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PubMedDate not supplied

[Quality and efficiency of the Health Service in the Italian Region of Lombardy].

The Regional Law No. 31 of 1997 has revised the Lombardy Health Service as a whole, separating "providers", credited Public and Private Health Institutions, from "purchasers", Local Health Agencies. To this purpose, the improvement of the quality of assistance has been enhanced through an accreditation process aimed at implementing second level regional requirements considered as being necessary for carrying out effective treatment and meeting patient needs. Training, implementation and evaluation of quality service within Health Institutions have been carried out with the assistance of the Regional Observatory on the Quality of Health Service, which helped to identify initial intervention areas, define process indicators, activities and outcomes and verify patient satisfaction, all this to improve performance, reduce risks and control costs. To fully develop the Institutions in the accreditation process, the complex and difficult aspect of health care quality has been more extensively and deeply dealt with by adopting an "Excellence accreditation" model in cooperation with the Joint Commission International Accreditation and by experimenting with Professional accreditation supported by Scientific Societies to further contribute to the development of technical skills and knowledge. The Quality Project carried out so far is based on the integration of various projects, which will be the object of practical interventions by the General Health Direction. All the information and results gathered from this project will be very helpful in finding solutions that will enable all Health Institutions in Lombardy to reach an adequate level of quality.

Accreditation↗
PubMed2003

Building capacity of the Baltic States to meet the EU Water Framework Directive through watershed demonstration projects.

The Ohio River Valley Water Sanitation Commission (ORSANCO), in cooperation with the United States EPA, is completing it role in assisting the Baltic Countries of Estonia, Latvia, Lithuania and Kaliningrad Oblast, Russia with watershed management capacity building demonstration projects under the Great Lakes/Baltic Sea Partnership Program. The Countries of Estonia, Latvia and Lithuania view the skills gained through this program as important to their objective of complying with the European Union's Water Framework Directive and thus facilitating accession into the European Union. The program also addressed Kaliningrad's desire to work cooperatively with their neighboring countries concerning shared waters. Three watershed demonstration projects were designed and implemented, two of which involved joint country efforts: Parnu River (Estonia) modeling for nutrients and bacteria survey; river basin assessment and management planning for the Lielupe Basin (Latvia and Lithuania); and data base development and cooperative water quality survey and analysis for the Sesupe River (Lithuania and Kaliningrad). The benefits of the projects include enhancing the country's technical skills and the forging of relationships, without which achieving effective watershed management will be difficult to achieve.

Baltic States↗
PubMed2005

The ViCCU Project -- achieving virtual presence using Ultrabroadband internet in a Critical Clinical application -- initial results.

The ViCCU (Virtual Critical Care Unit) Project sought to address the problems of shortages of Critical Care staff by developing a system that could use the capabilities of Ultrabroadband networks so as to have a Critical Care Specialist virtually present at a distant location. This is not possible in a clinically useful way with current systems. A new system (ViCCU) was developed and deployed. Critically ill or injured patients are now routinely assessed and managed remotely using this system. It has led to a more appropriate level of transfers of patients and the delivery of a quality of clinical service not previously available. This paper describes the history of the project, its novelty, the clinically significant technical aspects of the system and its deployment. The initial results to the end of September 2004 are described.

Australia↗
PubMed1994

Computer applications in the intensive care unit.

Incorporating computers into all aspects of daily ICU operations is a formidable task both technically and logistically. To coordinate a project as complex as this, it is imperative to achieve close cooperation between physicians, nurses, basic scientists, computer specialists, hospital administrators, and equipment manufacturers. In this article, we have provided a blueprint and have discussed the implementation of a COmputational Model of PATient Health Status (COMPATHS) designed to carry out such integration.

Brain Diseases↗
PubMed1996

Networking consumer health information: bringing the patient into the medical information loop.

The Library of the Health Sciences at the University of Illinois at Chicago obtained a grant from the Illinois State Library to implement a statewide demonstration project that would provide consumer health information (CHI) using InfoTrac's Health Reference Center CD-ROM database. The goals of the project were to cooperate with targeted public libraries and clinics in providing CHI at the earliest point of need; to provide access to the database via a dial-up network server and a toll-free telephone number; and to work with targeted sites on database training, core CHI reference sources, and referral procedures. This paper provides background information about the project; describes the major systems and technical issues encountered; and discusses the outcomes, impact, and envisioned enhancements.

CD-ROM↗
PubMed1996

What we have here is a failure to communicate....

Implementing large-scale information system (IS) projects can be challenging; projects can get bogged down with technical and logistical details. Yet, the biggest threat is a communication style that does not meet the needs of the team involved.

Communication↗
PubMedDate not supplied

[Methodological structure for writing scientific papers].

Manuscripts submitted at meetings do not necessarily qualify as scientific papers since they do not adjust themselves to the objectives and structures required. It was concluded through this analysis that a scientific paper is an essential part of the proceeds of scientific research, which is not complete unless their results are published. Such a reason motivated us to conduct this study aimed at updating the methodological structure of the scientific paper, allowing those nursing professionals who review and prepare these texts to develop abilities in this sense, increasing the number and quality of the articles to be published. This bibliographic or documentary review was based on the study on PAHO's documents and from other Cuban authors that devote their time to examine these aspects. The nursing personnel will be able to improve and update their knowledge in this field and on the methodological structure of the scientific paper by this schematic information. This will influence on the quality, scientific and technical level, and national and international projection of the Cuban Journal of Nursing.

Cuba↗
PubMed1999

[In search of results of technical cooperation].

For the Pan American Health Organization (PAHO), technical cooperation (TC) is the process by which the PAHO Member States work with the Organization, as equal partners, to identify and reach their own health goals and to promote self-sufficiency in health development, through programs that respond to those countries' needs and national priorities. Since 1978, PAHO has used the American Regional Planning, Programming, Monitoring, and Evaluation System (AMPES) to establish management procedures and to facilitate decision-making in health TC. As part of AMPES, PAHO uses a "logical approach to project management" to structure the work program of the Organization and to identify the expected results from TC activities and TC resource investments. This project management approach, which replaces the "functional approaches" system used to date, also helps establish a causative relationship between the programmed activities and the results that PAHO expects, and between the activities and the hoped-for outcomes in the countries. As part of an ongoing process of rethinking international health TC, several years ago PAHO began a four-phase study on the usefulness and validity of functional approaches and on the need to propose new ones or to modify existing ones. The results of the initial phase showed it was difficult to classify the activities because the functional-approaches categories were not mutually exclusive and the TC activities were complex. Further, the expected results did not specify the product for which the PAHO Secretariat was accountable within a certain time frame nor the Secretariat's level of responsibility. Thus, a new and more flexible classification of expected results was proposed, with the following categories: cooperation networks and alliances; surveillance and information systems; standards and guidelines; research and evaluation studies; plans, projects, and policies; methods, models, and technologies; training programs; promotional campaigns and advocacy; and direct support. In the second phase of the study, it was concluded that the proposed classification system made it possible to more precisely identify the products of PAHO technical cooperation projects, the Organization's degree of responsibility, and the bases for estimating needed resources. The new system could also facilitate monitoring and evaluation. In addition, the third phase of analyzing the functional approaches has begun. Its objective is to evaluate the effect of technical cooperation based on the changes incorporated in the programming of activities.

Delivery of Health Care↗
PubMed1994

Providing treatment to persons with mental illness.

The RWJF Program on Chronic Mental illness created centralized mental health authorities in nine cities as a demonstration project. Evaluation teams, selected after the project began, and a national program office, established to provide technical assistance and to communicate progress and results, worked in tandem with the program staff. The project was evaluated as "logic model" to determine the feasibility of centralized authorities and to estimate their effect on various outcomes. One finding was that service reorganization does not cancel out the need to supply funds or mental health care. The problems of delay in the publication of results and of public officials' reluctance to act without "definitive" research data are described, as are the remedies for these difficulties.

Chronic Disease↗
PubMed1999

International harmonization of standards for diagnostic tests and vaccines: role of the Office International des Epizooties (OIE).

The OIE is recognized as the world organization for animal health. Serving 145 member countries, the OIE provides current information on disease occurrence, coordinates studies on disease surveillance and control, and harmonizes regulations for trade in animals and animal products. This paper focuses on the role of one the OIE's specialist commissions, the Standards Commission. The Standards Commission works in close collaboration with the Scientific and Technical Department of the OIE's Central Bureau on the international harmonization of standards for diagnostic tests and vaccines. The Manual of Standards for Diagnostic Tests and Vaccines, approved by the International Committee, defines the international standards for diagnostic tests and for the production of biological products as applied to mammals, birds, and bees. The Manual lists and details those tests which are prescribed for international trade and others which are suitable for bilateral trade agreements. The Manual represents one of the key scientific and technical references for harmonization of regulations for trade in animals and animal products. The commission coordinates the activities of a network of some 110 OIE reference laboratories and six collaborating centers. By creating and nurturing this network, international harmonization is promoted through the sharing of knowledge and the establishment of collaborative projects related to methods development and standardization, production and distribution of international reference standards, quality assurance, and assay validation. Through a series of guidelines provided to participants, the commission ensures the quality and focus of these projects. In matters of a scientific and technical nature concerning diagnostic tests and vaccines, the Standards Commission collaborates with other international organizations such as the FAO, WHO, IICA, and PAHO, thus promoting harmonization at the international program level. Underscoring the important role of the OIE at this level, the Sanitary and Phytosanitary Agreement of the World Trade Organization, as included in the Marrakech agreement (1994), specifically recommends the use of standards, guidelines, and recommendations developed under the auspices of the OIE in order to promote harmonization of regulations for trade in animals and animal products.

Animal Diseases↗
PubMed1995

[Physical illness in the transference and countertransference].

The significance of severe physical illness in terms of the repercussions it may have on the course of psychoanalytic treatment is a topic that has received very little attention in the literature. The author approaches the problem from the point of view of transference and counter-transference on the one hand, and from a distinction between self and body-self on the other. Rodewig proceeds on the assumption that a physical ailment can have the character of an object and may thus attain the status of third object. Given the threat posed by dangerous physical illness, the ego has recourse to defence mechanisms such as splitting and separate projective identification of positive and negative object- and self-parts, projecting the omnipotent, idealizing desires onto the therapist and the negative desires onto the ailment itself. In a later stage a de-idealization of the therapist sets in and the latter is identified with the illness so that the illness is then bandied back and forth between patient and analyst. The most challenging technical problem for analysts is avoiding the projection of their own illness and death anxieties onto the patient with a view to resolving them there. Instead, they need to be worked in independently and then given back to the patient devoid of their original virulence. The author illustrates the various facets of the problem with brief reference to various case histories.

Attitude to Death↗