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At least 703 records · Page 39Linked to original sources

Universal access: but when? Treating the right patient at the right time: access to cardiac rehabilitation.

The Canadian Cardiovascular Society formed an Access to Care Working Group ('Working Group') in the spring of 2004. The mandate of the group was to use the best science and information to establish reasonable triage categories and safe wait times for access to common cardiovascular services and procedures. The present commentary presents the rationale for benchmarks for cardiac rehabilitation (CR) services. The Working Group's search for evidence included: a full literature review of the efficacy of CR, and the factors affecting access and referral to CR; a review of existing guidelines for access to CR; and a national survey of 14 CR programs across Canada undertaken in May 2005 to solicit information on referral to, and wait times for, CR. The Working Group also reviewed the results of The Ontario Cardiac Rehabilitation Pilot Project (2002) undertaken by the Cardiac Care Network of Ontario, which reported the average and median wait times for CR. Some international agencies have formulated their own guidelines relating to the optimal wait time for the onset of CR. However, due to the limited amount of supporting literature, these guidelines have generally been formed as consensus statements. The Canadian national survey showed that few programs had guidelines for individual programs. The Cardiac Care Network of Ontario pilot project reported that the average and median times from a cardiac event to the intake into CR were 99 and 70 days, respectively. The national survey of sampled CR programs also revealed quite remarkable differences across programs in terms of the length of time between first contact to first attendance and to commencement of exercise. Programs that required a stress test before program initiation had the longest wait for exercise initiation. Some patients need to be seen within a very short time frame to prevent a marked deterioration in their medical or psychological state. In some cases, early intervention and advocacy may reduce the risk of loss of employment. Or, there may be profound disturbances in the patient's family as a result of the cardiac event. For other patient groups, preferable wait times vary from one to 30 days, and acceptable wait times vary from seven to 60 days. All cardiovascular disease patients require core aspects of CR services. Patients who would derive benefit from formal CR programs should be provided the opportunity, given the proven efficacy and cost effectiveness of CR.

Benchmarking↗

Treating the right patient at the right time: Access to echocardiography in Canada.

The Canadian Cardiovascular Society is the national professional society for cardiovascular specialists and researchers in Canada. In the spring of 2004, the Canadian Cardiovascular Society Council formed the Access to Care Working Group ('Working Group') to use the best science and information available to establish reasonable triage categories and safe wait times for access to common cardiovascular procedures. The Working Group decided to publish a series of commentaries to initiate a structured national discussion on this important issue, and the present commentary proposes recommended wait times for access to echocardiography. 'Emergent' echocardiograms should be performed within 24 h, 'urgent' within seven days and 'scheduled' (elective) within 30 days. A framework for a solution-oriented approach to improve access is presented.

Canada↗

Treating the right patient at the right time: Access to cardiac catheterization, percutaneous coronary intervention and cardiac surgery.

The Canadian Cardiovascular Society Access to Care Working Group was formed with a mandate to use the best science and information available to establish reasonable triage categories and safe wait times for common cardiovascular services and procedures through a series of commentaries. The present commentary discusses the rationale for access benchmarks for cardiac catheterization and revascularization procedures for patients with stable angina, and access benchmarks for cardiac catheterization and surgery for patients with valvular heart disease. Literature on standards of care, wait times and wait list management was reviewed. A survey of cardiac centres in Canada was performed to develop an inventory of current practices in identifying and triaging patients. The Working Group recommends the following medically acceptable wait times for access to cardiac catheterization: 14 days for symptomatic aortic stenosis and six weeks for patients with stable angina and other valvular disease. For percutaneous coronary intervention in stable patients with high-risk anatomy, immediate revascularization or a wait time of 14 days is recommended; six weeks is recommended for all other patients. The target for bypass surgery in those with high-risk anatomy or valve surgery in patients with symptomatic aortic stenosis is 14 days; for all others, the target is six weeks. All stakeholders must affirm the appropriateness of these standards and work continuously to achieve them. There is an ongoing need to continually reassess current risk stratification methods to limit adverse events in patients on waiting lists and assist clinicians in triaging patients for invasive therapies.

Angioplasty, Balloon, Coronary↗

New media technology and youth: trends in the evolution of new media.

An information environment is emerging from the simultaneous, rapid, and interconnected evolution of transmission systems, interfaces, and content quantity, quality, and structure. It will be easy to underestimate the collective impact of the sum of these changes on how young people communicate and absorb information. Ultimately, it will be more important to understand how these technologies will facilitate, amplify, or alter the cognitive processes and/or social behavior of the Internet generation. The article analyzes the impact of the following trends on media use and cognition among youthful users: * Information expansion and overload: Accessible networked information will continue to grow at a rapid pace for at least the next 10-20 years. * Rapid increase in interface diffusion: The number of access points into the Internet is expanding in number, variety, and mobility. * Evolution toward more embodied computing: Interfaces are evolving to use more of the sensorimotor system to transfer information to and from the user. * The evolution of more intelligent sensors to interpret use behavior and intentions. * Evolution toward anthropomorphic agent techniques: Computers are evolving to use more social and interpersonal communication techniques to interact with the user.

Adolescent↗

Chemoinformatics--a new name for an old problem?

Library chemistry and high-throughput screening require greater use of chemoinformatics to increase their effectiveness. Recent advances in chemoinformatics include new molecular descriptors and pharmacophore techniques, statistical tools and their applications. Visualisation methods and hardware development are also opening new opportunities. The advent of a chemically aware web language and cross-platform working is ensuring that chemoinformatics methods are becoming available to all chemists in a more appropriate manner. Much time will continue to be wasted with incompatible file types without internationally agreed standards.

Chemical Phenomena↗

Information systems' approaches and designs and facility information: survey of acute care hospitals in the United States.

These survey results are based on a national survey of acute care hospitals. A random sample of 813 hospitals was selected with 115 responding and 33 incorrect address returns resulting in a 15% response rate. The purpose of the study was to measure the extent of information systems integration in the financial, medical, and administrative systems of the hospitals. The rate of adoption of information technology or technology transfer is discussed. Facility demographics are presented. Characteristics of information systems' approaches and designs are reviewed and their implications discussed. This information will provide benchmarks for hospitals to determine their information systems position and to set goals.

Benchmarking↗

Integrating evidence-based practice in the child mental health agency: a template for clinical and organizational change.

This article describes a linked set of activities designed to address the present "science-to-service" gap in evidence-based practice from the perspective of the nonprofit child mental health agency: (a) implementing "systems-of-care" principles; (b) logic modeling; (c) strategic partnerships with external researchers; (d) selective, in-depth program evaluation; (e) critical comparison with a limited number of evidence-based practice models of national significance; and (f) internal and external dissemination activities oriented to evidence-based practice. Implications are drawn both for continuous quality improvement of existing clinical services and for the potential for agencies to contribute high quality, science-based information to child mental health services, singly and through the future development of a national network of experimenting child mental health agencies.

Child↗

Cross-disciplinary verification of theories: the case of the triarchic theory.

There are at least 4 good reasons to study the history of psychology. First, we can give credit to those who deserve it. Second, historical views can provide converging operations that help demonstrate the validity of our own views (or rather, operations that invalidate our views). Third, we learn that other natural and social sciences can inform our views. Fourth, we learn that philosophical and psychological analyses often converge. I show how historical views can inform current thinking about intelligence.

Greece↗

Computer-assisted learning and the general dental practitioner.

Computer-assisted learning is an acceptable form of education for general dental practitioners. Critical assessment of program structure and content is required if the maximum benefits of the medium are to be obtained. There is a need for information technology support for general dental practitioners to allow them to make best use of the programs.

Adult↗