dose, this reduces the inverse planning optimization time for our implementation by a factor of 2 to 8 compared with pure SC optimization, without compromising the quality or accuracy of the final treatment plan.
Algorithms↗
[The tentative plan on development of National Laboratory Response Network for biological agents associated with public health emergencies].
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Biological Warfare Agents↗
A statistical analysis of weekday operating room anesthesia group staffing costs at nine independently managed surgical suites.
UNLABELLED: At many surgical suites, surgeons and patients schedule elective cases on whatever future workday they choose, resulting in there being no limit on the number of cases performed each day. Staff are then scheduled in the manner that satisfies the marketing guarantee to the surgeons, satisfies labor contracts, and minimizes staffing costs. We assessed weekday nurse anesthesia group staffing at nine such suites to determine whether statistical methods can identify staffing solutions whereby all the cases are covered but for which staffing costs are less than those obtained using the staffing plans implemented by anesthesia groups' managers. Two years of operating room information system case duration and staffing data were analyzed. First- and second-shift staffing was assessed using previously published algorithms. The statistical methods identified staffing solutions with significantly decreased labor costs than those currently being used at eight of the nine surgical suites. The statistical methods relied more on overtime than second-shift staffing. The incremental decrease in staffing costs achievable by using overlapping 8-, 10-, and 13-h shifts was negligible. Overall, we found that statistical methods can identify, for some surgical suites, staffing solutions whereby all the cases are covered but for which costs are significantly less and productivity significantly more than those obtained using the plans developed by the managers based on their experience and the data. IMPLICATIONS: Statistical methods can identify, for some surgical suites, anesthesia staffing solutions whereby all the cases are covered but for which labor costs are significantly less than those obtained using the staffing plans developed by the managers based on data and their experience.
Anesthesia↗
Land resource sustainability for urban development: spatial decision support system prototype.
Land resource sustainability for urban development characterizes the problem of decision-making with multiplicity and uncertainty. A decision support system prototype aids in the assessment of incremental land development plan proposals put forth within the long-term community priority of a sustainable growth. Facilitating this assessment is the analytic hierarchy process (AHP), a multi-criteria evaluation and decision support system. The decision support system incorporates multiple sustainability criteria, weighted strategically responsive to local public policy priorities and community-specific situations and values, while gauging and directing desirable future courses of development. Furthermore, the decision support system uses a GIS, which facilitates an assessment of urban form with multiple indicators of sustainability as spatial criteria thematically. The resultant land-use sustainability scores indicate, on the ratio-scale of AHP, whether or not a desirable urban form is likely in the long run, and if so, to what degree. The two alternative modes of synthesis in AHP-ideal and distributive-provide assessments of a land development plan incrementally (short-term) and city-wide pattern comprehensively (long-term), respectively. Thus, the spatial decision support system facilitates proactive and collective public policy determination of land resource for future sustainable urban development.
Conservation of Natural Resources↗
A comprehensive assessment of medical schools in Bosnia and Herzegovina.
OBJECTIVES: To perform internal and external evaluations of all 5 medical schools in Bosnia and Herzegovina against international standards. METHODS: We carried out a 2-stage survey study using the same 5-point Likert scale for internal and external evaluations of 5 medical schools in Bosnia and Herzegovina (Banja Luka, Foca/East Sarajevo, Mostar, Sarajevo and Tuzla). Participants consisted of managerial staff, teaching staff and students of medical schools, and external expert assessors. Main outcome measures included scores on internal and external evaluation forms for 10 items concerning aspects of school curriculum and functioning: 'School mission and objectives'; 'Curriculum'; 'Management'; 'Staff'; 'Students'; 'Facilities and technology'; 'Financial issues'; 'International relationships'; 'Internal quality assurance', and 'Development plans'. RESULTS: During internal assessment, schools consistently either overrated their overall functioning (Foca/East Sarajevo, Mostar and Tuzla) or markedly overrated or underrated their performance on individual items on the survey (Banja Luka and Sarajevo). Scores for internal assessment differed from those for external assessment. These differences were not consistent, except for the sections 'School mission and objectives', 'Curriculum' and 'Development plans', which were consistently overrated in the internal assessments. External assessments was more positive than internal assessments on 'Students' and 'Facilities and technology' in 3 of 5 schools. CONCLUSIONS: This assessment exercise in 5 medical schools showed that constructive and structured evaluation of medical education is possible, even in complex and unfavourable conditions. Medical schools in Bosnia and Herzegovina have successfully formed a national consortium for formal collaboration in curriculum development and reform.
Bosnia and Herzegovina↗
Barriers to the involvement of clients in family planning service development: lessons learnt from experience.
CONTEXT: Client involvement in service development underpins the Department of Health strategy for sexual health improvement in the UK. Participatory approaches to user consultation have been effectively piloted in this context but the responses of service providers to these data are rarely documented. OBJECTIVES: Recruiting clinic users and training clinic users to interview their fellow clinic users on sexual health service use and to document staff responses to the results of this consultation. DESIGN: Clinic users interviewed young clinic users (aged <25 years) using a time line to generate a description of their first clinic visit. The results were presented to staff with a questionnaire requesting their views. RESULTS: Forty-six clients were interviewed. More comments were made on the waiting room than any other aspect of clinic use. These comments were almost exclusively negative. The waiting room was described as uncomfortable, insufficiently confidential and lacking refreshment and entertainment. Most clients were happy with the clinical consultation. Both positive and negative comments on this aspect of service use related to staff attitudes. The priorities of clients and staff were different and potentially conflicting. Whereas staff are keen that the waiting room should appear tidy, clients require refreshments or children's toys that generate mess. Staff see the clinical service as the most important aspect of a clinic visit while users may view their comfort while waiting for long periods as equally important. DISCUSSION: This methodology documents clients' experiences (positive and negative) of a specific service and generates practical suggestions for improvement. Further work is required to identify common goals for staff and clients. An iterative process of staff and client consultation may ensure that future service development proceeds in a direction that meets the needs of both groups.
Adolescent↗
The role of medical education in planning the development of a national health care system.
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Allied Health Personnel↗
First wave PMS pilots: a critical analysis of documentation.
Contracts and interim local evaluation reports for the 14 first wave PMS pilots in Northern and Yorkshire region were analysed by documentary analysis. Both contracts and reports were found to vary considerably in size and scope. Most contracts contained aims and objectives that were too broad or vague to guide project management and they lacked useful milestones. This made it difficult to identify criteria for measuring success. The local evaluation reports were also of variable quality. It is recommended that contracts should be accompanied by a development plan containing specific objectives, timescale and process for implementation as well as an evaluation strategy. The relative importance of different targets should be agreed and specified at the outset, to allow weighting of partial success, where some objectives, but not others, are achieved. Project milestones would be made explicit and measurable in the development plan. More clarity in contracts and evaluation for future pilots is essential.
Continuity of Patient Care↗
[Plans for the development of public health in the Kazakh SSR during the 7-year plan for the development of national economy].
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Humans↗
Facility planning and development in Latin America.
Since the mid-1980s, the author has been involved in the development of healthcare facilities in the Caribbean and Latin America. This article highlights his experiences to date and provides insights relative to the many challenges U.S. developers and contractors might encounter when exporting U.S. healthcare expertise to Caribbean and Latin American countries.
Architecture↗
A framework for portfolio development in postgraduate nursing practice.
AIMS AND OBJECTIVES: The aim of this study is to explore the introduction of portfolios into the first year of an MSc in Nursing Programme. BACKGROUND: This paper outlines a framework for portfolio development in postgraduate nursing practice. The framework is being piloted, within the Irish context, with students in the first year of a Masters in Nursing programme and has the potential to be developed for other nursing programmes at postgraduate level. DESIGN AND METHOD: An action research approach has been chosen to study the implementation of the portfolio and the development of a framework to guide this initiative. To date the development of the framework is being piloted as part of the 'taking action' phase of a first action research cycle. RESULTS: In its current stage of development the framework is constructed to embrace the core concepts of specialist nursing practice and the nursing management competencies, from current Irish health care documents. In addition the portfolio is anchored around personal development planning and is supported by the use of action learning tutorials and academic and practice facilitators. The first evaluating phase will take place later this year and will involve the collection of data from students, facilitators and lecturers. CONCLUSION: The introduction of the portfolio at postgraduate level has highlighted, to date, issues of confidentiality in committing experiences to paper, issues around its assessment, and issues around sharing this document with other students. RELEVANCE TO CLINICAL PRACTICE: Portfolio development at postgraduate level emphasizes linking theory and practice and stresses the importance of reflection on practice. The portfolio can also be used by nurses to develop their clinical career pathways and encourage personal development planning.
Attitude of Health Personnel↗
Shaping animal body plans in development and evolution by modulation of Hox expression patterns.
Most animals exhibit distinctive and diverse morphological features on their anterior-posterior body axis. However, underneath the variation in design and developmental strategies lies a shared ancient structural blueprint that is based on the expression patterns of Hox genes. Both the establishment and maintenance of the spatial and temporal distribution of Hox transcripts play an important role in determining axial pattern. The study of many animal systems, both vertebrate and invertebrate, suggests that the mechanisms used to establish Hox transcription are nearly as diverse as the body plans they specify. The strategies for maintenance of Hox expression pattern seem more conserved among different phyla, and rely on the action of Pc and trx group genes as well as auto- and cross-regulation among Hox genes. In mice, the sharing of regulatory elements coupled with auto- and cross-regulation could explain the conservation of the clustered arrangement of Hox genes. In contrast, fly Hox genes seem to have evolved insulators or boundary elements to avoid sharing regulatory regions. Differences in Hox transcription patterns can be correlated with morphological modifications in different species, and it seems likely that evolutionary variation of Hox cis-regulatory elements has played a major role in the emergence of novel body plans in different taxa of the animal kingdom.
Animals↗
Health promotion at the workplace.
Health promotion encompasses those activities undertaken to improve the quality of one's life, thereby moving the individual forward toward a state of wellness or optimal health. Occupational health nurses are in a prime position to impart knowledge and change attitudes and behaviors and thus are uniquely qualified to plan, develop, implement, and evaluate workplace health promotion programs. Employee health promotion programs are based on the theory that it costs less to educate workers about controllable lifestyle health risks than to pay for the cost of ill health. Comprehensive workplace health promotion programs should be targeted at three levels: awareness, lifestyle/behavior change, and supportive environments, if long-term success is to be achieved. Occupational health nurses may use the Model for Workplace Health Promotion to assist them in planning, developing, implementing, and evaluating programs that provide health and cost benefits for both employees and employers.
Cost-Benefit Analysis↗