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PubMed2005

[Founding and development of the Croatian Health Information System].

Information systems, either computer or paper based, are the key to business effectiveness and efficiency of healthcare organizations. The rationale of starting a large healthcare informatics project by the Ministry of Health and Welfare may be argued by two needs: (1) the need of medical data transformation into the information required for public health policy decision-making; and (2) measures in the field of health and pharmacoeconomics, i.e. systematic surveillance of healthcare costs that define the prospects for savings without lowering the level of service (estimated at 20%-30% of potential savings), along with the need of transparency and adoption of European Union directives and standards. Implementation of the proposed system results in two groups of fundamental functions: (1) the creation of a central public health information system which facilitates real-time tracking of primary healthcare cost generators, which in turn are used for creating health economics policy, and (2) to automatize the process of generating a consolidated national health budget including the Croatian Institute of Health Insurance and hospitals as well as consolidated financial reports for all those involved in the healthcare system. The model of the National Health Information System of the Republic of Croatia is described.

Croatia↗
PubMed2005

Development and implementation of a real-time control strategy for the sewer system of the city of Vienna.

The paper describes the realization of a real-time control for the Vienna sewer system. The project is scheduled for completion for 2004. The 3.5 year project comprises all planning stages starting with the recording of data up to the planning of measuring and controlling units. The concrete steps of the planning stages are explained. A measuring system including 25 rainfall measurements, 40 flow measurements and 20 water level measurements is implemented as an online system. This measuring system is designed to achieve two objectives, on the one hand the real-time control and on the other hand the calibration of the model that is used for the hydrodynamic sewer system simulation. The approx. 53,000 pipes have served to generate a coarse network of no more than approx. 2600 pipes. The area data were derived with high accuracy from available aerial photograph interpretations. With simulation runs of a rule-based control software the system operation was examined. A self-learning system will improve the rule basis. A forecasting model that uses weather observation radar will additionally influence the controlling decisions. The findings from the investigations are immediately considered in the planning of measuring and control units. The simulated results for the first phase of implementation, which demonstrate the benefit of RTC for the Vienna sewer system, are explained.

Austria↗
PubMed1991

Sexual behaviors of intravenous drug users in treatment.

Sexual behaviors of a group of 313 intravenous drug users (IVDUs) (225 men, 88 women) were assessed by a structured interview at the start of an AIDS prevention project. Although the majority were celibate or monogamous during the prior year (men 52.5%, women 64.3%), many IVDUs had multiple sexual partners in that time, including 19.6% of men and 7.2% of women reporting five or more. Married male and female IVDUs were more likely to have multiple sexual partners than married people in general population samples. Only 38.5% of male and 35.4% of female IVDUs ever used condoms during the previous 5 years. Percentage of sexual encounters in which condoms were used correlated significantly with the number of partners for women (r = 0.37, p less than 0.01), but not for men (r = 0.03, ns). Use of intravenous drugs in the prior year, sharing of needles, use of stimulants, exchange of sex for money or drugs, and combining sexual events with drug use were all associated with greater numbers of sexual partners. A subset of male IVDUs engages in the dual-risk behaviors of needle sharing and unprotected intercourse with multiple partners. This group could act as a highly efficient vector for human immunodeficiency virus transmission and should become a focus of intensive preventive intervention.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[What happens during the first encounter between a patient and a physiotherapist?].

Doctors refer several patients with problems connected to muscles and joints to physiotherapists. What happens when the patient meet the physiotherapist? This question is the starting point for a research project on first encounters in physiotherapy practice focusing on function assessment and communication. The analysis is based on videotapes of the encounters and semistructured interviews with patients and physiotherapists. This article is based on one of the videotaped encounters. The analysis assumes that all actions convey messages. Professional actions are interpreted in a communicative perspective. It appears that the patient's presentation of her problems is to some extent excluded from the therapeutic frame of understanding. The encounter displays problems and challenges between the person seeking help and the professional

Humans↗
PubMed1981

Hazards of chemicals used in agricultural aviation: a review.

Chemicals at the present time are the only means of controlling pest damage to crops on economic, efficient, and compatible grounds. Timely application, particularly over large areas or inaccessible areas, requires aircraft to apply them. Aerial agriculture is an essential industry, and growing in worldwide use. It is being used more and more in areas of the world where food is in short supply, and will be used more extensively to increase food production. Problems are associated with the use of chemicals, or more particularly, their misuse. There is an almost infinite variety of potentially valuable insecticides. Whilst the number of individual agents can become quite large, it is fortunate perhaps, that only a few types of classes of chemicals possess useful pesticidal activity. The aerial applicator's toxicological problems are mainly concerned with four classes: dinitrophenols, carbamates organochlorines, and organophosphates. It is recommended that application pilots and ground crews using these classes of pesticides should have their individual cholinesterase levels established at the start of a season for project, and monitored at intervals. Recommended lowest levels in blood and plasma are tabulated. Electromyography is also introduced in establishing a non-invasive method of measuring toxicity in the pilots and ground crews.

Accidents, Aviation↗
PubMed1997

[Evaluation of the effectiveness of an ambulatory after-care rehabilitation program].

Effects of an outpatient cardiological rehabilitation programme that is offered to patients following their inpatient treatment in a rehab clinic are measured and compared with the data collected from an untreated group. The study group consists of 155 cardiological patients (after heart attack, bypass operation and heart-valve prosthesis) in the treatment group as well as 136 in the non-treatment group. The outpatient programme takes place twice a week in a cardiological rehab clinic, with patients participating for a maximum period of twelve weeks. Data are collected at the beginning, the end and three months after the end of the programme from the treatment group resp. twice with a six months interval from the non-treatment group. The used outcome measures are a number of medical variables (e.g. stress ECG, BMI, blood pressure), variables concerning vocational reintegration, plus a questionnaire. This questionnaire consists of a Functional Limitation Scale, a Mood Check List, a "Health Locus of Control"-Scale as well as a number of items regarding health-related behaviour and heart complaint symptoms. The project duration was 36 months, starting in June 1993. The funding source is the "Landesversicherungsanstalt Westfalen", a regional division of the German Statutory Old Age Insurance. As data concerning vocational reintegration indicate, the programme can be a meaningful complement to a larger amount of reintegrated patients (66.9%) compared to the non-treatment group (50.2%). To estimate the long-term effects of the programme, a 24-month-follow-up was started in January 1996.

Adult↗
PubMed1989

[The syringe dispenser project in Larvik. Experiences after one year].

Limiting the use of contaminated syringes is an important step in the battle against hepatitis B and HIV epidemics. In 1987 a project, the first of its kind, was started in Larvik and the county of Vestfold in Norway. Syringe dispensers were put up in order to ensure that drug addicts had access to sterile syringes throughout the day and night. Looking back on one year's operation, the results and reactions are positive. The programme led to increased availability of syringes, reduced use of contaminated syringes, no pollution problems of significance and a decrease in the incidence of hepatitis B. We have also been able to channel increased information to a group hitherto difficult to reach. The involvement of the local public-health authorities has increased their contact with intravenous drug users. This has in turn laid the foundation for better future cooperation with this group. Setting up syringe dispensers has been shown to be an important factor in the battle against hepatitis B and HIV epidemics. This project has also provided a starting point for further work on drug abuse.

Evaluation Studies as Topic↗
PubMed2005

Deploying Six Sigma in a health care system as a work in progress.

BACKGROUND: An integrated health care system deployed Six Sigma in four clinical projects. The selected projects targeted Medicare profitability, emergency department cycle time reduction, clinic patient preparation, and medication safety. CROSS-PROJECT ANALYSIS: The six-month start-up period yielded several lessons. For example, the selection and sequence for implementing strategic performance improvement (PI) projects, and the decision to use Six Sigma methods, should be guided by an overall system of project portfolio management. IMPLEMENTING SIX SIGMA: Fairview Health Services (FHS) had begun with a partial deployment with the intent of using the experience to inform subsequent full deployment. Yet even before completing analyses of project outcomes, FHS decided to proceed with full deployment. Leaders developed strategic and communication plans, allocated resources, and provided for further training. In 2005, three years after the initial implementation period, Six Sigma implementation has continued. A systemwide method for setting priorities for PI projects is in place, supported by a Web-based system for managing, tracking, monitoring, and communicating results. FINAL REFLECTIONS: Cultural change is a challenge in any environment where staff is rooted in a single PI methodology and is skeptical about the credibility of Six Sigma because of its tie to manufacturing. Health care organizations will need to find better ways to engage physicians, especially community physicians whose patients and clinical practices could be affected by Six Sigma projects.

Delivery of Health Care, Integrated↗
PubMed2000

Using serial ultrasound measures to generate models of marbling and backfat thickness changes in feedlot cattle.

Serial ultrasound estimates of backfat thickness and marbling score were obtained on two groups of steers fed high-energy rations for averages of 166 and 148 d. These measurements were used to develop mathematical models that described the changes in those two attributes as functions of days on feed. An exponential model best described the increase in backfat thickness, and the rate coefficients were .0117 and .0096 for the two groups (doubling times = 59 and 72 d, respectively). A modified power function was better than either a linear or exponential model for describing the development of marbling. In this model, marbling increased very slowly, approximately one degree every 100 d, in the interval from low Select to low Choice but then increased at faster rates as initial marbling scores became higher. Ultrasound backfat measures could be used to predict days to reach a target carcass backfat level with an average error of 30 d or less when backfat thickness averaged more than 3 mm at evaluation. Projections from measurements taken when cattle were started on feed were not accurate from one group, which averaged only 1.7 mm backfat at that time. Projections of carcass marbling improved as evaluation date neared slaughter date. Projections from the initial evaluation date allowed tentative categorization of candidates for Choice or not Choice but were only 64% accurate. Projections from evaluations made later in the feeding period exceeded 75% accuracy in distinguishing Choice from Select. Only small relationships (r2 = .07 or .16) existed between carcass backfat thickness and marbling score. Results indicate that ultrasound estimates of backfat and marbling made during the feeding period can be used to predict carcass merit at slaughter.

Adipose Tissue↗
PubMed2000

Better oral health for infants and toddlers: a community based program.

Effective partnerships between health professional educational institutions and social service community programs can result in improved health outcomes for the people of the community being served. Such partnerships also may contribute considerably to student maturation into compassionate providers who have an appreciation for how an individual's health and quality of life may be affected by societal factors. A dental hygiene program at a private university and an Early Head Start Program joined in partnership to develop, and implement successfully, a project that was highly productive and of reciprocal benefit. With a focus on infant oral care in general, and early childhood caries in particular, dental hygiene students were able to provide much needed oral health services to 45 families with children enrolled in the Early Head Start Program, at multiple rural locations in Maine. In addition to meeting the needs of the Early Head Start Program, the project created a foundation for student exchange on the issues of dental caries in very young children, and the complexity of the factors contributing to them. Professional dental hygienists may choose to adopt all or portions of this innovative project when planning for the delivery of dental hygiene care to specialized populations in community-based settings.

Cariostatic Agents↗
PubMed1998

APOM-project: a survey of pharmacy organization and management.

In 1994, a Ph.D-study started regarding pharmacy, organization and management (APOM) in the Netherlands. The APOM-project deals with the structuring and steering of pharmacy organization. This article describes the summary of the empirical results of a survey in a relatively large sample (n = 169). Generalization to the population of pharmacies in the Netherlands was made. Thought results comprised a total number of seven clusters of priorities of pharmacy mixes. Most pharmacy managers were observed with product and customer activities in the first position; pharmaceutical and customer activities were perceived as the most important. Action results comprised a total number of five clusters of activities of pharmacy mixes. Most pharmacy managers were observed with product and process activities in the first position; pharmaceutical and process activities were performed most frequently. The results showed that the traditional conception of the work in the community pharmacy is still vividly present.

Data Collection↗
PubMed1988

[Assumption of projective reduplication in psychosomatic patients. I. Results of an empirical study].

The starting position of this study was the striking discrepancy between clinical hypothesis on "projective reduplication" and their empirical validation. Empirical data for the statistical analysis derived from a heterogeneous group of psychosomatically ill persons (N = 33) and a group of normal controls (N = 30). Using the similarity of the image of one's self and the one of others as an experimental analogy of the "projective reduplication", we could not ascertain any verifying hint for this syndrome. The results of the present study do not support the assumption of a clinical phenomenon according to the hypotheses tested. But it still remains uncertain whether these hypotheses are appropriate transformations of clinical experience.

Adult↗
PubMedDate not supplied

[AIDS and school: proposal for institutional and interdisciplinary prevention].

The project AIDS and School emerges as an institutional and interdisciplinary new proposal for HIV/AIDS combat. In 1992, Rio de Janeiro State University represented by Social Work and Nursing Faculties and by Adolescent Health Studies Nucleus and Education and Health State Secretaries and yet Oswaldo Cruz Foundation (FIO-CRUZ), thought about a way of preventively intervene with the age where the contact with the virus is mostly contacted. The adolescent should be worked on but for achieving a great number of students, a teacher was needed. From this, the project was designed and its development started in 1994 with '1 degree and 2 degrees graus' teachers capacitation in six districts of Rio de Janeiro. The work is of relevance for its supervision characteristics and support to GEPAE (AIDS and School Project Executive Group). At the workshops themes are worked with the teachers, such as: Loss and Death; Sexuality; Sexuality in AIDS times; Technical Information and Applied Methodology. This project is sponsored by the World Bank through Health Ministry. Nowadays, we are evaluating the project and we have already detected that for its performance and characteristics it will be turned into a Programme.

Acquired Immunodeficiency Syndrome↗
PubMed1994

[Women in occupational rehabilitation--findings of a Federal Rehabilitation Council conference].

The working programme of the Federal Rehabilitation Council includes the subject of reducing participation disincentives for women in the field of vocational rehabilitation. A working conference in 1990 had already dealt with this topic, and its findings were further scrutinized and substantiated in a second conference in 1993, in order to develop concepts more appropriate than hitherto to meeting the specific requirements present in women-oriented vocational rehabilitation measures. In-depth counselling and the possibility of pre-vocational orientation services were considered particularly important. Both concerning their range of occupational options and their timing as well as organizational specifics, the vocational rehabilitation programmes should to a greater extent be geared to the life situation and life planning of women. Consequently, the issue of community-based, and hence family-friendly, provision of vocational rehabilitation services is an increasing focus of discussion. Model projects have already been drafted or started relative to certain aspects in this field of women-focussed further development of vocational rehabilitation, but an overall concept capable of uniting the various approaches and requirements continues to be out of sight. A project group to help remedy this situation has hence been established by the Federal Rehabilitation Council.

Persons with Disabilities↗
PubMed1990

How many projections are really needed in angiographic assessment of the femoral bifurcation?

The purpose of this study was to analyze how many angiographic projections are needed in the diagnosis of hemodynamically significant stenoses of the femoral bifurcation. A total of 134 femoral bifurcations were examined with triplanar angiography in 67 patients (45 men and 22 women). The patients, ranging in age from 42 to 81 years (mean 63), suffered from incapacitating symptoms of peripheral arterial disease. The contralateral posterior oblique projection proved to be the most valuable in the assessment of hemodynamically significant arterial stenoses of the femoral bifurcation. An AP projection added information on stenoses of the inlets of the deep femoral artery in 9% of cases and on stenoses of the inlets of the superficial femoral artery in 6% of cases. An arteriographic examination should be started with a contralateral posterior oblique projection and this view will suffice in most cases.

Adult↗
PubMed2000

The Uganda Memory Project: mothers disclosing their HIV status to their children.

Since 1992, the National Community of Women Living with HIV/AIDS in Uganda has been working to improve the quality of life of Ugandan women living with HIV/AIDS. HIV-positive mothers who were finding it difficult to tell their children about their HIV status started the so-called Memory Project, which tries to help HIV-positive parents give their children the support they need to survive with as little trauma as possible after the deaths of their parents.

Africa↗
PubMed1999

National Tuberculosis Programme in Romania 1997-2000: how it works.

Romania displays one of the highest epidemiological parameters of tuberculosis among European countries: the incidence reached 113.3 per 100,000 in 1998, the prevalence of chronic cases was 18.9 and mortality 11.5 per 100,000 in 1996. A National Tuberculosis Programme aimed at decreasing the present burden of the disease has been elaborated according to the WHO strategy in 1997 and for its implementing. The National Committee on Pneumophtisiology and the Central Unit of the National Institute of Pneumophtisiology were made responsible. Tuberculosis managers and supervisors were nominated in each of the 48 counties and a total of 18,000 family doctors were involved in this programme at the primary health care level. Tuberculosis has been declared the second health priority in Romania and the following budget providers for its effective control were acquired: Ministry of Health, World Bank, Open Society Foundation, Funds of Romania and World Health Organization. The following achievements can be mentioned so far: A technical manual on the National Programme has been published, WHO modules on DOTS strategy were translated into Romanian, a training course on the WHO-DOTS strategy was organized for tuberculosis managers and laboratory chiefs, a pilot project on the WHO-DOTS strategy started in lasi, first control visits in counties and pneumophtisiologists were implemented, training for family doctors was organized and a project for health education with video shots was presented on the national TV channel.

Adolescent↗
PubMed1990

Comprehensive waste regulation dumped. A limited demonstration project is all that remains.

When medical wastes started washing up along the Eastern Seaboard and the shores of the Great Lakes in 1988, healthcare providers became subject to close public scrutiny. Not only was the situation deplorable; the solution, they feared, would keep them entangled in red tape for years. Public outcry sent members of Congress scurrying to legislate medical waste regulation. But what many had predicted would be a comprehensive, nationwide regulation that tracked medical waste from cradle to grave turned out to be a demonstration project limited to Puerto Rico and four states in the Northeast. The Medical Waste Tracking Act of 1988 went into effect in June 1989. When it expires in June 1991, the Environmental Protection Agency (EPA) will report to Congress on the program's impact, presumably with an eye toward whether further legislation and continuing regulations are necessary. In the meantime, participating states must establish a system of tracking medical waste from its point of generation to its disposal by either incineration or burial in a landfill. Medical waste generators must separate it from other kinds of waste and place it in special labeled containers. They must also prepare a tracking form that accompanies the cargo and requires sign-off by generator, transporter, and disposal facility operator. The EPA has legal access to medical waste tracking forms and can inspect any site where medical wastes are located. Violators are subject to stiff civil and criminal penalties.

Facility Regulation and Control↗