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PubMed2004

Societal aspects of genetically modified foods.

This paper aims to examine some of the reasons behind public controversy associated with the introduction of genetically modified foods in Europe the 1990s. The historical background to the controversy is provided to give context. The issue of public acceptance of genetically modified foods, and indeed the emerging biosciences more generally, is considered in the context of risk perceptions and attitudes, public trust in regulatory institutions, scientists, and industry, and the need to develop communication strategies that explicitly include public concerns rather than exclude them. Increased public participation has been promoted as a way of increasing trust in institutional practices associated with the biosciences, although questions still arise as to how to best utilise the outputs of such exercises in policy development. This issue will become more of a priority as decision-making systems become more transparent and open to public scrutiny. The results are discussed in the context of risk assessment and risk management, and recommendations for future research are made. In particular, it is recommended that new methods are developed in order to integrate public values more efficaciously into risk analysis processes, specifically with respect to the biosciences and to technology implementation in general.

Animals↗
PubMedDate not supplied

Technology assessment and equipment planning in Kaiser Permanente, Northern California Region.

Hospitals face a significant challenge to select and appropriately place clinically warranted, safe, and cost-effective medical devices. To meet this challenge, the Kaiser Permanente, Northern California Region developed a comprehensive medical device technology assessment and equipment planning program. This paper discusses the structure of the program, physician leadership and accountability, the role of clinical engineers and other support personnel, and the program's influence on strategic planning and policy development.

Biomedical Engineering↗
PubMed1980

Words as scalpels: transmitting evidence in the clinical dialogue.

This paper examines rationales and policies developed by physicians through history about what to tell patients found to have serious illness. The widespread belief among doctors that the revelation of threatening news causes patients considerable anguish and seriously erodes the prospect of maintaining their hope encouraged a policy of concealment for many centuries. Arguments that encourage candor have been increasingly pressed during the last two centuries. Advocates point out that candor can be beneficial and is favored by many patients, and that a policy of concealment usually fails to work, tends to place stress on patients by constraining discussion of anxieties generated by vague or explicit knowledge of the true situation, and exerts a damaging effect on trust in the medical relationship. Not only the moral aspects of this problem but also its clinical dimensions, such as mastering the skill to discuss threatening news with patients, bear considerable scrutiny by physicians and medical educators.

Attitude of Health Personnel↗
PubMed1986

Mortality transition in Korea: its implications for health policy and education.

This paper discusses the progress and prospects for mortality reduction in Korea, drawing upon the scanty data available in the literature. Data suggest that recent mortality improvement in Korea is slowing; that male mortality patterns at older ages are deviating from model life tables: that infant and child mortality is relatively high; and that transitional changes in the cause-of-death structure of infants and children are lagging behind their elders. Implications of these trends form a principal basis for concern about health policy issues in Korea. Any continuing progress in mortality would require major effort in several areas: accurate and adequate assessment of disease patterns and health behavior; reexamination of current health care strategies and public health measures; and analyses of social and economic development policies relevant to health conditions.

Adolescent↗
PubMedDate not supplied

Designing solutions for securing patient privacy--meeting the demands of health care in the 21st century.

OBJECTIVES: To define the issues surrounding patient privacy, examine the political context in which debate is taking place, and present a novel technology model for addressing privacy, confidentiality, and security in 21st century health care. SUMMARY: The discussion of privacy addresses one of the basic issues in health care today--the tension between the needs of the individual patient for privacy and confidentiality and the needs of society to effectively manage health care practices and control health care costs. Patient concerns for privacy, confidentiality, and security are legitimate, and can usually be reduced to issues that potentially affect an individual's employment, ability to get and maintain health coverage, and have control over his or her records and care. These concerns, combined with several precipitating events, are forcing the issue of privacy into the political arena, where new health policy decisions will be made. The debate must be framed within a principle-centered approach that focuses on boundaries, security, consumer control, accountability, and public responsibility. A global, distributed electronic health record management model that provides location-independent, secured, authenticated access to relevant patient care records by qualified health care professionals on a need-to-know basis provides solutions. Information asset considerations should be designed to equitably represent the ownership needs of corporate entities, society, and the individual. CONCLUSION: A secure electronic health record structure that systematically ensures a high level of accountability combined with thoughtful dialogue among key stakeholders in the public policy development process can offer the privacy outcomes we seek.

Delivery of Health Care↗
PubMed1997

State legislators' intentions to vote and subsequent votes on tobacco control legislation.

The predictive validity of state legislators' behavioral intentions in relation to their votes on tobacco control legislation was assessed by using the theory of planned behavior (I. Ajzen, 1991). Intentions to vote for cigarette tax increases were measured through interviews in the summer of 1994. A bill containing cigarette tax increases was considered about 8 months later. Votes were compared with intentions and were found to be consistent for 78% of these legislators (N = 120). Multiple logistic regression analyses showed a strong independent relationship between intentions and voting and a similar effect of political party; results suggested but did not confirm that votes were predicted by interactions between intentions and perceived control. Legislator surveys that use this conceptual model can provide results relevant to understanding tobacco policy development.

Adult↗
PubMed2004

Comparative performance data for critical access hospitals.

CONTEXT: Among small rural hospitals, there is a growing recognition of the need to measure and report on the use of resources and the safety and quality of the services provided. Dashboards, clinical value compasses, and balanced scorecards are approaches to performance measurement that have been adopted by many health care organizations. However, there exists very little comparative performance data specific for critical access hospitals. PURPOSE: To identify how comparative performance data for critical access hospitals (CPD-CAH) might facilitate performance and quality improvement, to assess the potential benefits and drawbacks of such data, and to identify some of the critical issues in the development and implementation of CPD-CAH. METHODS: Assessment of discussions by participants at a rural hospital performance improvement summit and authors' analyses. FINDINGS: CPD-CAH potentially could improve quality of care and patient outcomes, provide comparative data and benchmarks, inform policy development, facilitate collaboration, and enhance community relations. However, CPD-CAH could also impose an unaffordable cost, produce poor information, require complex coordination, induce a negative public reaction, and result in perverse hospital behavior. Development and implementation of CPD-CAH would require including stakeholders' assessment of its desirability and feasibility, setting objectives, establishing guiding principles, developing a method, collecting and analyzing data, and disseminating results. CONCLUSIONS: CPD-CAH could significantly advance CAH performance and quality improvement. However, development and implementation would be a complicated exercise requiring academic expertise and practitioner consultation. The potential value of CPD-CAH should be carefully weighed against its potential cost.

Benchmarking↗
PubMed1999

The spectrum of prevention: developing a comprehensive approach to injury prevention.

OBJECTIVE: The purpose of this paper is to describe the "spectrum of prevention", a framework for developing multifaceted approaches to injury prevention. The value of the tool is that it can help practitioners develop and structure comprehensive initiatives. METHODS: The spectrum is comprised of six inter-related action levels: (1) strengthening individual knowledge and skills, (2) promoting community education, (3) educating providers, (4) fostering coalitions and networks, (5) changing organizational practices, and (6) influencing policy and legislation. Activities at each of these levels have the potential to support each other and promote overall community health and safety. CONCLUSIONS: The spectrum of prevention is a tool which can help practitioners and policy leaders move beyond a primarily educational approach to achieve broad community goals through injury prevention strategies that include policy development. This framework has been endorsed and applied in a variety of disciplines, however it has not been formally evaluated, a process that could clarify the scope of its effectiveness.

Community Participation↗
PubMed2006

Preparing the work force for retirement--the role of occupational health nurses.

As baby boomers reach retirement, the need to develop realistic plans is pressing. Recent political and social developments involving Social Security, savings accounts, and pensions indicate a need for greater self-sufficiency. The greatest challenges facing retirees are maintenance of self-sufficiency, productivity, generativity, and social satisfaction. Employers can optimize the investment in their work force by implementing policies and work practices that take advantage of the improved cognitive functions of aging workers despite their declining physical abilities. Occupational health nurses have the skills in policy development, regulatory issues, and ergonomic principles to advise corporate leaders. Occupational health nurses can organize and present retirement planning skills to the work force in a variety of formats and with targeted content.

Adaptation, Psychological↗
PubMed1996

Health planning and health care for the poor: the internal ethic of public health.

Health planning involves assessing health care needs of a defined population, setting priorities, then developing, implementing,m and evaluating programs that address priority needs. The concepts of health planning are central to the 1988 report of the Institute of Medicine on the Future of Public Health, which defined the three core functions of public health as assessment, policy development, and assurance. Generally, when health planning is instituted, poor people are identified as having the poorest health status and the greatest need. An internal ethic is therefore created for public health to focus on the health care needs of those in poverty. This internal ethic of public health health can become the driving force for reforming the present U.S. health care system. A reformed health care system would be guided by the principle of care according to need, which not only has a basis in health planning, but in social justice as well.

Adult↗
PubMed1995

Strategic planning for an information system.

1. BACKGROUND. This strategic plan was developed by members of the Ontario Nursing Informatics Group (ONIG), an affiliated group of the Registered Nurses Association of Ontario (RNAO), in response to priorities set by its membership. This project management approach is an overview of the step-by-step approach described in the workbook Framework for Planning Nursing Information Systems [1]. 2. PLANNING PROCESS. The first phase, "Getting Ready," of the planning process emphasizes the importance of developing a strategic vision and preparing a business case. The objectives to be attained include a review of the current healthcare trends and state-of-the-art, the development of commitment from managers, and the establishment of a project structure. Secondly, one must "Analyze the Needs" of the health care facility. The current system is reviewed and future information requirements are defined. To facilitate this analysis, a detailed review of the current system is undertaken, the current system costs are identified, the technical and functional requirements are determined, and anticipated costs and benefits are outlined. Phase three, "Choosing a System," involves selecting system(s) that best meet the needs of the healthcare facility. A detailed system review is undertaken; it includes planning for the selection process, developing a request for information and/or a request for proposal, attending vendor demonstrations, attending site visits, and negotiating the contract. "Implementing the System" outlines the project plan for integrating the selected system in the work environment. The activities involved in managing the change process include the identification of the project team, defining the project plan, reviewing the budget, tailoring the system to meet the health care facility requirements, developing policies and procedures, outlining educational requirements, installing new hardware and software, piloting the system, and managing the transition. During the "Going Live" phase, the new system is integrated in the health care facility work activities. To manage this transition, an implementation checklist is developed, all staff that will be using some component of the system is educated, and the old system is converted to the new system. Following implementation of the system, a preventative "Maintenance" program must be developed to ensure the optimum level of functioning of the new system. This includes maintenance of the healthcare facility processes implemented during the conversion and maintenance of the application software and hardware. The last phase of the planning process is "Continuous Quality Improvement" (CQI). This phase stresses the importance of evaluating the system on an ongoing basis. A CQI program should be developed, on-going review must be scheduled, and the evaluation documented and communicated.

Information Systems↗
PubMed1996

Focusing Biodiversity Research on the Needs of Decision Makers

/ The project on Biodiversity Uncertainties and Research Needs (BURN) ensures the advancement of usable knowledge on biodiversity by obtaining input from decision makers on their priority information needs about biodiversity and then using this input to engage leading scientists in designing policy-relevant research. Decision makers articulated concerns related to four issues: significance of biodiversity; status and trends of biodiversity; management for biodiversity; and the linkage of social, cultural, economic, legal, and biological objectives. Leading natural and social scientists then identified the research required to address the decision makers' needs and determined the probability of success. The diverse group of experts reached consensus on several fundamental issues, helping to clarify the role of biodiversity in land and resource management. The BURN participants identified several features that should be incorporated into policy-relevant research plans and management strategies for biodiversity. Research and assessment efforts should be: multidisciplinary and integrative, participatory with stakeholder involvement, hierarchical (multiple scales), and problem- and region-specific. The activities should be focused regionally within a global perspective. Meta-analysis of existing data is needed on all fronts to assess the state of the science. More specifically, the scientists recommended six priority research areas that should be pursued to address the information needs articulated by decision makers: (1) characterization of biodiversity, (2) environmental valuation, (3) management for sustainability-for humans and the environment (adaptive management), (4) information management strategies, (5) governance and stewardship issues, and (6) communication and outreach. Broad recommendations were developed for each research area to provide direction for research planning and resource management strategies. The results will directly benefit those groups that require biodiversity research to address their needs-whether to develop policy, manage natural resources, or make other decisions affecting biodiversity.KEY WORDS: Biodiversity; Ecosystem management; Ecological stewardship; Sustainable development; Assessment

Journal Article↗
PubMed2002

The World Health Organization and the Pharmaceutical Industry. Common areas of interest and differing views.

No article published in the scientific press in the last 10 years reviews the various areas of interest common to the World Health Organization (WHO) and the pharmaceutical industry. Despite a vast amount of information in the public domain, the policies expound the views only of the bodies they represent rather than comparing differing views. An understanding of the factors which affect the interaction between these organisations as well as the organisational structures and the actual areas of intersecting interest, may help to find ways for the industry to assist the WHO in its endeavours in developing countries. Modern drug development is performed initially in and for western society, leaving the areas of infectious or tropical diseases with relatively less industry investment than cancer and cardiovascular disorders. Aspects of the development of an ethical drug, regardless of its therapeutic class (selection of drug name, intellectual property rights, drug safety, marketing and pricing, quality assurance and counterfeiting, generic use, emerging drug donations) are influenced to varying degrees by the triad of money, politics and medical need and the perspectives (each defensible) placed thereon by the WHO and industry. Instead of simply defending their positions combining the best of these strategies to optimise drug development for the needs of developing countries appears logical. Similarly, via its philanthropic initiatives, industry will have donated over $US1 billion in drug and research aid in the period 1995 to 2005. These charitable projects should yield useful information for planning and organising future aid efforts. Global warming, only recently given serious governmental consideration, is an area not yet addressed in drug development policy although along with geographical effects, it is likely to have an impact on the epidemiology of diseases e.g. malaria returning to the Mediterranean, worldwide. With changing disease patterns (and particularly if the western world is affected directly), a shift in emphasis on future medical needs and drug development can be anticipated. Furthermore, given the increased modern interest in herbal medicines and the fact that poorer countries rely heavily on traditional medicines, archiving of botanicals under threat would preserve plants for future medicinal testing or use. Coupled with the environmental and poverty issues that the WHO already attempts to address in developing countries, it is timely for both bodies to work towards certain agreed mutual aims. To work effectively, it is realistic that both bodies must benefit and also make concessions in this interactive process.

Developing Countries↗
PubMedDate not supplied

Evidence-based practice: a mixture of motives?

The growing importance of research and development in the NHS presents a major challenge to nurses. They are not centrally involved in influencing the R&D agenda, while nursing research, despite its recent boom, is not seen as integral to evidence-based practice. This paper suggests that the R&D initiative, like most policy developments, mixes altruism and pragmatism. Its aims include cost containment and control of the professions, alongside its more overtly expressed commitment to improving the quality of care. Useful efforts are being made to tackle the shortcomings of nursing research. However, the paper argues that nurses attempting to influence the R&D agenda need to be alert to its political nuances if they are to be effective.

Clinical Competence↗
PubMed2005

Strengthening health information systems to address health equity challenges.

Special studies and isolated initiatives over the past several decades in low-, middle- and high-income countries have consistently shown inequalities in health among socioeconomic groups and by gender, race or ethnicity, geographical area and other measures associated with social advantage. Significant health inequalities linked to social (dis)advantage rather than to inherent biological differences are generally considered unfair or inequitable. Such health inequities are the main object of health development efforts, including global targets such as the Millennium Development Goals, which require monitoring to evaluate progress. However, most national health information systems (HIS) lack key information needed to assess and address health inequities, namely, reliable, longitudinal and representative data linking measures of health with measures of social status or advantage at the individual or small-area level. Without empirical documentation and monitoring of such inequities, as well as country-level capacity to use this information for effective planning and monitoring of progress in response to interventions, movement towards equity is unlikely to occur. This paper reviews core information requirements and potential databases and proposes short-term and longer term strategies for strengthening the capabilities of HIS for the analysis of health equity and discusses HIS-related entry points for supporting a culture of equity-oriented decision-making and policy development.

Developing Countries↗
PubMed2003

Drinking and its burden in a global perspective: policy considerations and options.

AIMS: To identify the policy implications of the magnitude and characteristics of alcohol consumption and problems, viewed globally, and to summarize conclusions on the effectiveness of the strategies available to policymakers concerned with reducing rates of alcohol problems. DESIGN/METHODS/SETTING: This summative article draws on the findings of the articles preceding it and of reviews of the literature. FINDINGS AND CONCLUSIONS: Overall volume of consumption is the major factor in the prevalence of harms from drinking. Since consumption and associated problems tend to increase with economic development, policymakers in developing economies should be especially aware of the need to develop policies to minimize overall increases in alcohol consumption. Unrecorded consumption is also an important consideration for policy in many parts of the world, and poses difficulties for alcohol control policies. Drinking pattern is also an important contributing factor toward alcohol-related harm. Although some drinking patterns have been shown to produce beneficial health effects, because the net effect of alcohol on coronary disease is negative in most parts of the world, policies that promote abstinence or lower drinking overall may be the safest options. Moreover, sporadic intoxication is common in many parts of the world, and policies are unlikely to change this drinking pattern at least in the short to medium term. At the same time, because injuries comprise a large proportion of the burden of alcohol, it is appropriate to enhance these policies with targeted harm reduction strategies such as drinking and driving countermeasures and interventions focused on reducing alcohol-related violence in specific high-risk settings. Alcohol consumption is a major factor for the global burden of disease and should be considered a public health priority globally, regionally, and nationally for the vast majority of countries in the world. The need for alcohol policy is even stronger when it is taken into consideration that the burden of alcohol estimated in the WHO Global Burden of Disease project includes primarily health problems related to drinking. From the limited evidence available, however, social problems related to drinking seem to impose at least as much burden. Moreover, the burden for both social and health harms fall not only on the drinker, but also on others. There is a broad literature on policy interventions to reduce alcohol problems. Effective strategies include controls over distribution and sale, taxation, drinking-driving countermeasures, brief interventions by health workers or counselors, and selected harm reduction measures. There is a need to develop the growing literature on comparative evaluations of cost-effectiveness of such strategies. In addition, international agreements are needed to support the effectiveness of national strategies.

Alcohol Drinking↗
PubMed1995

Speaking truth to power: empowerment ideology as social intervention and policy.

The popularity, and subsequent ambiguity, in the use of the term "empowerment" has created an even greater need for reassessment in the applied context than in the theory and research literatures. This paper outlines some of the areas of community, organizational, and societal level social intervention and policy ostensibly based on the concept of empowerment. These include neighborhood voluntary associations (for environmental protection, community crime prevention, etc.), self-help groups, competence-building primary prevention, organizational management, health care and educational reforms, and national and international community service and community development policies. Issues in applying social research to community organizations and to legislative and administrative policy making are reviewed. Ten recommendations are offered, including the value of a dialectical analysis, for helping researchers and policy makers/administrators make more effective use of empowerment theory and research.

Community Networks↗