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PubMed1998

The role of animal science in natural resource management: current decision making models and future needs.

Sustainable systems for land and natural resource management must be biologically, economically, and socially sustainable. Scientists and educators have historically viewed their role as developing new knowledge and technology to enhance biological and economic sustainability. Scientists have traditionally viewed sociopolitical sustainability and policy development as beyond our appropriate roles. Changing public values and perceptions on appropriate land use and natural resource protection are forcing land grant universities and their scientists and educators to re-evaluate traditional paradigms. The animal science community, in concert with the social and other biological sciences, must become more proactive in decision making processes on appropriate land use and natural resource management if we are to remain relevant. This paper describes the current situation and outlines approaches for the research and education communities to be important contributors to collaborative decision making processes on land and natural resource management.

Animal Husbandry↗
PubMed1989

New needs in health management.

National health development policies demand the building of operational and management capacities. A WHO study has identified key requirements in these areas and has found that few countries are in a position to meet them.

Delivery of Health Care↗
PubMed2005

Combined use of GIS and environmental indicators for assessment of chemical, physical and biological soil degradation in a Spanish Mediterranean region.

Soil is one of the main non-renewable natural resources in the world. In the Valencian Community (Mediterranean coast of Spain), it is especially important because agriculture and forest biomass exploitation are two of the main economic activities in the region. More than 44% of the total area is under agriculture and 52% is forested. The frequently arid or semi-arid climate with rainfall concentrated in few events, usually in the autumn and spring, scarcity of vegetation cover, and eroded and shallow soils in several areas lead to soil degradation processes. These processes, mainly water erosion and salinization, can be intense in many locations within the Valencian Community. Evaluation of soil degradation on a regional scale is important because degradation is incompatible with sustainable development. Policy makers involved in land use planning require tools to evaluate soil degradation so they can go on to develop measures aimed at protecting and conserving soils. In this study, a methodology to evaluate physical, chemical and biological soil degradation in a GIS-based approach was developed for the Valencian Community on a 1/200,000 scale. The information used in this study was obtained from two different sources: (i) a soil survey with more than 850 soil profiles sampled within the Valencian Community, and (ii) the environmental information implemented in the Geo-scientific map of the Valencian Community digitised on an Arc/Info GIS. Maps of physical, chemical and biological soil degradation in the Valencian Community on a 1/200,000 scale were obtained using the methodology devised. These maps can be used to make a cost-effective evaluation of soil degradation on a regional scale. Around 29% of the area corresponding to the Valencian Community is affected by high to very high physical soil degradation, 36% by high to very high biological degradation, and 6% by high to very high chemical degradation. It is, therefore, necessary to draw up legislation and to establish the policy framework for actions focused on preventing soil degradation and conserving its productive potential.

Agriculture↗
PubMed1993

A model for technology assessment applied to pulse oximetry. The Technology Assessment Task Force of the Society of Critical Care Medicine.

OBJECTIVES: To test a model for the assessment of critical care technology. To develop practice guidelines for the use of pulse oximetry. DATA SOURCES: A computer-assisted search of the English language literature and interviews with recognized experts in the field of pulse oximetry. STUDY SELECTION: Those studies that addressed one or more of the seven questions contained in our technology assessment template were analyzed. Study design was not a factor in article selection. However, the lack of well-designed clinical outcome studies was an important factor in determining the method of practice policy development we utilized. DATA EXTRACTION: A focus person summarized the data from the selected studies that related to each of the seven assessment questions. The preliminary data summary developed by the focus person was further analyzed and refined by the task force and then sent to 16 expert reviewers for comment. These expert comments were considered by the task force, and this final consensus report was developed. DATA SYNTHESIS: Pulse oximetry combines the principles of spectrophotometry and plethysmography to noninvasively measure oxygen saturation with a high degree of accuracy over the range of 80% to 100% saturation, assuming the device is being used according to the manufacturer's instructions and without any adverse operating conditions. The appropriate clinical uses of pulse oximetry fall into one of two broad categories: as a warning system based on continuous real-time measurement of arterial desaturation, or as an end-point for titration of therapeutic interventions. There are no published studies that allow for definitive, outcome-based conclusions concerning either the clinical impact or cost-benefit ratio of pulse oximetry. CONCLUSIONS: The model developed for technology assessment proved to be appropriate for assessing pulse oximetry. The available data have allowed us to develop an evidence-based practice policy for the use of pulse oximetry in critical care. Critical care clinicians, researchers, and industry have a shared responsibility to provide valid outcome and efficacy studies of new technologies.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2006

Evidence-based clinical policy: case report of a reproducible process to encourage understanding and evaluation of evidence.

We report within a case study a reproducible process to facilitate the explicit incorporation of evidence by a multidisciplinary group into clinical policy development. To support the decision-making of a multidisciplinary Intersectoral Advisory Group (IAG) convened by the Royal Australasian College of Physicians Health Policy Unit, a systematic review of randomized controlled trials about environmental tobacco smoke and smoking cessation interventions in paediatric settings was first undertaken. As reported in detail here, IAG members were then formally engaged in a transparent and replicable process to understand and interpret the synthesized evidence and to proffer their independent reactions regarding policy, practice and research. Our intention was to ensure that all IAG members were democratically engaged and made aware of the available evidence. As clinical policy must engage stakeholder representatives from diverse backgrounds, a process to equalize understanding of the evidence and 'democratize' judgment about its implications is needed. Future research must then examine the benefits of such explicit steps when guidelines, in turn, are implemented. We hypothesize that changes to future practice will be more likely if processes undertaken to develop guidelines are transparent to clinicians and other target groups.

Advisory Committees↗
PubMed1995

Comfort at the end of life: palliative care policy.

Despite the lack of evidence for improvement in symptom relief, quality of life, or length of survival, patients who are terminally ill often are subjected to unnecessary invasive procedures and denied the symptom relief that modern technology and pharmacology make possible. Nursing administrators are in an ideal position to initiate interdisciplinary policy changes in this area and are encouraged to become familiar with the principles of palliative care. A recently developed policy is described and a review of supportive literature is given.

Academic Medical Centers↗
PubMed1993

Community-based research initiatives in prevention.

An overview of community-based action research projects is presented focusing on the community/research agenda interaction, the difficulties and rewards of this approach, and the unique opportunities of these projects. The potential for policy development as a result of these initiatives has not been fully explored, and some suggestions for the implementation of policies based on the results of action research projects are made. The policy implication of several specific interventions are discussed, along with the limitations and benefits of policy components within a project, rather than as spin-offs. The paper concludes with suggestions for planning community action projects to enhance the policy formulation aspect of these projects.

Alcohol Drinking↗
PubMed2005

Tobacco control in the 21st century: a critical issue for the nursing profession.

Tobacco control is central to reducing death and disability and improving quality of life worldwide and nursing action is imperative. This article addresses tobacco as a global health issue with implications for nursing practice, education, research, and policy development. The lack of knowledge and skills, lack of expectation for clinical intervention, limited research, an absence of professional policies, and minimal nursing leadership have diminished the critical role that nurses can play in confronting this epidemic. Swift action is needed to ensure that all nurses are prepared to effectively engage in activities to prevent tobacco use, provide evidence-based cessation interventions, and support efforts to prevent exposure to secondhand smoke. Increased opportunities are needed to support creative nursing research efforts that test interventions and strategies to reduce barriers to tobacco control within different cultures, subcultures, and countries.

Clinical Competence↗
PubMedDate not supplied

[Public health and chemical-pharmaceutical companies].

This article is concerned with the establishment of the Brazilian pharmaceutical industry. It addresses some issues of relevance to social-economic history, such as the emergence of the public health system, procedures for combating infectious disease, the relations between disinfection campaigns and the chemical industry, serotherapy and the production of serums and vaccines by public research institutions and private pharmaceutical companies. Focusing on the private pharmaceutical industry in Brazil, with special reference to the Instituto Pinheiros - Produtos Terapêuticos S.A., this article highlights the relations between scientists technology and product development. It also considers the debate which involved the scientific community and some governmental research institutions for public health policy development in the state of São Paulo.

Brazil↗
PubMed1980

Hospital planning in France and the Federal Republic of Germany.

This article on hospital planning programs in France and North-Rhine Westfalia (a state in the Federal Republic of Germany), assembles information on the formal building blocks of inter-organizational relations in the formulation and implementation process. Because these planning programs are embedded in past social policy developments and institution-building, it is necessary to first compare the two countries' compulsory health insurance schemes. This is followed by a general profile of each health care system. A third section examines the formulation and implementation of the countries' hospital planning programs and participation patterns. Based on this comparison, inferences are drawn that are relevant to policy and research. The analysis yields three major conclusions. First, despite abundant legal and administrative controls at the disposal of central health bureaucracies, the capability of the national leadership to influence the hospital system through innovative planning is limited by jurisdictional, institutional, functional and territorial fragmentation, and differentiation of control and public responsibility in health. However, the diverse goal orientations of participants may provide the necessary tension to allow for some change in otherwise highly structured political and administrative systems. Second, despite differences in historical, political and administrative developments, the decision making systems for health care policies in France and the Federal Republic, with the exception of health insurance, are strikingly similar to the fragmented decision making system in the United States. Third, the effect of government-mandated participation is empirically uncertain. Opening up the circle of participants seems to have reinforced alliances between public bureaucracies and corporate vested interests. Hospital planning continues to be carried out for rather than with the consumer and citizen. Hospital planning which is a mixture of goal and process-oriented planning does not change the basic orientation of health care systems, which are disease-oriented, and hospital-centered.

Delivery of Health Care↗
PubMed1995

Management and health care reform in sub-Saharan Africa.

Recent discussions of health care reform in sub-Saharan Africa have centered on the potential of alternatives to public financing and provision of health care to address efficiency and resource weaknesses. This paper informs these discussions by reporting an overview of the findings of a detailed evaluation of the efficiency and quality of public and non government primary level health services in Tanzania, a sub-Saharan leader in health policy development since the 1960s and used here as an exemplar country for the region. The paper discusses the management actions necessary to address the performance weaknesses identified and considers the possible contribution alternative financing strategies might make in addressing the weaknesses. However, financing reforms will not by themselves address the performance failures; health care reform packages must allow for financing, organizational and management development.

Costs and Cost Analysis↗
PubMed2005

Inequalities in children's health.

This article explores some of the differences between adult and child health services and aims to assist readers appreciate the possible inequalities that can occur. In order to achieve this, different factors affecting child development are explored and the problems of developing policies and practices that support children's health considered.

Child↗
PubMed2001

The characterisation, treatment and sustainable reuse of biosolids in Ireland.

Ireland is an island country on the western boundary of the European Union. A suite of environmental legislation over the last decade has combined to increase the amount of municipal sludge for treatment fourfold, while, simultaneously, eliminating traditional disposal methods. The Irish Government has instituted a comprehensive programme of policy development, infrastructure provision and drafting of "codes of good practice" to meet these environmenta; and legislative challenges. As the programme has developed, it has become clear that the sludge/biosolids issue shares many of the philosophical and logistical elements of other environmental issues that are developing apace in Ireland, including municipal waste management, agricultural waste management and overall integrated development. In many ways, it represents a model of the ultimate "sustainable development" issue. To provide specific data for decision making and policy/infrastructure/technology development, the Irish Government has funded a US$600k programme of research in The Characterisation, Treatment and Sustainable Reuse of Biosolids. The design philosophy of the programme is a "cradle-to-grave" approach, in order to integrate the outcomes of specialised research studies into an overall sustainable development model.

Conservation of Natural Resources↗
PubMed1989

Federal nutrition policies: impact on dietetic practice.

Current federal nutrition policies are likely to have a major impact on dietetic practice. Several examples have been selected to explain why and how members of the American Dietetic Association and other nutrition professionals should become involved in policy development and implementation.

Cholesterol↗
PubMed1985

Regulatory development of the interim and revised regulations for radioactivity in drinking water--past and present issues and problems.

Developing the Revised Regulations for Radioactivity in Drinking Water under the Safe Drinking Water Act requires information from all related areas and disciplines. As one step in the regulatory process, the background and history of that process as it applies to radioactivity in drinking water is described. The issues involved in developing the revised regulations are as follows: monitoring and sources of exposure, dose evaluation, health effects, engineering, economics and general policy development.

Animals↗
PubMed2005

Treatment of Candida infection: a view from the trenches!

PURPOSE OF REVIEW: To provide an overview of the treatment of Candida infections from the perspective of the infectious disease clinician in the community. An insight is given into relevant issues as they apply to clinical practice. As community hospitals strive to provide state-of-the-art medical care to critically ill patients, effective infection control programs and the infectious disease consultation availability become indispensable. RECENT FINDINGS: Candida infections rank as the fourth most common cause of nosocomial bloodstream infections. Although C. albicans remains the most common pathogen, emerging trends in invasive candidiasis are notable for a dramatic increase in infections due to non-albicans Candida species, reflecting changes in clinical practice. These trends affect our practice because infections with non-albicans species raise concerns for inherent decreased antifungal susceptibility, ultimately impacting our preventive, empirical and therapeutic approaches. It seems inevitable for most acutely ill patients today to be admitted to the intensive care unit, thus increasing their risk for nosocomial infections. In addition, cost containment efforts may force patients receiving intravenous therapy into less supervised environments, potentially increasing their risk for candidemia. SUMMARY: Potentially fatal Candida infections are commonplace in seriously ill hospitalized patients. The infectious disease physician is challenged to develop expertise in using the newly introduced antifungal agents, applying evidence-based guidelines developed from quality randomized clinical trials. The infectious disease specialist is called to play a multidisciplinary role formulating infection control policies, developing drug formularies, educating the staff and treating the sickest patients. Infection surveillance in local communities coupled with available antifungal agents may improve our management of Candida infections.

Antifungal Agents↗
PubMed2001

The role of MCH and family planning services in HIV/STD control: is integration the answer?

During the mid 1990s, high HIV and sexually transmitted disease (STD) prevalence led to calls for the integration of effective services with maternal and child health and family planning (MCH/FP) programs. There are advantages and disadvantages to integration, but little evidence existed to assess the practicalities of implementing this policy. Analysis of policy development for integration was conducted in Ghana, Kenya, South Africa, and Zambia. Semi-structured interviews were conducted with policy-makers at national, provincial and district levels and a survey of facilities was undertaken to identify gaps between policy intent and implementation. Significant advances had been made at the national level to formulate policies to integrate reproductive health and primary health care. However, barriers to implementation included entrenched HIV/STD and MCH/FP vertical programs; diverse demands on district managers and providers, such as on-going institutional reform; and conflicting objectives of international donors. Policy-makers need to address conflicting objectives between the needs for vertical accountability and the reality of providing integrated services. More careful consideration of implementation is required at earlier stages of policy design. Increased consultation with those who are to implement and provide integrated services is recommended.

Child↗