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PubMed1992

The General Hospital Colombo Rehabilitation Project.

The General Hospital Colombo (GHC) Rehabilitation Project was to be implemented in 6 phases in about 25 years. The proposed funding was a grant of 100% from Finland for technical assistance and training, and 85% for investments. The development objective was to reinforce the status of the hospital as the apex of the medical care system. In Phase I (1985-1990) an 8 storeyed accident and orthopaedic services building with modern facilities has been commissioned. A water tower and a 'septic' operating theatre have been built. Infection control and maintenance organizations have been started. Phase I cost Rs.960 million. In the Bridging Phase, the existing six storeyed building is being renovated. Phase II has been drastically curtailed. It will concentrate on infrastructure development such as water supply, kitchen, stores and transport, and the construction of four new medical wards. The project will end in 1993.

Costs and Cost Analysis↗
PubMed2004

[Taiwan nursing accreditation for nursing education].

On 1st January 2003, with the support and assistance of Professor Kun-Yan Huang, the Ministry of Education assembled its University Nursing Departments Evaluation Planning Group. Professor Yu-Mei Yu Chao led the group in over a year of hard work and planned an accreditation of systematic evaluation of university nursing departments. The hope is to accumulate experience through this accreditation to promote nursing undergraduate programs evaluation to the Ministry of Education's technical and vocational training system. This article illustrates the 12 core disciplines that the evaluation system stresses as embodying the spirit and aims of nursing. Once the spirit and aims of education have been dealt with, the evaluation turns to the six important matters of conduct of departmental affairs, faculty, students, curriculum and teaching, teaching resources and educational outcomes. The system is expected to raise the quality of nursing education, help in the monitoring of the citizens' health care, and raise the success and satisfaction levels of students.

Accreditation↗
PubMed2004

Hands across the waters.

American hospitals have for years quietly offered used equipment and supplies to struggling sister facilities in developing countries. Some hospitals even send volunteers to provide technical assistance and training. A number of nonprofit organizations have formed to reduce the hassle factor for hospitals, helping to collect, ship and set up the donations overseas. Although the impetus to donate is primarily humanitarian, there are ancillary benefits. For instance, according to some estimates, hospitals throw away up to 10 billion dollars in equipment and supplies every year. Even if only 10 percent of that amount can be reused, the reduction in the health care industry's waste stream would be considerable.

Altruism↗
PubMed2005

Using the State Plan Index to evaluate the quality of state plans to prevent obesity and other chronic diseases.

INTRODUCTION: Implicit in public health planning models is the assumption that good public health plans lead to good programs, and good programs lead to desired health outcomes. Despite considerable resources that are devoted to developing plans, public health agencies and organizations have lacked a tool for evaluating the finished product of their planning efforts -- the written plan itself -- as an important indicator of progress. To address the need for an instrument to assess the quality of state plans designed to prevent and control chronic diseases, we created and tested the State Plan Index and used it to evaluate the quality of nine state plans aimed at preventing and reducing obesity. METHODS: The State Plan Index was developed under the auspices of the Centers for Disease Control and Prevention (CDC) in collaboration with public health experts in federal, state, and academic settings. The State Plan Index included 55 items related to plan quality arranged into nine components. Each item was rated on a Likert scale from 0 to 5, with 5 being the highest rating. Each plan also received a separate overall plan quality score using the same scale. Each state plan was evaluated by four or five raters using the State Plan Index. For each plan, the 55 items were averaged to calculate an item average score, and a subscore was calculated for each State Plan Index component. Finally, five states also self-rated their own plans (self score). RESULTS: The mean item average score for all plans was 2.4 out of 5.0. The range of item average scores was 1.0 to 3.0. The component of the State Plan Index with the highest mean component score (3.3) was Presentation of Epidemiologic Data on Disease Burden. The components with the lowest component scores were Resources for Plan Implementation (0.7); Integration of Obesity Efforts with Other Chronic Disease Efforts (1.7); and Program Evaluation (2.0). Plan quality was rated higher when based on the single overall plan quality score assigned by raters. In addition, self scores were consistently and substantially higher than rater-assigned scores. CONCLUSION: Evaluation of plans early in the life of programs can be used to strengthen existing programs and to guide programs newly engaged in chronic disease prevention planning. The CDC has used the State Plan Index evaluation results to guide technical assistance, plan training sessions, and enhance communication with state staff about plan content, quality, and public health approach. Some state program directors self-evaluated their obesity draft plan and used the evaluation results to strengthen their planning process and to guide plan revisions. Other states have adapted the State Plan Index as a framework for new planning efforts to prevent obesity as well as other chronic diseases.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Alaska/Magadan EMS project: phase two.

In July, 1991, five members of the Alaska/Magadan Medical Exchange group visited the Magadan/Chukotka Region of the Soviet Far East, to continue studies of the emergency medical services (EMS) system, and to implement recommendations for system improvement developed during the previous year. During this exchange visit, major efforts focused on development of a rapid defibrillation system for the city of Magadan, technical assistance and training to upgrade burn treatment capabilities, and training and equipping prehospital emergency medical service providers to perform spinal immobilization techniques on traumatic injury patients. Further studies were conducted to compare EMS in the Magadan/Chukotka Region with EMS in Alaska, and recommendations are being presented for further collaborative projects.

Alaska↗
PubMedDate not supplied

Telemedicine and rural health care applications.

Telemedicine has the potential to help facilitate the delivery of health services to rural areas. In the right circumstances, telemedicine may also be useful for the delivery of education and teaching programmes and the facilitation of administrative meetings. In this paper reference is made to a variety of telemedicine applications in Australia and other countries including telepaediatrics, home telehealth, critical care telemedicine for new born babies, telemedicine in developing countries, health screening via e-mail, and teleradiology. These applications represent some of the broad range of telemedicine applications possible. An overriding imperative is to focus on the clinical problem first with careful consideration given to the significant organisational changes which are associated with the introduction of a new service or alternative method of service delivery. For telemedicine to be effective it is also important that all sites involved are adequately resourced in terms of staff, equipment, telecommunications, technical support and training. In addition, there are a number of logistical factors which are important when considering the development of a telemedicine service including site selection, clinician empowerment, telemedicine management, technological requirements, user training, telemedicine evaluation, and information sharing through publication.

Australia↗
PubMed1990

[Role of angioplasty in the treatment of arteritis of the lower limbs].

During the last ten years, the role of angioplasty in the management of peripheral vascular disease has considerably increased. Angioplasty requires a specific radiological equipment and qualified radiologist trained to this technics. The results depend mainly on the clinical, indication of angioplasty, on the importance and site of the lesion. The different reports give more or less the same rates of patency for stenosis or short occlusions: 80% for iliac arteries and 60% for femoral arteries within 3 years. The clinical benefit of angioplasty also depends the development of new atherosclerotic lesions. The new technics (laser, endoprosthesis) seems to be interesting for the prevention of restenosis. Their real place is still to be defined. The diversity of treatments for peripheral vascular diseases makes the collaboration of cardiologist, surgeon and interventional radiologist necessary for their management.

Angioplasty, Balloon↗
PubMed1990

[The present status of vascular surgery and perspectives for its development in Slovakia].

The authors submit information on the state of vascular surgery in the SSR. The report is based on statistical data and numbers of different operations obtained from questionnaires in 1987 and 1989. In the number of vascular operations we lag behind after some European countries as well as after the Czech Socialist Republic. Consistent with the concept of surgery, departments of vascular surgery should be established in all hospitals polyclinics type III and in selected hospitals polyclinics type II with a catchment area with a population of more than 300,000. For this a material and technical basic and trained personnel must be ensured.

Czechoslovakia↗
PubMed1988

[Evaluation of female intrapelvic blood vessels and their hemodynamics with real-time two-dimensional Doppler ultrasound].

Real-time two-dimensional and pulsed Doppler ultrasound examinations were performed on 5 healthy Japanese with a history of normal menses and 27 pregnant subjects with regular menstrual cycles and no complications. The objective of the study was to visualize blood flow and record blood flow velocity waveforms from the pelvic vessels. This approach led to an accurate estimation of blood flow in a non-invasive manner. No particular technical skill or training is required. The resistance index of the arcuate artery was high in non-pregnant subjects and in those in early pregnancy. By 15 weeks the index became low and there was little change thereafter. We propose that real-time two-dimensional and pulsed Doppler ultrasound will prove to be good diagnostic tools for the detection of various pathologies encountered in the field of obstetrics and gynecology.

Female↗
PubMed1986

Update on pregnancy testing.

Laboratory testing is an extension of the physical examination, reaching sites that are otherwise inaccessible to the examiner. Pregnancy testing is one such diagnostic extension. Like physical examination, it must be used carefully. In choosing a pregnancy test for office use, many factors must be considered, so that accurate information will be available for patient management. Such factors as the technical skills and training of the office staff performing the test, shelf life of the test, need to refrigerate reagents, and frequency of usage are all important considerations. Test results must always be correlated with specific patients and clinical findings, and at times, doubts may be allayed by simply retesting patients with negative or equivocal results at a later time (currently a matter of days instead of weeks). Recent developments in pregnancy testing have been directed toward improved sensitivity and specificity, as well as speed, simplicity, and reduced cost. The clinical issue of greatest interest to most primary care physicians is the early diagnosis of normal pregnancy, where "early" may be defined as prior to the first missed menses. Diagnosis in the first 21 days of gestation is currently possible with more sensitive methods, and especially with enzyme-linked immunoassay. In this regard, because of its easy methodology and basic reliability, the enzyme-linked immunoassay may well become the new standard for office pregnancy testing.

Biological Assay↗
PubMed1979

[Aanalysis of nursing in Latin America].

The article presents a comprehensive analysis of health and nursing practices and their relationship to the economic structure and dominant means of production in Latin America. The analysis stems from a division of economic history into the following periods: 1900 to 1930, 1930 to 1960, and from the end of 1960 to present. The writer examines the characteristics of economic and social development in each of those periods and correlates them with health and nursing practices. She delves particularly into the predominant forms of nursing practice and the various approaches to training for auxiliary, technical, and professional staff. She seeks to show that both practice and knowledge in the field of health and nursing are related to the process of economic production. She suggests that recognition of this fact would contribute to a better understanding of the problems confronting the health and education sectors and would permit a search for more realistic solutions to the problems.

Economics, Nursing↗
PubMed1978

Quality assurance practice in rural and urban hospital clinical laboratories.

This survey examined quality assurance practice in matched pairs of rural and urban hospital clinical laboratories. Questions directed at personnel qualifications, laboratory management, internal quality control mechanisms, and proficiency testing enrollment revealed no major differences between the rural-urban pairs. Deficiencies observed were either generic or size-related. Most laboratories were directed by physicians; however, almost half spent 5 or less hours per week in the laboratory. All respondents employed at least one individual professionally certified at the "technologist" level. Virtually all respondents insisted they employ a laboratory management system for ensuring quality performance, although 20% did not document their practice. Internal quality control practice varied widely. Many respondents recognized shortcomings related to volume and budget, and requested specific training courses for technical personnel. At least 20% of the laboratories were not enrolled in any recognized proficiency testing program, an integral part of the total quality assurance process.

Blood Banks↗
PubMedDate not supplied

The challengers, interactors and mainstreamers: second step education and nursing roles.

What impact have post-licensure or "Second Step" programs for nurses had been upon experienced nurses? How successful have they been in developing more professional orientations among nurses trained for a technical role? A factor analysis of longitudinal data from 236 nursing students in six Second Step programs revealed that students entering these programs varied greatly in professional attitudes. Three types of students--the challengers, the interactors, and the mainstreamers were differentiated, by their contrasting nursing styles as well as by diverse sociopolitical views and personality characteristics. Data indicated that, at graduation, students in all three groups perceived themselves as more professionally involved, committed, and competent, but they did not change similarly in other areas of life. The challengers and the interactors made significant changes in their sociopolitical views and in some personality characteristics, while the mainstreamers made fewer changes and maintained greater consistency from entry to graduation. Second Step education promoted professional development, but its impact upon other areas of life varied, depending upon the students' receptivity and readiness for change.

Adult↗
PubMedDate not supplied

Evaluation of parallel pelvic/breast and male genital/rectal teaching programs.

Pelvic/breast (PB) and male genital/rectal (GR) programs were evaluated to learn if male and female students differed in their reactions to the programs and if observations of the programs confirmed students' reactions. In-depth interviews were conducted with male and female teaching associates to uncover the need for program improvements beyond those suggested by observation and student reactions. Participating in the PB program were 74 men and 85 women; 79 men and 90 women took part in the GR program. Sex differences were found in the GR program: Female students admitted to greater anxiety about examining male genitalia prior to the program (p = .009) and expressed more dissatisfaction with the timing (too late in the curriculum p = .006). Male students were less likely than females to improve their ability to communicate as a result of the GR program (p = .009). Observations and interviews indicated that the programs were successful in teaching technical skills but that they needed further work in integrating technical and communication training, especially during GR examination training.

Breast↗
PubMed1995

[Teaching digestive laparoscopic surgery in France: from education to accreditation?].

The extremely rapid development of laparoscopic surgery since 1989 has given evidence, by the increase in the number of local and vital complications, that teaching of laparoscopic surgery is absolutely necessary, especially technical and practical training. Indeed, laparoscopic surgery is not only a new and different way to attain abdominal organs, but it needs also a complete different acquiring of gestures, which are difficult since the eyes and hands are dissociated due to the videotechnics. The University post-graduate training courses (University Diploma D.U.), which were first organized by the authors in Paris and Nice since 1990, have given the best answers to this challenge: training a large number of surgeons in a minimum of time. In 1994, a new Collège of general visceral and digestive surgeons was founded and the teaching conditions have been modified since. This college courses of general and digestive surgery (D.E.S and D.E.S.C respectively) and during post-graduate formation (F.M.C). After having given recommendations for the program of theoretical and practical teaching of laparoscopic surgery, the authors suggest that this teaching should be integrated in graduate courses of general surgery and in post-graduate courses. These courses represent the best training and are the guarantee of good quality and it would be a big error to suppress them. They should continue under the constant control of the French College of Digestive Surgeons and be supervised by the French National order of medical Doctors.

Accreditation↗
PubMed1996

Occupational injuries among fishermen.

A sample of 187 medically treated injuries among fishermen was the basis for this study. Nearly half the injuries occurred while shooting or hauling fishing gear. The most common injuries were in the upper extremities (48.7%). Twenty-two percent of the injuries occurred while working with winches ropes and wires and about 30% were caused by falls or slips. Seventy-five percent of accidents occurred on trawlers, where the trawl doors (other boards) are a special hazard. Medical treatment ashore was delayed for more than 24 hours in 35% of the injuries, showing the need for providing optimal treatment facilities on board. Prevention measures should include technical improvements, safety training courses and efforts to enhance the motivation for safe work. The fishermen's proposals for prevention seem to be most useful and should be used to the full extent.

Absenteeism↗
PubMed1997

Outpatient use of left ventricular assist devices: nursing, technical, and educational considerations.

Improvements in technology and in the selection, care, and treatment of patients have led to wider clinical use of mechanical circulatory support. Considerable progress has been made with the use of left ventricular assist devices. Patients are currently maintained in outpatient facilities until a donor heart becomes available; recently, left ventricular assist devices have started to be used as permanent implants. This article outlines the steps that are taken to prepare the patient, the patient's family, and the medical staff for discharge from the hospital of a patient supported with a left ventricular assist device. Extensive technical and clinical training of the primary caregiver and the patient is required to prepare for discharge from the hospital. Data are rapidly accumulating that show that left ventricular assist devices are safe and efficacious for outpatient use. Similar success is expected in clinical trials of permanent left ventricular assist devices, suggesting that many more patients will benefit from this technology in the future.

Heart-Assist Devices↗
PubMed1998

Contributions of respiratory care practitioners to intensive care: a review.

Through the years, the professional practice of respiratory care has continually evolved to include management of critically ill patients. Although the functions and duties of respiratory care practitioners (RCPs) in this setting may vary across different institutions, it is widely recognised throughout the United States that RCPs contribute importantly to intensive care unit (ICU) outcomes. The American Association for Respiratory Care (AARC) has painstakingly established guidelines to more precisely define the role of RCPs in performing procedures in the ICU. Published studies demonstrate the added value of RCPs' collaboration in several ICU activities, including placement of arterial catheters, sampling of arterial blood gases, endotracheal intubation, and management of and weaning from mechanical ventilation. Other ICU activities in which RCPs participate include assisting with bronchoscopy, obtaining haemodynamic measurement, and indirect calorimetry and supporting specialised techniques such as extracorporeal membrane oxygenation (ECMO) and continuous veno-venous haemofiltration and/or haemodiafiltration (CVVH/CVVHD). Based on the demonstrated impact of RCPs and their technical and cognitive training, a continuing role expansion for RCPs in the ICU is expected.

Airway Obstruction↗