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PubMed2004

Community based participatory approaches to address health disparities in Hawai'i: recent applications in cancer prevention, detection and treatment programs.

Assessment of recent trends in the prevalence and incidence of cancer, and its associated risk and protective factors in the State of Hawai'i illustrate that there are definite ethnic, socio-economic, and geographic health disparities. Disparities in access to health care are reflected in decreased and under utilization of all types of preventive cancer screening tests and decreased proportions of people with health insurance coverage. Increases in obesity mirror U.S. national trends and disproportionately affect certain ethnic groups and those with low income. Tobacco use has increased among at-risk populations including: certain ethnic groups, those with low-income and/or low education and those in rural areas. Data that reveal continuing or worsening health disparities imply that either the old methods have not been effective and/or resources are not available or are not being applied to address such disparities. Promising methodologies and programmatic focuses to reduce health disparities are needed as mechanisms for improving the circumstances of at-risk populations. Community based participatory approaches are described here for cancer prevention, detection, and treatment programs that utilize culturally appropriate methods.

Community Health Planning↗
PubMed2006

Improving access to evidence-based acute stroke services: development and evaluation of a health systems model to address equity of access issues.

Level 1 evidence for management of patients with stroke in a dedicated Stroke Care Unit (SCU) demonstrates improved outcomes by about 20%. It has been estimated that 21% of Australian hospitals provide an SCU and that these SCUs are mainly located in either metropolitan sites and/or in hospitals with more than 300 beds. To address equity issues related to access to SCUs, the National Stroke Foundation and the Australian Government undertook the National Stroke Units Program. One program outcome was the development of a conceptual model of acute stroke service delivery. The development process and initial evaluation of the model are described. Use of the model to increase capacity within the health care system to treat stroke is discussed.

Acute Disease↗
PubMed2005

[Implementing simple tools for clinical practice in primary care: reports from the Project Diabetes registry addressed to primary care groups in Modena].

We implemented simple tools for Clinical Practice in Primary Care, i.e. reports of Diabetes Project's Registry addressed to Primary Care Groups in Modena in order to promote the clinical practice through a detailed peer-review of program indicators. The efforts of health organisations to involve the general practitioners in clinical practice should be improved by implementing audit-and-feedback tools of simple interpretation for clinical practice.

Ambulatory Care↗
PubMed2006

How healthcare IT can address the nursing shortage.

But if applied correctly, IT can play an important role in redefining the way nursing is conducted. It can do so by introducing flexible models of nursing education to increase the pool of qualified nursing professionals; automating and standardizing nursing workflows; eliminating paperwork; supporting patient care delivery models that address the needs of an older workforce; establishing point-of-care clinical decision support tools to improve patient safety; and making health, wellness, and patient education information available. If healthcare IT solutions are deployed in direct response to nursing's ills, particularly job dissatisfaction, the positive image of nursing can be restored, once again making it a career of choice. IT can further reverse the tide of nursing defections, which continually drain the healthcare industry of experienced and dedicated professionals. Finally, both individually and collectively, healthcare IT technologies can reorient nursing activity back towards its principal role of delivering quality patient care.

Hospital Information Systems↗
PubMed2005

Hospital addresses ED overcrowding, sees treatment times and walkout rates drop.

Mary Washington Hospital in Fredericksburg, VA, addressed the new accreditation standard on overcrowding and saw its treatment times drop by about two hours and its walkout rate drop to 2%, despite increases in volume. A Patient Flow Excellence and Accountability Team focused on getting patients upstairs in under one hour, which was achieved through nurse and supervisor buy-in. Monthly staff meetings were added for all shifts. Computers and equipment for trauma and codes were placed closer to where they were needed. The staffing ratio on the acute side was reduced to 1:4 for nurses and 1:12 for physicians. The ED converted to a five-level triage system, and the hospital is experimenting with a triage nurse focused on lower acuity areas and a "virtual bed system" in which patients are seen by a physician/nurse team at triage and start having labs and X-rays done immediately.

Crowding↗
PubMedDate not supplied

Defining and addressing moral distress: tools for critical care nursing leaders.

Nurse clinicians may experience moral distress when they are unable to translate their moral choices into moral action. The costs of unrelieved moral distress are high; ultimately, as with all unresolved professional conflicts, the quality of patient care suffers. As a systematic process for change, this article offers the AACN's Model to Rise Above Moral Distress, describing four A's: ask, affirm, assess, and act. To help critical care nurses working to address moral distress, the article identifies 11 action steps they can take to develop an ethical practice environment.

Adaptation, Psychological↗
PubMed2005

Using a context-aware medical application to address information needs for extubation decisions.

Information overload has been one of the causes of preventable medical errors [1] and escalating costs [2]. A context-aware application with embedded clinical knowledge is proposed to provide practitioners with the appropriate amount of information and content. We developed a prototype of a context-aware medical application to address clinicians' information needs that arise in a data intensive unit, the Cardio-Thoracic Intensive Care Unit (CTICU). A major clinical decision supported by the prototype, the extubation decision, is illustrated.

Decision Making, Computer-Assisted↗
PubMed2006

SPEAK. A mnemonic tool for addressing health literacy concerns in geriatric clinical encounters.

Healthcare providers can enhance the effectiveness and efficiency of the care they provide by recognizing their patients' health literacy. Health literacy is defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." It is a measure of the clarity of the communication between the healthcare system and the patient. The consequences that can occur when the patients' health literacy is not addressed include: poorer health status, high rates of health services use, compromised patient safety, and increased health care costs. The mnemonic SPEAK (Speech, Perception, Education, Access, and Knowledge) provides a simple framework that healthcare providers can use to enhance their own awareness of health literacy components during patient care. Case examples show how the mnemonic can be used in everyday practice.

Aged↗
PubMed2006

Physicians' ethical responsibilities in addressing racial and ethnic healthcare disparities.

Patients belonging to racial and ethnic minority populations continue to receive lesser-quality healthcare relative to other patients, even when controlling for relevant demographic variables. Such disparities represent a significant challenge for physicians who are ethically committed to serving all patients equally, irrespective of personal characteristics. Accordingly, this report explores the ethical obligations of individual physicians and the medical profession as they pertain to racial and ethnic disparities in healthcare. To address these disparities, the AMA Council on Ethical and Judicial Affairs recommends that physicians customize the provision of medial care to meet the needs and preferences of individual patients. Moreover, physicians must learn to recognize racial and ethnic healthcare disparities and critically examine their own practices to ensure that inappropriate considerations do not affect clinical judgment. Physicians can also work to eliminate racial and ethnic healthcare disparities by encouraging diversity within the profession, continuing to investigate healthcare disparities, and supporting the development of appropriate quality measures.

Ethics, Medical↗
PubMed2006

Addressing a community's cancer cluster concerns.

The felling of a telecommunications mast highlighted a community's concern regarding an alleged cancer cluster of eleven cases in a small rural area of Northern Ireland. At the request of the Local District Council, the Northern Ireland Cancer Registry (NICR) undertook an investigation. After extensive searching and contact with the community, only 6 of the alleged cases could be identified. Of these six, two did not have cancer and one had a non-malignant tumour. In addition to the three confirmed cancer cases, a search of the NICR database identified a further 17 cancers of mixed types in keeping with the population pattern of cancers. Standardised incidence and mortality rates were within, or lower than, the expected level. The results were presented to the local community at an open meeting. Despite extensive media interest when the issue of the alleged cluster was first raised, the negative findings received only local media attention. This study illustrates the value of an accurate population cancer registry in addressing cancer cluster concerns.

Attitude to Health↗
PubMed2006

Addressing the need for HIV specialists: the AAHIVM perspective.

HIV medicine is a complex and rapidly changing field that requires experienced care providers. Clinical research has shown what has always been intuitive: providers with more experience have patients with better outcomes, and the resultant decrease in morbidity, mortality, and inpatient costs of expert care are cost-effective. As a result, there is a need to identify providers who can give the best quality care to persons living with HIV/AIDS. The American Academy of HIV Medicine has established a credentialing process to identify HIV specialists who demonstrate continuing competency in key aspects of HIV medicine from among a broad range of HIV health care providers. Several other organizations have attempted to identify qualified HIV medical providers but differ in key aspects of their definition of an HIV expert, with differing effects on the quality of health care delivered to persons living with HIV/AIDS. There is a need for all interested parties to come together to find solutions; to address the need for, and barriers to, increasing the number of HIV specialists; and to come to a consensus about the best way to ensure quality care for all those living with HIV/AIDS.

Clinical Competence↗
PubMed2006

An evidence-based context to address health care for gay and lesbian patients.

There is extensive, credible evidence in the medical literature, and overwhelming consensus among professional medical organizations, that disparities in health care provided to gay and lesbian patients and their families must be addressed and changed. As physicians, we continue to assess the latest medical evidence in order to provide the highest quality health care to all our patients. We will tell the truth when attempts to discriminate, whether legislative or societal, harm our patients or hamper our ability to care for them. Examples from Michigan, Ohio, and Nebraska, where constitutional amendments banning same sex civil unions or marriage have passed, are noteworthy, with increasing legal challenges to domestic partnerships. These discriminatory laws and amendments have jeopardized health care decision-making, hospital visitation rights, health insurance, and legal protections for gay as well as heterosexual couples. In Wisconsin, we can and must do better than that as we strive to improve the health of all of our citizens.

Female↗
PubMed2006

Addressing multigenerational conflict: mutual respect and carefronting as strategy.

This article addresses the challenges faced by nurses as they work side-by-side with nurses from a variety of generational cohorts. First a brief overview of the generational characteristics of the four generational cohorts in today's workplace is presented. Next the importance of each nurse using respect and carefronting as antidotes to generational conflict is discussed. Finally the role of nursing leadership in facilitating respect and carefronting is noted.

Conflict, Psychological↗
PubMed2006

Toward eliminating health disparities in HIV/AIDS: the importance of the minority investigator in addressing scientific gaps in Black and Latino communities.

Dialogue in the medical and public health communities has increasingly focused attention in the area of health disparities. We believe that the elimination of health disparities in the United States will require a multipronged approach that includes, at the very least, new approaches in both biomedical and prevention interventions. We also believe that since health disparities primarily affect communities of color, a model which fosters the development of junior scientists, clinicians and researchers of color who serve these communities will yield important progress in this field. The Minority HIV/AIDS Research Initiative at the Centers for Disease Control and Prevention (CDC) is a program that, through targeted research, aims to address health disparities in HIV/AIDS. Although the program is disease specific, there are a variety of lessons learned from its inception and implementation that can be useful throughout the scientific, medical and public health communities.

Black or African American↗
PubMed1991

[Study of the structural-energy aspects of complementary-addressed modifications of nucleic acid with reactive 4-]N-methyl-N-(2-chloroethyl)-amino]benzyl-3'- or 5'-phosphamide oligonucleotide derivatives by a molecular mechanics method].

Calculations of probabilities of the complementary addressed modification of target NA by 3'- or 5'-reactive derivatives of oligonucleotides carrying a 4-[N-(2-chloroethyl)-N-methyl]aminobenzyl group attached to the 3'- or 5'-terminal phosphates through a phosphoroamide linkage have been made. It is shown that the structural basis of the high efficiency and positional specificity depending on the NA target base sequence is the extent of structural correspondence of the energetically optimal conformation of the active group in the complex to the mutual arrangement of the active group and nucleophilic site needed for the chemical reaction. The 3'-derivative has the highest dependence of efficiency and positional specificity of the alkylation on the target NA base sequence. The maximal positional specificity of the alkylation is found for the modification of the cytidine at the first position from the terminal complementary base pair at the 5'-end of the target NA. For the 5'-derivative, the alkylating ability was determined to depend on the insertion of additional methylene bridges into the standard phosphoroamide linker: two methylene groups provide for the maximal increase of the modification ability of the nucleophilic site of the target NA in the double-stranded part of the complex. The efficiency of alkylation of the target NA in a three component complex with oligonucleotide-effector also complementary to the target NA have been studied. It was found that formation of the three-component complex lead to an additional stabilization of the conformation needed for the reaction of the active group, in comparison with two-component complex, by means of the intercalation of the phenyl group of the reagent in the gap between the oligonucleotide derivative and the oligonucleotide effector.

Alkylation↗
PubMed1991

[Study of the structural-energy aspects of complementary-addressed modifications of nucleic acids by reactive oligonucleotide derivatives having a 4-[N-methyl-N-(2-chloroethyl)amino[benzylidene group at the 3'end by a molecular mechanics method].

Calculations of probabilities of the complementary addressed modification of a target nucleic acid by derivatives of oligonucleotides carrying a 4-[N-(2-chloroethyl)-N-methyl]aminobenzylidene group attached to the 3'-end (3'-BDO) have been made. The results show that the complementary complex of a target NA with 3'-BDO having R-configuration of carbon atom of the dioxalane ring is more stable than the complex including the S-stereoisomer. The S- and R-epimeres of 3'-BDO have essentially different positional abilities for alkylation of the target. The R-epimer alkylates best of all the third base of the target NA from terminal complementary pair of the complex. The S-epimer has another site the most sensitive to alkylation, which is a terminal complementary base of the target NA or the adjacent nonpaired base. Formation of the alkylation complexes are accompanied with a loss or a breakdown of hydrogen bonds in the terminal complementary base pair, thus decreasing the efficiency of alkylation. The modelling results are considered along with experimental data on modification which therefore can be interpreted on the fundamental structural level.

Alkylation↗
PubMed1991

A two-part quality assurance project addressing infection rates of wounds sutured in the emergency department.

The process and outcome of our QA program suggest many areas for further examination; a study featuring a larger sample and more rigorous experimental research could address these. Our immediate goals, however--to examine the quality of wound care in our emergency department and to improve it--were accomplished. What is perhaps more important, this QA project made us look at our practice and realize that we could change things. We identified a problem, studied it, and did something about it.

Adolescent↗
PubMed1991

The self-injury hypothesis: addressing a neurologist's concerns.

Coulter (1991) concluded that a "poor study design" (p. 81) was used and my hypothesis was unproven. My article was not an experimental study in the sense of presenting experimental data intended to confirm or deny my hypothesis. Rather, it: 1. Described remarkable similarity between movements in patients with mental retardation during self-injury episodes and reports in the literature of involuntary movements during confirmed frontal lobe seizures; 2. Pointed out that the movements by some patients with mental retardation were so frequent and/or forceful that self-injury resulted; 3. Presented the hypothesis that the movements by patients with mental retardation may, in some cases, be involuntary and due to undiagnosed frontal lobe seizures; and 4. Suggested that if this hypothesis were correct, then one ought to consider what sort of treatment approaches might reduce the incidence/severity of frontal lobe seizure episodes. I agree that a well-designed experimental study to test my hypothesis would be very desirable. The preceding literature review has shown how difficult it would be using present methods to do a definitive study that rigorously confirms or rejects my hypothesis. Other approaches might be considered for testing my hypothesis with persons who are unable to give informed consent. One approach using rigorous observable criteria was suggested. In the interim, it seemed worthwhile to present my hypothesis to mental retardation professionals with the hope that others would consider this possibility and its implications for diagnosis and treatment, and the hope that some patients might benefit sooner rather than later. I appreciate Coulter's (1991) comments because they provided an opportunity to clarify potential misunderstandings. It is possible that other readers have had similar concerns, and I trust that this is the appropriate forum for addressing such matters.

Electroencephalography↗