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PubMed1991

Special report. Patients in possession of illegal drugs: what can you do about it?

Illicit drug use affects every area of the hospital/health care setting and presents thorny legal dilemmas for security directors and risk managers when patients are found using and/or attempting to sell controlled substances. Should you handle it privately or should you call in the police? Do local law enforcement and prosecutors really want to be bothered with every $25 worth of cocaine seized from a patient? If you inform the police and arrests are made, could your hospital develop a reputation as a drug-infested combat zone? If you handle it privately, are you at risk for litigation because of invasion of privacy or an illegal search? On the other hand, if drugs are reported and you do nothing, are you liable for a negligence lawsuit? Clearly, there is a need for proactive planning and policy development prior to being confronted with patient drug possession. In this report, hospital security directors discuss how they handle this situation at their facilities and how they formulate policies and procedures. We'll also offer advice from legal experts on patient privacy issues and interacting with local law enforcement.

Community-Institutional Relations↗
PubMed2000

"At my age I should be sitting under that tree": the impact of AIDS on Tanzanian lakeshore communities.

In 1992, the author led a participatory rural appraisal (PRA) exercise for a community fisheries project in Kagera region, on the western side of Lake Victoria, Tanzania. The PRA team visited four settlements: the prime harbor settlement on Kerebe Island; N'toro beach, in Bukoba district, near the Ugandan border; Chamkwikwi landing site in Muleba district; and Buzirayombo bay settlement in Biharamulo district in the south. This article draws on that research, to give an outsider's analysis of the ways in which AIDS was changing livelihoods in poor fishing and farming communities. On the lakeshore and islands, adults were falling ill and dying. This loss of men and women in their prime was causing major economic and social stresses for the single parents, grandparents, and orphans whom the authors met. They showed resilience and adaptability in the face of this threat to their already precarious livelihoods. The article ends by suggesting ways in which development policy makers and practitioners should support livelihoods in the era of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Statistical analysis of case-control studies.

Methods of analysis of results from case-control studies have evolved considerably since the 1950s. These methods have helped to improve the validity of the conclusions drawn from case-control research and have helped to ensure that the available data are utilized to their fullest extent. Logistic regression modeling, in its various forms, has become by far the most frequently applied method for multivariable analysis of case-control studies. As with any type of statistical modeling, the appropriateness of its formulation can be verified only partially through examination of the data themselves, and cautious interpretation has been urged (80-83). In this article, I have concentrated on methods that are extremely well suited to the evaluation of fairly specific etiologic issues, where one or two particular exposures are designated as being of a priori interest. In situations where a large number of associations are examined for possible case-control differences, additional complexities arise. Several authors have argued strongly against statistical adjustment for "multiple comparisons" in such situations (6, 7, 84). However, recent work suggests that, when background information is limited, certain forms of multiple-comparison procedures can be useful, specifically within a decision-analysis framework (85-87). Further methodological work relevant to the analysis of case-control studies is needed in at least two important areas. First, as discussed above, we need additional methods for conducting analyses that take appropriate account of the considerable error to which measurements in case-control studies are subject. Only with such methods available can estimates from case-control studies be confidently employed for elucidating pathogenesis, for developing policy, and for individual decision-making. Second, there has been a renewed effort in recent years to clarify the nature of causal effects and to relate these to the typically calculated epidemiologic parameters (88-92). As this work develops further, it is likely that the analysis of case-control studies will be enriched.

Bias↗
PubMed2006

Looking beyond survival: how are we looking at survivorship?

BACKGROUND: The prevalence of cancer survivors is increasing worldwide. This creates the imperative to look beyond cancer survival to cancer survivorship. This review explores cancer survivorship from an international perspective in two ways: from a cancer control perspective through a review of cancer control strategies and from a cancer care perspective through a review of clinical practice guidelines and research on cancer follow-up care. RESULTS: Many national cancer control strategies or cancer charities consider survivorship obliquely, primarily under the umbrellas of quality of life and rehabilitation. Few have well-developed policies or plans specifically directed at survivorship. Cancer follow-up care is recognized internationally as a pressing health care issue. Many countries have tested new and innovative models to deliver follow-up care. Similarly, many countries have developed guidelines that specifically address follow-up care. Few studies or guidelines address the broader, multifaceted aspects of cancer survivorship. DISCUSSION: This review suggests that research and recognition of cancer survivorship as a unique phase of the cancer care trajectory need to be improved. In many of the poorer countries of the world, the imperative remains the basics of cancer care: timely diagnosis, access to treatment, and alleviation of suffering.

Aftercare↗
PubMed1997

The extent and nature of alcohol-related problems in public senior housing.

To examine both the extent and nature of alcohol-related problems in senior housing and how management responds to these problems, 100 local housing authorities (LHAs) in Connecticut with responsibility for senior housing were surveyed. The response rate was 90%. Results indicated variability among LHAs regarding their experiences with alcohol misuse among residents. It was evident in the numbers of residents abusing alcohol, the procedures for addressing problems when they occur, and LHAs' assessment of the extent and seriousness of problems. Few LHAs had either staff training regarding alcohol abuse or policies to address alcohol-related problems. Conclusions concerning whether alcohol-related problems were widespread in public senior housing were related to the size of the LHA. Housing specialists, public policymakers, and educators should assist management personnel in developing policies and procedures regarding misuse of alcohol. In addition, resources should be directed to educate housing authority staff about detection of the problem and strategies for intervention.

Aged↗
PubMed2005

The ways that people talk about natural resources: discursive strategies as barriers to environmentally sustainable practices.

In this paper, we analyse talk about water and energy use taken from nine interviews with citizens of Perth, Western Australia. Participants' talk offered representations of water as a scarce, shared, natural resource that must not be wasted, whereas talk about energy use focused on the environmental impacts of different technologies for generating electricity, rather than on energy as a consumable resource. Participants accounted for their water-use habits by positioning themselves as caught between a personal desire to conserve water and an (incompatible) social obligation to maintain the appearance of their gardens in keeping with the aesthetic appeal of the suburbs in which they lived. We identify several discursive strategies by which people construct the environmental impact of their actions as minimal or unavoidable. These constitute a barrier to the promotion of more environmentally sustainable practices. Potential implications for environmental policy development are discussed, as are the wider issues associated with the development of 'applied' discourse analysis.

Communication↗
PubMed1984

The Medical Care Advisory Committee for state Medicaid programs: current status and trends.

Each State Medicaid program is required by Federal Regulations to have a Medical Care Advisory Committee ( MCAC ) which includes provider, consumer, and government representatives and which participates in policy development and program administration. Data are presented about the composition of these committees, their structure, the administrative and financial support they receive, and the nature of their activities. It is argued that they can play an important role in policy formulation and implementation, but that they need to be reformed in order to exploit that potential.

Health Planning Councils↗
PubMed2006

Vaccinia immune globulin: current policies, preparedness, and product safety and efficacy.

In 1980 the World Health Organization declared that smallpox was eradicated from the world, and routine smallpox vaccination was discontinued. Nevertheless, samples of the smallpox virus (variola virus) were retained for research purposes, not least because of fears that terrorist groups or rogue states might also have kept samples in order to develop a bioweapon. Variola virus represents an effective bioweapon because it is associated with high morbidity and mortality and is highly contagious. Since September 11, 2001, countries around the world have begun to develop policies and preparedness programs to deal with a bioterror attack, including stockpiling of smallpox vaccine. Smallpox vaccine itself may be associated with a number of serious adverse events, which can often be managed with vaccinia immune globulin (VIG). VIG may also be needed as prophylaxis in patients for whom pre-exposure smallpox vaccine is contraindicated (such as those with eczema or pregnant women), although it is currently not licensed in these cases. Two intravenous formulations of VIG (VIGIV Cangene and VIGIV Dynport) have been licensed by the FDA for the management of patients with progressive vaccinia, eczema vaccinatum, severe generalized vaccinia, and extensive body surface involvement or periocular implantation following inadvertent inoculation.

Bioterrorism↗
PubMed2001

Hospitals, geriatric medicine, and the long-term care of elderly people 1946-1976.

This article investigates the development and interaction of the views of medical professionals and health officials on elderly care between 1946 and the early 1970s. It examines how the cultural and political context in which new ideas on the treatment of elderly people emerged in the early post-war period affected policy development in this area. The article argues that, in combination, the political and financial imperatives of health officials and the cultural prejudices of many in the medical profession created a situation in which progressive ideas about geriatric medicine and home care were used, not to improve the overall standard of care for elderly people, but to restrict their access to long-term medical and nursing care. The most important development in this respect, it will be argued, were efforts made by government from the mid-1950s to restrict the amount of provision for older people in hospitals, through the introduction of a geriatric bed norm. What lay at the heart of this question, the article concludes, was the reluctance of policy-makers to confront directly issues relating to the continuing care of old people with complex health problems. The reasons for this reluctance will be examined.

Aged↗
PubMed1999

Profit, payment and pharmaceutical practices: perspectives from hospitals in Bangkok.

Means by which to improve the quality of care offered in the private sector have received increasing interest. This paper considers the influences upon hospital physician prescribing practices. It presents data on drug management practices and prescribing patterns in a sample of private for-profit, private non-profit and public hospitals in Bangkok. Clear differences emerge in prescription patterns between the different groups of hospitals: public hospitals exhibit greater use of essential drugs and generic prescribing than either group of private hospital, and prescriptions at private for-profit hospitals tended to have more essential drugs and drugs prescribed by generic name than non-profit hospitals. Prescribing patterns in public hospitals are probably largely explained by national government policy on pharmaceutical procurement. In contrast, prescribing patterns in private for-profit hospitals appear heavily influenced by pressure upon management to contain costs, in circumstances where high drug costs cannot be passed on to purchasers. Hence hospital management have developed policies encouraging the use of generic drugs and essential drugs. These same financial pressures also explain some less desirable forms of behaviour in private for-profit hospitals such as prescribing courses of antibiotic treatment of extremely short duration. Possible measures which government may take to encourage appropriate prescribing within private hospitals are discussed.

Data Collection↗
PubMed1995

Relationship of anxiety, stress, and psychosocial development to reproductive health.

In this review of articles on prenatal stress, anxiety, development, and reproductive health outcomes in pregnancy, the focus is on recent research in which the relationships among the major types of stressors, anxiety, and development, on the one hand, and maternal, fetal, and neonatal problems or complications, on the other hand, were examined. Available and effective treatment measures, although limited, are introduced and discussed at length in a follow-up article. Recommendations for policy development based on current research and treatment methods and directions for future research and treatment studies are presented in a third article.

Animals↗
PubMed2006

Nationwide survey of hospital practices when compounding parenteral nutrition solutions in latex-allergic patients.

We surveyed 100 institutions in 50 states, varying in size from 50 to 1,000 beds. The purpose of this survey was to examine the policies and techniques hospitals used in confirming latex allergy (LA) in patients and preparing parenteral nutrition (PN) for LA patients. Our survey indicated that within the institutions in our study, many inpatient pharmacists do not use any defined method for confirming LA other than what is documented in the patient profile upon admission. Most inpatient pharmacies are not aware of any institutional policy concerning parenteral medications in LA patients, and some do not identify the importance of LA in preparing PN. It is apparent from the results of this survey that uniform guidelines or practice standards for this important issue should be developed. Although the publications on LA are numerous, they mostly deal with the exposure to latex gloves or latex devices. Knowledge of preparing parenteral medications for LA patients in the literature is minimal. It is also clear that awareness and knowledge of pharmacy personnel should be enhanced. Finally, we are hoping that this survey will send a clear message to pharmacy organizations to develop guidelines or pharmacy practice standards for this issue, and for health institutions to develop policies and make them available to their personnel.

Clinical Protocols↗
PubMed1996

The future of cancer control research and translation.

The future holds great promise for translating advances in cancer control research to populations at risk-much is known about how to prevent cancer. Within the Institute of Medicines overall framework of assessment, policy development, and assurance, this article summarizes 10 cancer control priorities. Important themes include evaluation, cost-effectiveness analysis, shrinking the "latency period" between elucidation of preventive technologies and widespread application, coalition building, and development of adequate cancer control resources. Despite increased cancer control efforts among public health agencies over the past decade, little measurable progress has been made in reducing overall cancer mortality. A renewed commitment to controlling cancer is needed from health policy makers and even the public health community.

Decision Making, Computer-Assisted↗
PubMed2005

Can minimal patient restraint be safely implemented in the intensive care unit?

The introduction of a corporate policy on the minimal use of restraints created concern within our intensive care unit. It was thought that corporate leaders did not understand the necessity of patient restraints within critical care. In an effort to make a stand against the developing policy, a group of critical care nurses reviewed the literature for evidence to support the use of restraints\with this patient population. The evidence that was found surprised the group and created the impetus to construct tools and a learning package to support minimal restraint within the intensive care unit. The results after one year demonstrate that minimal restraint practices can be safely implemented in intensive care using a comprehensive program; a program that effects a paradigm shift from caregiver paternalism to one that supports the patient's dignity of risk.

Critical Care↗
PubMed2006

An evaluation of the Health Promoting Health Service Framework: the implementation of a settings based approach within the NHS in Scotland.

In 1996 the Health Education Board for Scotland (now NHS Health Scotland) began a process of developing a 'settings'-based framework that would inform health promotion work across Scottish health services--the Health Promoting Health Service Framework (HPHS). It took the form of a flexible guidance document, attending to the foundations of integrated and sustainable health promotion practice via specific areas like partnership work, policy development and staff health. The project has subsequently been progressed over an extended period, comprising three phases: an initial development of the resource; piloting of the framework; and a wider assessment of implementation and initial impact. This paper reports on the latter phase. Within the context of various issues pertaining to the evaluation of a 'settings' approach and based on the use of case study methodology in nine HPHS pilot sites, this paper reports on the latter 2 year phase. This involved ongoing concern for understanding intervention processes and a growing interest in intervention outcomes and the paper reports on findings in each of these domains. In relation to outcomes, some positive gains in various indicators were detected though significant problems were experienced in this aspect. More significantly, the work was able to gain insights into what we call 'necessary conditions' of implementation. We theorize a range of 'contextual' factors (e.g. responsiveness to health improvement policy agendas) and project specific 'mechanisms' (e.g. providing skilled support) and present these as a nexus of conditions required for effective implementation of health promotion practice within explanatory models. Most significantly, we stress the relative frailty of any settings implementation strategy based simply on the uncoordinated dissemination of a tool or resource.

Community Networks↗
PubMed2004

Effecting dietary change.

A world epidemic of diet-related chronic disease is currently being faced. In the UK incidence of obesity alone has tripled in the last 20 years and this trend is predicted to continue. Consensus exists for the urgent need for a change in diet and other lifestyle factors and for the direction and targets for this change. The evidence for how this change can be achieved is less certain. It has been established that disease processes begin in childhood. Recent evidence indicates that dietary habits too are established in childhood but that these habits are amenable to change. While establishing a healthy lifestyle in childhood is paramount, interventions have the potential to promote positive change throughout the life course. Success in reversing current trends in diet-related disease will depend on commitment from legislators, health professionals, industry and individuals, and this collaboration must seek to address not only the food choices of the individual but also the environment that influences such choices. Recent public health policy development in England, if fully supported and implemented, is a positive move towards this goal. Evidence for effective strategies to promote dietary change at the individual level is emerging and three reviews of this evidence are discussed. In addition, three recent dietary intervention studies, in three different settings and with different methods and aims, are presented to illustrate methods of effecting dietary change. Further work is required on what factors influence the eating behaviour and physical activity of individuals. There is a need for further theory-based research on which to develop more effective strategies to enable individuals to adopt healthier lifestyles.

Chronic Disease↗
PubMed1999

Maternal substance abuse and infant health: policy options across the life course.

Maternal substance abuse is a significant contributor to infant morbidity and mortality. The setting of prenatal care has long been the focus of interventions and policies to prevent these adverse outcomes. However, substance abuse programs and policies that are designed for women who are not yet pregnant can have a significant impact upon this problem. Thus it is essential to view the female life course from a broader perspective in order to consider the full range of policy options for reducing the infant mortality and morbidity caused by maternal substance abuse. This framework also allows comparisons across and between substances and offers new directions for policy development.

Adolescent↗