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PubMed2005

Education and credentialing in respiratory care: where are we and where should we be headed?

Respiratory care is indeed at a crossroads. The profession will continue to develop by advancing the education and credentialing needed to function as physician extenders-true cardiopulmonary physician's assistants. As such, the respiratory therapist of the future will focus on patient assessment,care plan development, protocol administration, disease management and rehabilitation, and patient and family education, including tobacco education and smoking cessation. Respiratory therapists, through primary, secondary, and tertiary prevention activities, can positively affect peoples'quality of life. This advanced level professional will work in the intensive-and acute-care settings, applying sophisticated cardiopulmonary technologies, as well in clinics, physician offices, home care, long-term and rehabilitation facilities, industry, educational institutions, and research facilities. The alternative to this advanced practice is for the profession to remain a task-oriented technical field, focused on procedures and the technical aspects of oxygen and aerosol therapy, mechanical ventilatory support, and related diagnostic and monitoring techniques. Although there is a dignified and important role for the provision of the technical aspects of respiratory care, the authors believe that the future role of the respiratory specialist is that of physician extender. Higher-order performance will result in higher-order contributions to health care. This role will require increased numbers of baccalaureate and graduate degree programs in respiratory care and increased numbers of respiratory therapists who hold higher degrees,including the master's degree in respiratory care and doctoral degrees in related fields. Community colleges, 4-year colleges, and universities should be encouraged to develop effective articulation agreements and mechanisms to offer the bachelor of science degree in respiratory care to the community college student. Professional associations and accrediting agencies should promote the development of additional baccalaureate and master's degree programs in respiratory care. Education is best defined as positive behavior change. Amplified education can only improve the ability of respiratory therapists to contribute to the cardiopulmonary health of people worldwide.

Allied Health Personnel↗
PubMed2005

Developing a nursing management degree programme to meet the needs of Irish nurse managers.

BACKGROUND: The study is placed within the context of the Irish health care system, which has undergone tremendous change, at the dawn of the new millennium, in particular from the nursing management and leadership viewpoint. AIM OF THE STUDY: The aim of this study is to explore nurses' expectations of the content and delivery of a nursing management degree programme. METHODS: This is an on-going action research study. Data has been collected using a focus group interview, questionnaire, document analysis and a reflective diary. Data was analysed using thematic analysis and SPSS as appropriate to qualitative and quantitative data respectively. To date two action research cycles are near completion and a total sample of 117 students have taken part in the study. FINDINGS: Nurses commencing the programme were unsure of their education and training needs, as they had not yet taken on board the recommendations of the Irish Commission on Nursing (Government of Ireland 1998). The findings suggest that nurse managers may not know what they need to know in light of the many current changes taking place in the Irish health system. The introduction of personal development planning (PDP) is among new strategies taking place as part of the second action research cycle. PDP can help nurse managers to reflect on their current responsibilities and plan for their future career pathways. CONCLUSIONS: The findings are presented in the context of one institution. Action research, which nests comfortably with certain management styles, has proved suitable as a tool for developing and changing this programme. The need for university teachers to focus on management development skills as well as the transmission of management theory is supported.

Education, Nursing, Baccalaureate↗
PubMed2002

Process and impact of mergers of NHS trusts: multicentre case study and management cost analysis.

OBJECTIVE: To study the processes involved in and impact of mergers between NHS trusts, including the effect on management costs. DESIGN: Cross sectional study involving in depth interviews and documentary analysis; case study to compare savings in management costs between case trusts and control trusts. SETTING: Nine trusts (cross sectional study) and four trusts (case study) in London. PARTICIPANTS: 96 interviews with trust board members, other senior managers, clinicians, service managers, and representatives of health authorities, regional office, community health councils, local authorities, other trusts in the area, and primary care groups and trusts. MAIN OUTCOME MEASURES: Stated and unstated drivers, and impact of merger on delivery and development of services, management structures, and staff recruitment, retention, and morale. Effects of difference in trust size before and after the merger. Savings in management costs two years after merger. RESULTS: Some important drivers for merger are not publicly stated. Mergers had a negative effect on delivery of services because of a loss of managerial focus on services. Planned developments in services were delayed by at least 18 months. Trusts' larger sizes after mergers had unintended negative consequences, as well as predicted advantages. The tendency for one trust's management team to dominate over the other resulted in tension. No improvement in recruitment or retention of clinical and managerial staff was reported. Perceived differences in organisational culture were an important barrier to bringing together two or more organisations. Two years after merger, merged trusts had not achieved the objective of saving pound 500 000 a year in management costs. CONCLUSIONS: Important unintended consequences need to be accounted for when mergers are planned. Mergers can cause considerable disruptions to services, and require greater management support than previously acknowledged. Other organisations undergoing restructuring, such as primary care groups developing into primary care trusts and health authorities merging into strategic health authorities, should take these findings into account.

Attitude of Health Personnel↗
PubMed2002

Using differences between perceptions of importance and competence to identify teaching needs of primary care preceptors.

BACKGROUND: An important goal of a comprehensive faculty development plan is to improve teaching. This is especially important for clinical preceptors. PURPOSE: This study used a novel approach to assessing the teaching needs of preceptors, an essential and often neglected first step in faculty development. Measurement focused on discrepancies between importance and current performance related to a rich variety of teaching behaviors. This study also considered differences in perceived teaching needs among primary care specialties. METHOD: Twenty-six clerkship directors from 13 participating medical schools in the Northeast United States invited randomly selected family medicine, internal medicine, and pediatric preceptors to complete a teaching needs survey. One hundred five preceptors responded. RESULT: Findings revealed that preceptors most need to develop general teaching skills that will help them save time such as selecting appropriate teaching behaviors, assessing learners' needs and providing appropriate feedback, and helping learners learn independently. On the other hand, preceptors expressed less need to improve teaching related to cost containment, disease prevention, clinical decision making, office management, and using computers to aid teaching. Family practice preceptors rated their current teaching performance significantly higher than pediatric preceptors despite no differences in previous faculty development experience. CONCLUSION: Faculty development for preceptors should focus on general teaching skills relative to teaching skills tied to specific medical areas. Novel approaches to teaching while practicing medicine that increase efficiency should be explored. Faculty developers should consider differences in confidence among preceptors from different specialties.

Clinical Clerkship↗
PubMedDate not supplied

Responding to pandemic influenza: a local perspective.

OBJECTIVE: To assess, via a tabletop exercise, the ability of a rural health unit to manage an influenza pandemic. PARTICIPANTS: The exercise brought together community stakeholders including representation from public health, hospitals, long-term care, social services, first responders, morticians, local government and the media. SETTING: Leeds, Grenville and Lanark, a rural region of Ontario. INTERVENTION: In June 2002, exercise participants were presented with a scenario involving the local response to pandemic influenza. Facilitators prepared a framework for the mock emergency in advance. However, the scenario was guided by decisions made by participants and the probable consequences of those decisions. Following the exercise, a debriefing session identified recommendations to be included in future plan development. OUTCOMES: The exercise identified critical issues, including communication, emergency decision-making, vaccination priorization, local surge capacity, and disease containment. Both participants and observers deemed the exercise successful. CONCLUSION: Improvements in the local contingency plan for pandemic influenza were identified. The exercise was an opportunity to familiarize participants with the contingency plan, practice working collectively and identify areas for further planning. The principles and lessons generated from the exercise can be used to guide the response to other large-scale infectious disease outbreaks.

Decision Making↗
PubMed2006

Bubble packing application in computerized planning of cryosurgery.

Among many factors, the effectiveness of the cryoprocedure is determined by the quality of the cryoprobes layout. A computerized planning tool for optimizing this layout has the potential of improving the outcome of cryosurgery, reducing post-operative complications, and reducing the cost of the clinical operation. As part of an ongoing effort to develop planning tools for cryosurgery, the current study takes a novel approach, based on bubble-packing method. This study shows that the application of bubble-packing shortens runtime by an order of magnitude. In this study, the bubble-packing method is integrated with bioheat transfer simulations to demonstrate the quality of planning.

Algorithms↗
PubMed1979

Prospects and services for medical rehabilitation.

In the developed world, comprehensive services for disabled patients are usually well established for children and elderly people. Services for rehabilitation of middle-aged patients generally consist of specific treatment facilities, such as for physiotherapy. On the other hand, a range of services of psychiatric patients is now established, with a model suitable for most disorders. Arrangements are flexible, ranging from crisis intervention to long-term care, in some places being remarkably comprehensive and well coordinated. There is a need to plan development of medical and social services for patients prone to chronic morbidity from whatever cause; this plan for the physicially disabled should take account of their many needs, and of the many facilities now available, some statutory, some voluntary. There is reason to believe that redeployment of resources existing in many countries could improve the standard of medical rehabilitation for patients of all ages.

Adolescent↗
PubMed1988

Health policy in Finland. Organization, planning, and high technology development.

This article surveys attempts by the Finnish government to plan and budget health care since the Primary Health Care Act of 1972. A national board of health allocates approved resources to local authorities who develop plans for preventative and primary health care and hospital services. The acquisition of expensive technologies are debated at the national level. The author presents studies which suggest that there is a considerable need for expansion of both diagnostic and therapeutic technologies in Finland. These adjustments will be necessary to meet the needs of an economically, socially, and demographically changing country.

Data Collection↗
PubMed1985

Epidemiology training: a necessity for primary health care.

In spite of planned development and expansion of health services, especially in rural areas in India, mortality due to preventable conditions has remained unacceptably high. Important reasons for failure of the health system to detect the problems early are centrally planned programmes based on inadequate data and time-bound numerical targets for achievement. This promotes a tendency for passive implementation which destroys initiative and incentive for conceptualisation of problems and strategies. For health programmes to be far more successful, the entire health team needs to be given training in epidemiology appropriate to the level of each category, so that programme planning based on epidemiologically determined local needs can be done at district level by the District Health Organisation. Participation of health workers and the community will then be more active and relevant to the needs of the community.

Community Health Workers↗
PubMedDate not supplied

Using time management to achieve balance.

A recent MGMA survey showed work-life balance as the number one issue facing group practice managers. This article explains techniques from the field of time management that will enable group practice managers to gain control of their schedules, reduce time pressures and stress and increase productivity. The article covers: goal setting, daily lists, handling paperwork, delegating and limiting involvement, socializing, communicating, overachieving, planning, writing, telephone calling, attending meetings, reading, financial planning, developing a philosophy, involving family, evaluating skills and teaching time management to employees.

Communication↗
PubMed2000

Louisiana Rural Health Access Program.

Louisiana Rural Health Access is part of a Robert Wood Johnson Foundation project to address primary and preventive medical care for indigent, uninsured people residing in underserved rural parishes. This 15-month grant funds the development of a pilot program to improve access to health care in Acadia, Evangeline, Iberia, Lafayette, St Landry, St Martin, St Mary, and Vermilion parishes. Led by representatives from the Department of Health and Hospitals and the Louisiana State University Health Sciences Center, team committees designed the program's innovative use of telemedicine, loan development, network integration, and community involvement. A benefit of the program will be to measure the outcomes of each objective in order to determine which intervention works best. This information will be invaluable for the design of a five-year rural health care development plan.

Capital Financing↗
PubMed2001

CDC's strategic plan for bioterrorism preparedness and response.

The Department of Health and Human Services (DHHS) has played a critical lead role over the past two years in fostering activities associated with the medical and public health response to bioterrorism. Based on a charge from Secretary Donna Shalala in 1998, the Centers for Disease Control and Prevention (CDC) is leading public health efforts to strengthen the nation's capacity to detect and respond to a bioterrorist event. As a result of our efforts, federal, state, and local communities are improving their public health capacities to respond to these types of emergencies. For many of us in public health, developing plans and capacities to respond to acts of bioterrorism is an extension of our long-standing roles and responsibilities. These are stated in the CDC Mission Statement: to promote health and quality of life by preventing and controlling disease, injury, and disability, and the Bioterrorism Mission: to lead the public health effort in enhancing readiness to detect and respond to bioterrorism. CDC's infectious diseases control efforts are summarized below: --Initially formed to address malaria control in 1946; --Established the epidemic Intelligence Service in 1951; --Participated in global smallpox eradication and other immunization programs; --Estimated 800-1,000 + field investigations/year since late 1990s; --New diseases: Legionnaire's Disease, toxic shock syndrome, Lyme disease, HIV, hantavirus pulmonary syndrome, West Nile, etc. -- Today: focus on emerging infections and bioterrorism. Over the past 50 years, CDC has seen a decline in the incidence of some infectious diseases and an increase in some, whereas others continue to present on a more unpredictable basis (i.e., hantavirus). Outbreak identification, investigation, and control have been an integral part of what we do for more than 50 years. We estimate that 800 to 1,000 field investigations have occurred every year since the late 1990s. Today, however, we have a new focus on emerging infectious diseases and bioterrorism.

Anti-Infective Agents↗
PubMed2004

Optimizing target selection and development strategy in cancer treatment: the next wave.

Successful cancer treatments of the future are being developed with a focus on the molecular targets underlying the pathophysiology of neoplasia. Prominent targets which have emerged are those which are mutated in the course of a cancer's development, and mediate activation or release from suppression of pathways mediating proliferation or apoptosis. These arguably are "pathogenic" targets. However, equally important are targets which can be defined on the basis of "large scale" analysis techniques of gene or protein expression in tumors which define targets expressed as a result of a tumor's differentiation state or tissue of origin ("ontogenic" targets); targets mediating drug uptake or metabolism ("pharmacologic" targets), and "microenvironmental" targets mediating the alteration of tumor stromal elements. Irrespective of the nature of the molecular target which is the focus of new therapeutic efforts, target definition in susceptible tumors or patients ideally would be part of the development plan. In addition, an understanding of the therapeutic index which might be achieved in host vs tumor tissues using a surrogate or actual marker of drug effect ideally would be available from animal models and inform the development strategy in humans.

Antineoplastic Agents↗
PubMed2004

Oil and wasser.

It was supposed to be an amicable "merger of equals," an example of European togetherness, a synergistic deal that would create the world's second-largest consumer foods company out of two former competitors. But the marriage of entrepreneurial powerhouse Royal Biscuit and the conservative, family-owned Edeling GmbH is beginning to look overly ambitious. Integration planning is way behind schedule. Investors seem wary. But for Royal Biscuit HR head Michael Brighton, the most immediate problem is that he can't get his German counterpart, Dieter Wallach, to collaborate on a workable leadership development plan for the merged company's executives. And stockholders have been promised details of the new organizational structure, including a precise timetable, in less than a month. The CEO of the British company--and of the postmerger Royal Edeling--is furious. It's partly a culture clash, but the problems may run deeper than that. The press is harping on details that counter the official merger-of-equals line. For instance, seven of the ten seats on the new company's management board will be held by Royal Biscuit executives. Will the clash of cultures undermine this cross-border merger? Commenting on the fictional case study are Robert F. Bruner, the executive director of the Batten-Institute at the University of Virginia's Darden Graduate School of Business Administration in Charlottesville; Leda Cosmides and John Tooby, the codirectors of the Center for Evolutionary Psychology at the University of California, Santa Barbara; Michael Pragnell, the CEO and director of the board for the agribusiness firm Syngenta, based in Basel, Switzerland; and David Schweiger, the president of the Columbia, South Carolina--based management consulting firm Schweiger and Associates.

Administrative Personnel↗
PubMed1993

The continuous improvement-focused quality improvement plan.

The QI plan of a department or functional area is a statement of philosophy about quality improvement and a guide to doing quality improvement. In that sense, the QI plan is both a roadmap and a description of the journey. The form of the QI plan varies by organization and is a reflection of the individual style of the organization. The substance of the plan is important. QI plan developers who consider structure, process and outcome will generate a viable document that supports meaningful quality improvement.

Hospital Departments↗
PubMed2006

A model for collaborative evaluation of university-community partnerships.

INTRODUCTION: Manitoba's The Need to Know project was presented with a unique opportunity to develop a collaborative approach to evaluation, and to explore the effectiveness of a variety of evaluation methods for assessment of university-community collaborative health research partnerships. OBJECTIVES: The evaluation was designed to incorporate participation of community partners in planning, developing, and evaluating all aspects of the project. Objectives included: (a) assessment of extent to which the project met its initial objectives; (b) assessment of extent participants needs and expectations were met; (c) refinement of evaluation questions; (d) identification of unanticipated impacts; (e) assessment of participant confidence as research team members; (f) development of knowledge translation theory; and (g) component analysis. METHODS: A "utilisation focused" approach was used. Primary stakeholders identified evaluation questions of concern, and how findings would be used. The multimethod time series design incorporated key informant interviews, a pre/post-test survey, written workshop evaluations, and participant and unobtrusive observation. All aspects of the evaluation were made transparent to participants, and formal feedback processes were instituted. RESULTS: There was a high level of participation in evaluation activities. Identifying evaluation questions of concern to community partners helped shape project development. While all methods provided useful information, only key informant interviews, participant observation and feedback processes provided insights into all evaluation objectives. CONCLUSION: Collaborative evaluation can make an important contribution to development of university-community partnerships. Qualitative methods (particularly key informant interviews, participant observation, and feedback processes) provided the richest source of data, and made an important contribution to team development.

Community-Institutional Relations↗
PubMed1977

[Planning and building with responsibility towards society].

Comprehensive general provisions in the field of social legeslation and an excellent building programme have provided essential pre-requisites for therapeutic work and rehabilitation procedures for the disabled. Less favourable, however, is the public attitude vis-à-vis the societal responsibilities. In the building sector this is reflected in the poor quality of the architectural environment, e.g., unimaginative layout plans, careless building agglomerations, and town planning developments determined by economic interests, all causative factors to disabilities and fruitless rehabilitation efforts. Depending upon the planners' and architects' understanding of the constructed environment as a decisive influential factor on the individual and society's behaviour the town planning and architectural prerequisites for integration, community living and solidarity will be provided, or not. Also, the individual performance of the building experts determine whether, for the disabled citizens, too, the houses, flats, towns and regions produce a friendly or inhospitable atmosphere, or no atmosphere at all. We must call for an architecture with artistic quality based on the liberal and social principles of our basic civil rights.

Architectural Accessibility↗
PubMed1982

The secondary importance of primary health care in South Cameroon.

Primary health care in Cameroon meets with serious obstacles. The state gives it a low priority in its budget and over-all policy. The health institutions are rarely active in this field. Institutions which do practice some primary health care are usually foreign. The villagers, finally, are little interested. They insist only on improvement of curative services and material life conditions. The conclusion is that primary health care is regarded as something of secondary importance. First comes a better life. The research for this paper was conducted in 1980 in the South of Cameroon.

Cameroon↗