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PubMed2005

Experience-based guidelines for the implementation of telemedicine services.

Many telemedicine projects fail to survive beyond the funded research phase. A review of seven Scottish telemedicine services was conducted to identify successes and failures. Qualitative interviews were conducted with key individuals in each project. All projects were partly successful. The main reasons associated with partial failure were: the service was not needs-driven; there was no commitment to provide the service; there was no suitable exit strategy after research funding expired; there was poor communication; there was a lack of training; there were technical problems; work practices were not updated; the protocols for use were poor or non-existent. Based on this, guidelines that might improve the chances of success in future projects were drawn up.

Communication↗
PubMed1999

Factors that may influence the implementation of nurse-centred telemedicine services.

A qualitative study of four UK telemedicine sites was carried out to explore reactions to nurse-centred telemedicine services and their possible implications. Using semistructured schedules, 36 people directly involved in these services were interviewed--25 nurses, four general practitioners, two advising medical consultants, three service managers and two researchers. Factors identified which may influence successful implementation included: early involvement of all groups affected, prior consideration of the practical implications, thorough initial equipment testing, good technical support, imaginative training and clarity of the purpose of the service. The study showed that all those involved must be prepared for the rapid learning that is implicit in the implementation of change. The challenge is to maximize the potential for the primary operator to use new techniques. In respect of nurse-centred services, the nurse must not be viewed as a technician, nor should telemedicine be seen as a substitute for an available doctor.

Clinical Competence↗
PubMed2005

Development of the Safe Tractor Assessment Rating System.

We describe the development of the Safe Tractor Assessment and Rating System (STARS), a design-based tractor safety rating system that can be applied to new or used tractors to provide an objective assessment of their inherent safety features. A predictive rating system model, based on technical inspection, was used. Key principles underlying the system included the potential for design features to reduce the risk of an injury event occurring, and to reduce the risk of injury if such an event did occur. The rating system was based on current standards, research literature, injury and fatality data, and farmer input via focus groups. Development was an iterative process involving field, pilot, and inter-rater reliability tests. The final system was divided into six domains: rollover protection, runover protection, user protection, information and controls, pedestrian protection, and options. Within each domain, optimum design features were described for the common or serious potential injury risks, and a score was assigned for each feature. Scores were translated into a star rating, from zero stars for virtually no inherent safety features to five stars for the highest inherent safety, for each of the six domains. STARS distinguished well between older tractor models known to have few inherent safety features and newer tractor models known to have higher levels of inherent safety. STARS can provide tractor manufacturers, dealers, and users with information critical for managing tractor-associated injury risk. In Australia, it is initially being implemented within the curriculum of the technical education and training sector.

Accidents, Occupational↗
PubMed2006

Local implementation of the Family Health Program in Brazil.

This article discusses the implementation of the Family Health Program in the municipalities of Camaragibe, Aracaju, São Gonçalo, and the Federal District of Brazil, aiming to identify possible interfaces between the program's shaping and different incentives structures, the local health system's case-resolving capacity, experiences with social participation, and accountability mechanisms. The article shows that aspects related to the constitution of local health systems in terms of the quantitative and qualitative supply of services, technical and management training within the Municipal Health Department, investment in other levels of care, and local political traditions are crucial variables for understanding the diversity of experiences in the implementation of the Family Health Program.

Brazil↗
PubMed1981

Occupational health in Cuba.

Health and safety regulation, training, and research were practically non-existent in Cuba before the Revolution in 1959. Since that time important advances have been made. Specialized inspectors, occupational physicians, and other such personnel are now trained in Cuba. An Occupational Health Institute, founded in 1976, provides training and specialized technical services, and conducts research. In 1978, a far reaching "Work Safety and Health Law" was enacted which defines the rights and responsibility of government agencies, workplace administrators, unions, and workers. Comprehensive control of toxic substances in workplaces, still at an early stage, is likely to increase in light of the new law, the growing availability of qualified personnel, and the mounting concern of public health authorities with the increasingly "developed" health profile of the population.

Cuba↗
PubMed2000

Quality of midwifery care in Soroti district, Uganda.

OBJECTIVES: To determine the quality of care provided by midwives in Soroti district; and specifically, to identify training needs, gaps in knowledge and other barriers to accessibility of emergency obstetric care (EmOC) services in Soroti district. DESIGN: Cross-sectional descriptive study. SETTING: One regional hospital, one district hospital, two health centres and four dispensaries, all health units in the district. SUBJECTS: Patients admitted in the health units with pregnancy complications; attendants of patients (above); midwives delivering health care at the health units; pregnant women exiting from (after attending) antenatal clinics; and health unit records. INTERVENTIONS: Participatory observation, midwife and client interviews, records review, facility assessment and focus group discussions with clients and patients. MAIN OUTCOME MEASURES: Ability of midwives to provide antenatal care of a minimum standard, or recall causes, signs, symptoms or the management of common obstetric complications; and patients and patient attendants' perception of care received. RESULTS: Many midwives were providing care of poor quality for both antenatal and delivery care due to their inability to identify and manage women with or at risk of pregnancy complications. CONCLUSION: The main factors identified as responsible for the poor quality of care were inadequate pre-service and in-service training, lack of technical support supervision and absence of standard treatment guidelines.

Clinical Competence↗
PubMed1999

Surgery in the information age.

Currently, surgical procedures involve direct data flows of sensation and mechanical output. As information technology progresses, surgery will change to a system of electronic data flows, with technical, ethical, and training implications.

Biomedical Technology↗
PubMed2005

Electronic health records: just around the corner? Or over the cliff?

We recently implemented a full-featured electronic health record in our independent, 4-internist, community-based practice of general internal medicine. We encountered various challenges, some unexpected, in moving from paper to computer. This article describes the effects that use of electronic health records has had on our finances, work flow, and office environment. Its financial impact is not clearly positive; work flows were substantially disrupted; and the quality of the office environment initially deteriorated greatly for staff, physicians, and patients. That said, none of us would go back to paper health records, and all of us find that the technology helps us to better meet patient expectations, expedites many tedious work processes (such as prescription writing and creation of chart notes), and creates new ways in which we can improve the health of our patients. Five broad issues must be addressed to promote successful implementation of electronic health records in a small office: financing; interoperability, standardization, and connectivity of clinical information systems; help with redesign of work flow; technical support and training; and help with change management. We hope that sharing our experience can better prepare others who plan to implement electronic health records and inform policymakers on the strategies needed for success in the small practice environment.

Computers↗
PubMedDate not supplied

Canadian community health centres and the Internet: exploring the challenges and solutions.

Community Health Centres (CHCs) across Canada are providing essential health and social services to many communities, and this function is becoming more vital as provinces concentrate on cutting costs and developing more economic and efficient solutions to the current healthcare system. More than 300 of these community-based organizations currently serve upwards to 13% of the Canadian population, providing a wide range of services in an attempt to promote total wellness in their communities. Over one half of all CHCs are located in rural or remote areas. However, despite the apparent need for, and success of, CHCs, they are among the most underserved health provision groups in the country. Many CHCs lack critical funding and resources, particularly in the area of technology. In this Information Age, the health sector is realizing the importance of using information technologies to increase efficiency, improve services, and maintain viability. Community Health Centres, however, often do not have money for even the most basic technologies such as fax machines, let alone computers and Internet access. Community Health Centres in Canada need to be given the tools they need in order to continue providing quality health care to their communities. This article provides an overview of the current situation of CHCs in Canada vis(-)à-vis the Internet and other information technologies. Some of the practical and organizational challenges facing CHCs in this area will be discussed, as well as potential solutions that could and are being developed to overcome these barriers. It is an objective of this article to facilitate information and resource-sharing and the creation of links between CHCs across Canada. Community Health Centres may benefit from better understanding of the implications of these new technologies, discovering ways in which their peers are using the Internet, and communicating with one another in order to begin basic planning and needs assessments. As part of this overview, a brief update on the status of the HealthNet Community Access Pilot will be provided. The HealthNet Community Access Pilot is a collaborative project aimed at educating and providing CHCs across Canada with the tools to help them begin implementing Internet systems and policies within their own context. Part of this grassroots effort involves developing appropriate technical solutions, software, training materials, and support resources to help demystify and simplify the technology. Some of these tools and recommendations will be available at ITCH '96 for use by other CHCs.

Canada↗
PubMed1986

Guidelines to major equipment purchases.

A major equipment purchase represents a large outlay of cash and effort by a medical group practice. The prudent buyer will carefully negotiate with the seller in a number of areas before any final arrangements are made. These include a detailed description of what is being purchased; price; warranties and guarantees; standards; environmental requirements; technical support and training; payment and delivery provisions; acceptance criteria and testing; and service and maintenance responsibilities. When all provisions are clearly delineated in the acquisition document, there is greater potential for successful equipment acquisition and installation.

Capital Expenditures↗
PubMedDate not supplied

[Measurement of airborne asbestos fibers on railroad rolling stock].

In February 1995 the Italian Railways Health Department set up a special study group in order to assess the effectiveness of the measures adopted against hazards due to the presence of asbestos in rolling stock currently in use on the rail network. The group set up specific procedures for sampling and analysis, on the basis of the criteria fixed for civil buildings in Ministerial Decree of 6/9/94, which was subsequently applied to rolling stock by Ministerial Decree of 26/10/95. In accordance with these procedures the study group carried out environmental studies via test runs programmed by the Railways Technical Departments, on trains made up of different types of vehicles. Insulated, completely or partially deinsulated and originally non-insulated vehicles were studied. Samples were analysed via scanning electron microscopy (SEM) with elementary dispersion X spectroscopy (EDXS) carried out by highly qualified public laboratories (ISPESL--National Institute for Prevention and Work Safety, ARPA--Regional Environmental Protection Agency, CRA--Veneto Region, University Departments). Altogether, from the start of the programme up to September 1998, 1464 samples in 170 test runs on 619 rolling stock vehicles were examined. These involved 83 locomotives, 83 electric rail-cars and 453 carriages. The results showed that in over 99% of the samples the fibre concentrations were below 2 fibres/litre, which is the value fixed by law for buildings and rail vehicles in order to qualify for effective decontamination status. Values exceeding 2 fibres/litre were found in only 4 vehicles, which were withdrawn or blocked for further checks. As a precaution, 18 vehicles where concentrations over 1 but less than 2 fibres/litre were found, were also blocked and their return to service has been postponed for further checks and analyses until the results show concentrations below 1 fibre/litre. Environmental analyses carried out up to the present indicate an overall situation comparable to that usually found in the general environmental without any asbestos dispersion sources. Surveillance and investigations are still under way in order to achieve the aims of the safety programme set up by the Italian Railways to ensure health and environmental protection.

Air Pollution, Indoor↗
PubMed2000

Future directions and emerging issues in technology transfer between HIV prevention researchers and community-based service providers.

The public health objective of preventing new HIV infections can be achieved only through effective information exchange among service providers, researchers, and policymakers. The potential for successful transfer of research-based HIV prevention technology to service providers will be enhanced if investigators take into account in the research planning stage how interventions will be used in the field, seek early input from community members and service providers, test variations of interventions that may increase their practicality in applied settings, and determine the cost and effectiveness of intervention delivery. Strategies are needed to ensure that the experiences of service providers help to inform the HIV prevention research agenda, improve service organization infrastructure and capacity development, and facilitate organizational networking so that providers can use new-generation HIV prevention interventions. Policies are needed to facilitate the development of intervention packages, training, and ongoing technical assistance for service providers in implementing effective HIV prevention interventions.

Community Health Services↗
PubMed2001

[Standardization and recommendations for the appropriate use of automated devices for self-monitoring blood glucose].

The effectiveness of the self-monitoring of blood glucose(SMBG) for the management of diabetic patients has widely been accepted, and many improvements in the devices to meet the demands of lay users have been made, yet no standardization has been performed in Japan. Expert committees of the Japan Society of Clinical Chemistry and Clinical Laboratory Automation and the Japan Diabetes Society made, in cooperation, a report on the characteristics of the devices and the present status of technical performance evaluation in April, 2001. This paper is based mainly on the committee's report and refers to the future trials being prepared by the committee to achieve standardization of the devices. The importance of technical assistance by trained healthcare professionals in applying the devices for the treatment of diabetic patients and the appropriate frequency of SMBG for good glycemic control are also mentioned.

Blood Glucose Self-Monitoring↗
PubMed1988

Resolution 64/85, 1985.

This Resolution provides that the Argentine social program on behalf of women and the family has the following objectives: to study the situation of women and the family in the legal, labor, educational, cultural, health and socioeconomic areas; to collect information and documentation regarding women and the family for use in the establishment of a data bank capable of serving as a basis for the formulation of programs and standards designed to achieve the full involvement of women in social planning; to prepare reports and support measures contributing to the elimination of existing discrimination against women in society; to promote the involvement of women in organized community activities aimed at improving the quality of life of the population; to promote the technical and occupational training of women in accordance with their psychosocial characteristics and the requirements of the labor market; to promote, in the communication media, a change in the image of women more in keeping with their actual role at the present time; to develop basic, nontraditional support services for women designed to bring about improvements in the conditions of family and occupational life and to eliminate instances of social discrimination against women; and to coordinate and monitor activities of promotion, prevention, or treatment on behalf of families in critical situations or vulnerability due to their socioeconomic circumstances.

Americas↗
PubMed2002

[The medical French-speaking world].

Medicine has always been and remains the most solid base of the French-speaking world which was born in Africa and Indochina with the admirable action of "colonial" military physicians, the implantation of the Pasteur Institutes and the emergence of resulting overseas medical schools. Obviously, we are referring to the French-speaking medical world. Since the first International Conference of the Deans of French-Speaking Medical Schools in Abidjan in 1981, today medical schools from 40 French-speaking countries participate. The conference undertakes co-operative medical school initiatives in a multi-lateral spirit, comprised by concrete, practical actions to assist universities in developing countries strive for excellence. These actions, which are conducted with the help of both institutional (AUF, MAE, WHO, UNESCO) and private partners mainly concentrate on promoting medical education of medicine, the evaluation of medical schools, the development of scientific and technical information and training teachers in the methodology of scientific clinical research and in public health. For the future, the Conference has three important objectives, to assist in training researchers and consequently in the development of research centres in emerging countries, to promote continuing medical education in rural areas far from medical schools by taking advantage of modern computer technology, and finally to open horizons toward other communities which speak other languages, and first of all, towards non French-speaking countries who live in a French-speaking environment.

Internationality↗
PubMed2003

Semen analysis: its place in modern reproductive medical practice.

Semen analysis is the most important laboratory investigation for men when assessing the infertile couple. Advances in in vitro fertilisation (IVF) techniques, particularly intracytoplasmic sperm injection (ICSI) involving the direct injection of a single spermatozoon into an egg, have not diminished the role of semen analysis in modern reproductive practice. Semen analysis is the most basic laboratory investigation undertaken and is descriptive in terms of semen volume, appearance, viscosity, sperm concentration, sperm motility and morphology. Since the results are used by clinicians to choose appropriate treatment options, a reliable service is imperative. It is crucial that the laboratory is experienced in the performance of semen analyses to ensure an accurate result. To ensure a quality semen analysis service, laboratories must participate in internal and external quality assurance activities, incorporate rigorous training protocols for technical staff and use reliable procedures. The World Health Organization laboratory manual for the examination of human semen and sperm cervical mucous interaction, clearly describes the variables that need to be assessed and the methods of analysis and quality assurance to be used.

Humans↗
PubMed1992

Biomedical engineering. A means to add new dimension to medicine and research.

Biomedical engineering is an evolving science that seeks to insert technically oriented and trained personnel to assist medical professionals in solving technological problems in the pursuit of innovations in the delivery of health care. Consequently, engineering solutions are brought to bear on problems that previously were outside the training of physicians and beyond the understanding or appreciation of the conventionally educated electrical or mechanical engineers. This physician/scientist/engineer team has a capability to extend medicine and research far beyond the capability of a single entity operating alone. How biomedical engineering has added a new dimension to medical science at the Kennedy Space Center is described.

Adaptation, Physiological↗