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PubMed2006

(A3) HIV Phenotypes, oral lesions, and management of HIV-related disease.

Workshop participants discussed: the role of HIV subtypes in disease; the treatment of oral candidiasis; the relationship between and among viral load, CD4+ counts, oral candidiasis and oral hairy leukoplakia, pigmentation; and the development of a reliable oral index to predict disease progression. Regarding HIV, the literature revealed that Type I (HIV-I), in particular group M, is involved in the majority (90%) of documented infections, and groups N and O to a lesser extent. Viral envelope diversity led to the subclassification of the virus into nine subtypes, or clades-A-D, F-H, J, and K-each dominating in different geographical areas. HIV-2, currently occurring mostly in West Africa, appears to be less virulent. No evidence could be produced of any direct impact of type, subtype, or clade on oral lesions, and participants believed that further research is not feasible. Oral candidiasis in patients from resource-poor countries should be prevented. When the condition does occur, it should be treated until all clinical symptoms disappear. Oral rinsing with an antimicrobial agent was suggested to prevent recurrence of the condition, to reduce cost, and to prevent the development of antifungal resistance. Lawsone methyl ether, isolated from a plant (Rhinacanthus nasutus leaves) in Thailand, is a cost-effective mouthrinse with potent antifungal activity. Evidence from a carefully designed prospective longitudinal study on a Mexican cohort of HIV/AIDS patients, not receiving anti-retroviral treatment, revealed that the onset of oral candidiasis and oral hairy leukoplakia was heralded by a sustained reduction of CD4+, with an associated sharp increase in viral load. Analysis of the data obtained from a large cohort of HIV/AIDS patients in India could not establish a systemic or local cause of oral melanin pigmentation. A possible explanation was a dysfunctional immune system that increased melanin production. However, longitudinal studies may contribute to a better understanding of this phenomenon. Finally, a development plan was presented that could provide a reliable prediction of disease progression. To be useful in developing countries, the index should be independent of costly blood counts and viral load.

AIDS-Related Opportunistic Infections↗
PubMed1993

Strategic planning for hotel operations: The Ritz-Carlton Hotel Company (Part II).

The Ritz-Carlton Hotel Company won the Malcolm Baldrige National Quality Award in 1992. One key to its success is its strategic planning process. In this second part of a two-part article, Stephen Shriver concludes his review of the Ritz-Carlton's approach to strategic planning. Shriver begins by outlining some key steps in plan development and goes on to describe how the Ritz-Carlton disseminates, implements, and evaluates the plan.

Commerce↗
PubMed2001

Issues and dilemmas of developing a new faculty practice plan.

Due to changes in health care and increased knowledge of the public concerning health care, faculty need to assume a more active role in practice settings. Faculty involvement in the practice of their disciplines allows them to remain on the "cutting edge" as well as be models for their students. Most faculty practice plans will provide some external funding but more importantly will allow additional educational opportunities for the students as they work with the faculty. These plans allow faculty to interact with the community and strengthen the ties of the community and the academic institution. However, there are dilemmas in establishing faculty plans, for the quality of teaching cannot be threatened, and most universities expect their faculty also to be involved in scholarly activities. This article discusses 1) the process used in planning and developing a faculty practice plan; 2) details of the plan, to include faculty incentives, administrative cost, etc.; and 3) strategy for implementation.

Faculty↗
PubMed1992

3D treatment planning for heavy charged particles.

The comments herein describe, at a necessarily superficial level, a number of issues which must be addressed in developing plans for heavy charged particle therapy. Programs now exist which provide the needed capabilities. The challenge now is to make the planning process easier and faster--and possibly more effective. It seems likely that this will be achieved in the next few years.

Equipment Design↗
PubMed2006

Community-based disaster preparedness and climate adaptation: local capacity-building in the Philippines.

Community-based disaster preparedness (CBDP) approaches are increasingly important elements of vulnerability reduction and disaster management strategies. They are associated with a policy trend that values the knowledge and capacities of local people and builds on local resources, including social capital. CBDP may be instrumental not only in formulating local coping and adaptation strategies, but also in situating them within wider development planning and debates. In theory, local people can be mobilised to resist unsustainable (vulnerability increasing) forms of development or livelihood practices and to raise local concerns more effectively with political representatives. This paper focuses on the potential of CBDP initiatives to alleviate vulnerability in the context of climate change, and their limitations. It presents evidence from the Philippines that, in the limited forms in which they are currently employed, CBDP initiatives have the potential both to empower and disempower, and warns against treating CBDP as a panacea to disaster management problems.

Community Networks↗
PubMed1989

Agricultural development and nutritional status in Malawi.

A comparative anthropometric assessment involving 2175 measurements of 1533 children under the age of 5 was carried out in Malawi, both before and after the harvest seasons (February and May, 1985). Subjects were randomly drawn from socioeconomically similar rural environments within and outside a large-scale agricultural development project. Chronic malnutrition (height for age less than 90 per cent of the median) was found to be 36 per cent in February and 41 per cent in May. The prevalence of acute malnutrition (weight for height less than 80 per cent of the median) was 4 per cent and 5 per cent, respectively. Tests of significance found no statistical difference between the project and non-project children for a variety of nutritional status indices. It is postulated that such factors as increased female access to extension services and male access to nutrition education may have greater impact on morbidity than income increases alone, and should be part of agricultural development planning.

Agriculture↗
PubMed2000

Clinical pathways: a direction forward in health care.

As in many developed nations, health care consumers in Singapore are demanding better (and more costly) services. At the operational level, one way to address consumers' demands while ensuring cost-effectiveness is through the implementation of a clinical pathway program. This paper provides an overview of the program at Changi General Hospital (CGH), a regional general acute care hospital in the Republic of Singapore. The paper highlights the problems encountered during the planning, developing and implementing phases. It concludes by predicting what the future might hold for clinical pathways in Singapore and the South East Asian Region.

Cholecystectomy, Laparoscopic↗
PubMed2001

Joining them up: the challenges of organisational change in the professional politic of general practice.

Primary health care in the UK is currently centred around independent contractor organisations (general practices). Although the development of these organisations is considered necessary to improve the quality of health care, no structures exist to support the systematic development necessary to attain this goal. Part of the failure to change clinical processes has been the requirement that general practitioners attend passive educational events for continuing professional development, without reference to organisational or local health priorities. A feasibility study to integrate professional and practice development planning sought to overcome this mismatch. NHS Staff College Wales, as a facilitating organisation in this study, developed a model to assist practices to identify, prioritise and implement developments, interlinked with individuals' professional development. The paper summarises the experiences of facilitators supporting this integrated approach, using Senge's model of the challenges to the successful implementation of change. The role of facilitation in negotiating these challenges is also explored. The paper concludes that the approach is effective in the integration of professional and practice development and offers a useful framework to progress the quality improvement agenda.

Cooperative Behavior↗
PubMed1996

Case management: meeting the needs of chronically ill patients in an HMO.

Primary care staff education plays a critical role in a health plan making a transition from a case management model to a model that emphasizes close care coordination for chronically ill patients with multiple care needs. Multidisciplinary teams can help refine the system to have a positive impact on care across diverse settings: Health Plan of Nevada found that such training aids staff in identifying at-risk individuals and in developing plans for preventive health screening activities, medication compliance, and needs assessment.

Activities of Daily Living↗
PubMed1976

Health planning and resources development: an opportunity for optometry.

The American Optometric Association views the goal of the National Health Planning and Resources Development Act of 1974, as the promotion of physical, emotional and environmental health for all. The National Health Planning and Resources Development Act will work towards this goal by identifying problems, preparing reports and studies and developing recommendations for implementation directed toward solving the problems. These functions will be carried out in collaboration with private and governmental individuals and organizations concerned with health care services. Only through this coordinated effort will success be achieved.

Health Planning↗
PubMed2001

Clinical information systems--developing a systematic planning process.

CHW is a large and diverse hospital system that developed a systematic planning process to define, prioritize, and assess the current status of those functionalities needed by caregivers to assist them in providing optimal care. In order to develop a durable consensus, a bottom-up approach was used. The details of the process including the structure of the meetings and many of the methodologies employed are presented.

Benchmarking↗
PubMed1998

Missed opportunities for cervical cancer screening of HMO members developing invasive cervical cancer (ICC).

OBJECTIVE: To identify potential missed opportunities and to suggest interventions for cervical cancer screening in members of a prepaid health plan by examining the membership histories and medical records of women who had no Pap smear performed in the 3 years prior to the diagnosis of ICC. METHODS: Medical records of all 642 members of a prepaid health plan developing ICC during the period from 1988 to 1994 were reviewed and details of patient interaction with the health care system were abstracted. Assessment of screening history and history of clinic visits was limited to the period 36 months prior to diagnosis, but excluded the last 6 months prior to diagnosis, so as to avoid including smears or visits which were part of the evaluation that led to the recognition of ICC. RESULTS: Of women developing ICC, 384/642 (60%) had not had a smear in the period from 36 months to 6 months preceding the diagnosis. Of these 384 unscreened women, 241 (63%) had been insured by our HMO for at least 30 of the 36 months prior to diagnosis. Contact with the medical system in one of the primary care outpatient clinics was documented in 180/241 (75%) of these long-standing members during the specified period. Considering only Internal Medicine and Family Practice clinic visits, 169/241 (70%) had been seen at least once and 101/241 (42%) had been seen 3 or more times. CONCLUSION: Most long-standing HMO members developing ICC without benefit of recent Pap smear screening were seen in primary care outpatient clinics in the 3 years preceding their diagnosis.

Female↗
PubMed1989

Medical Research Council AIDS Directed Program: program plan and research opportunities.

In 1987 the U.K. Medical Research Council established a Directed Programme of AIDS Research, the primary objective of which is the development of vaccines and therapeutic approaches against HIV infection and AIDS. The Programme's activities have been rapidly built up and by mid-1989 comprised some 130 individual research projects. The Programme provides the framework for a cohesive approach to AIDS research, comprising a clearly defined scientific development plan, the central provision of resources including laboratory reagents and specialized laboratory facilities and special arrangements for interaction with industry and for international collaboration and training. This article describes the organization, scientific strategies and progress of the Programme.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Considerations in the education of children with hearing loss.

It is crucial to the development of speech, language, academic, social, and vocational skills that children with a hearing loss be identified as early as possible with an intervention plan developed that encourages family inclusion and participation. Research indicates that early intervention is key to speech intelligibility and the development of age-appropriate language skills. Bess and colleagues found that without appropriate intervention, children with minimal hearing loss experience significant academic delay and social-emotional problems by the third grade. Because most children with an educationally significant hearing loss are in the mainstream of regular education, the best hope for true integration and inclusion is to implement a proactive management plan that prevents failure with its lifelong consequences.

Child↗
PubMed1999

Economic miracle for what?: State workers' health in South Korea.

This article is a study of the state's role in workers health in South Korea during the period of the 1950s to 1980s in which South Korea achieved its economic success through a series of economic development plans. The state's role in the protection of workers health will be examined by investigating the historical development of two main welfare state programs, workers' compensation and national health insurance, as the pillars of state policies on workers health. In contrast to the state's direct intervention in economic development, I will argue, the key characteristics of both workers' compensation and national health insurance are the state's minimal organizational and financial costs and the relative autonomy of firm managers. Also, the state first restricted the scope of beneficiaries to the core group of manufacturing and mining workers and then gradually expanded it over a long period of time. I will argue that such features suggest a strong dependence on business by the Korean welfare state programs that contradicts the image of a strong state that the scholars of East Asian states often claim.

Journal Article↗
PubMed1989

Planning at the unit level.

In recent years, management responsibilities at the unit level have expanded considerably. In this evolution of the nurse-manager role, the importance of the planning process in the overall productivity and success of the unit has gained widespread acceptance. To meet the challenges of today's health care climate, the nurse manager and the unit staff must have a clear understanding of what our business is, what it should be, and finally, depending on the plans developed, what it will be.

Cardiovascular Diseases↗
PubMedDate not supplied

Regional planning implementation and its impact on integration of a mental health care network.

This article questions the effectiveness of a managerial tool in changing a health-care system. The process of implementing regional planning and its impact on creating integrated service networks is examined, using a case study and a multi-dimensional analytic model. This model highlights the influence of contextual, structural, cultural and dynamic factors on forming networks. The regional planning developed in the province of Québec (Canada), aimed at a major transformation of the mental health-care system. In each district, organizations working with people who have serious mental disorders were mobilized to plan and implement a more coordinated, continuous and diversified supply of services, under the direction of a regional health body. This study outlines the limitations of regional planning as a tactic for transforming the system. It recommends instead developing more diversified integration strategies to further the process of forming integrated service networks within a complex system. In conclusion, a brief discussion deals with the difficulties related to the study of systemic change implementation.

Delivery of Health Care, Integrated↗
PubMed1975

Assessment of national family planning programs in developing countries.

Today, 34 developing countries have policies and programs to lower fertility, and an additional 32 countries provide family planning services for health and humanitarian reasons. Specific causal relationships and linkages between social and economic development, family planning programs, and fertility levels and changes remain mostly unclear at this point. Based on percent acceptors, percent users, and changes in fertility rates (the most commonly used measures to evaluate family planning program accomplishments), however, the performance of programs on the whole has been moderately encouraging.

Abortion, Legal↗