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PubMed2001

The value of the Ecological Station of Jataí's ecosystem services and natural capital.

The capacity of a given natural ecosystem to provide certain goods and services that satisfy human needs depends on its environmental characteristics (natural processes and components). It was described the availability of these goods and services (environmental functions) controlled and sustained by ecological processes operating in Ecological Station of Jataí (Luiz Antônio, SP). The environmental functions identified were grouped in four main categories. To make environmental values an integrated factor in planning and decision making it was assessed their socio-economic importance in qualitative terms and, if possible their monetary value. The combined potential annual return from identified functions of Ecological Station of Jataí is at least US$ 708.83/ha/year. In comparison to calculations made for other natural ecosystems this is a rather moderate estimate. The Ecological Station of Jataí is poorly protected and managed, it too is still threatened by human activity (agriculture) and many development plans. Although present day market economics do not recognize the monetary value of most environmental functions, such calculations do provide a revealing insight into the great socio-economic importance of Ecological Station of Jataí. More awareness of these values may provide an important incentive for their preservation and sustainable use.

Brazil↗
PubMedDate not supplied

Economic and demographic consequences of AIDS in Namibia: rapid assessment of the costs.

Recent announcements by the Government of Namibia to provide financial support to people living with AIDS (and their family members) have received considerable media attention. However, given the fact that government budgets are already stretched, and the need for resources to devote the prevention efforts remains, there is an urgent need to assign some values to the support the government is considering within the context of an explosive epidemic. It is against this background that this study attempts to provide a rapid assessment of the economic costs of HIV/AIDS in Namibia over the next 5 years of the First National Development Plan. The estimates include the direct and indirect costs. The direct costs are costs to the economy for inpatient and outpatient medical services, as well as the costs of support payments to people living with AIDS, their families and children orphaned by AIDS. Government and donor expenditure on national prevention and control efforts are also included. The study concludes that no sector of the Namibian economy will escape the impact of AIDS. The epidemic will definitely tax hospital, public health, private and community resources, and these substantial burdens underscore the need for coordinated long-term planning.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Provision of services for the diagnosis and treatment of heart disease. Fourth report of a Joint Cardiology Committee of the Royal College of Physicians of London and the Royal College of Surgeons of England.

The principal conclusions of the fourth report of the Joint Cardiology Committee are: 1 Cardiovascular disease remains a major cause of death and morbidity in the population and of utilisation of medical services. 2 Reduction in the risk of cardiovascular disease is feasible, and better co-ordination is required of strategies most likely to be effective. 3 Pre-hospital care of cardiac emergencies, in particular the provision of facilities for defibrillation, should continue to be developed. 4 There remains a large shortfall in provision of cardiological services with almost one in five district hospitals in England and Wales having no physician with the appropriate training. Few of the larger districts have two cardiologists to meet the recommendation for populations of over 250,000. One hundred and fifty extra consultant posts (in both district and regional centres) together with adequate supporting staff and facilities are urgently needed to provide modest cover for existing requirements. 5 The provision of coronary bypass grafting has expanded since 1985, but few regions have fulfilled the unambitious objectives stated in the Third Joint Cardiology Report. 6 The development of coronary angioplasty has been slow and haphazard. All regional centres should have at least two cardiologists trained in coronary angioplasty and there should be a designated budget. Surgical cover is still required for most procedures and is best provided on site. 7 Advances in the management of arrhythmias, including the use of specialised pacemakers, implantable defibrillators, and percutaneous or surgical ablation of parts of the cardiac conducting system have resulted in great benefit to patients. Planned development of the emerging sub-specialty of arrhythmology is required. 8 Strategies must be developed to limit the increased exposure of cardiologists to ionising radiation which will result from the expansion and increasing complexity of interventional procedures. 9 Supra-regional funding for infant cardiac surgery and transplantation has been successful and should be continued. 10 Despite advances in non-invasive diagnosis of congenital heart disease the amount of cardiac catheterisation of children has risen due to the increase in number of interventional procedures. Vacant consultant posts in paediatric cardiology and the need for an increase in the number of such posts cannot be filled from existing senior registrar posts. All paediatric cardiac units should have a senior registrar and in the meantime it may be necessary to make proleptic appointments to consultant posts with arrangements for the appointees to complete their training. 11 Provision of care for the increasing number of adolescent and adult survivors of complex congenital heart disease is urgently required. The management of these patients is specialised, and the committee recommends that it should ultimately be undertaken by either adult or pediatric cardiologists with appropriate additional training working in supra-regionally funded centers alongside specially trained surgeons. 12 Cardiac rehabilitation should be available to all patients in the United Kingdom. 13 New recommendations for training in cardiology are for a total of at least five years in the specialty after general professional training, plus a year as senior registrar in general medicine. An additional year may be required for those wishing to work in interventional cardiology and adequate provision must be made for those with an academic interest. 14 It is essential that both basic and clinical research is carried out in cardiac centres but these activities are becoming increasingly limited by the lack of properly funded posts in the basic sciences and restriction in the number of honorary posts for clinical research workers. 15 A joint audit committee of the Royal College of Physicians and the British Cardiac Society has been established to coordinate audit in the specialty. All district and regional cardiac centres should cooperate with the work of the committee, in addition to their participation in local audit activities.

Cardiac Surgical Procedures↗
PubMed1985

How can pharmacists develop and implement a home antibiotic program?

Many hospital pharmacists are evaluating home antibiotic programs (HAPs). In addition to providing a new role for the pharmacist, commercial activity in this area fosters the idea that providing an HAP is a profitable business. Those evaluating HAPs should take a careful approach to this service, evaluating the market potential and cost feasibility before devoting the time and effort in implementing a program. If the market potential exists, and the program appears to be feasible from a cost standpoint, a pilot project should be performed based on experiences reported in the literature. If this is successful, a training and services program can be fully planned, developed, and implemented. Evaluating an HAP is important to obtain data required to improve the program and establish the need for reimbursement. Joint ventures with vendors or other hospitals may be a way to provide this service without making a major commitment of resources from the hospital.

Anti-Bacterial Agents↗
PubMedDate not supplied

Waiting together: translating the principles of therapeutic relationships one step further.

ISSUES AND PURPOSE: Inconsistent nursing practices created nurse-patient boundary issues on a cardiac step-down unit related to confidentiality, limit setting, and professionalism with patients and families awaiting organ transplantation. CONCLUSIONS: A staff work group designed and implemented a plan to translate the principles of therapeutic relationships into daily practice. PRACTICE IMPLICATIONS: A work plan developed for nursing staff outlined concrete solutions and resources available within the hospital. This framework can be used to empower staff in the ongoing effort to manage relationships with chronically ill patients and their families.

Adolescent↗
PubMed1986

Information processes in movement learning: capacity and structural interference effects.

A series of experiments examined motor learning as an information processing activity occurring within a working short-term memory system and where response-produced feedback and knowledge of results (KR) are used to modify the action plan developed from previous attempts at the movement task. Use of interpolated activities in the KR delay interval allowed inferences to be made regarding the capacity and structural characteristics of these information processes. Results indicated no capacity limitations on the learning process but important structural effects were found. The results supported the idea that response-produced feedback is relatively unimportant as a feedback variable early in learning. Rather, the use of KR at a relatively high level of movement planning appears to be the important information processing activity underlying learning. Finally, the results supported the view that these information processes are related to cognitive problem solving activities.

Journal Article↗
PubMedDate not supplied

The development of market approaches in Russia.

In the late 1980s, it became clear that poor outcomes of the Russian health system were caused not only by underfunding but also by inadequate management of health care. Some features of the system led to great inefficiency in medical care provision and an irrational structure of medical care. The recognition of this fact has intensified the search for new methods of finance and management. The underlying idea of health care reforms in Russia is to weaken providers' dominance, to make them more responsive to consumer preferences, and to change the structure of medical care. The main developments of the reform parallel the reforms in Western countries. These are primarily the separation of finance and provision of medical care, with the shift from an integrated to a contractual model of relationships between payers and providers. But the specific characteristics of the health care situation, primarily the great underfunding and the absolute dominance of state-owned medical facilities, make the reform in the Russian health sector more radical. This paper highlights the issues of the current and planned developments in the Russian health sector. After presenting the main characteristics of the current health systems, it addresses economic experiments which are underway in several regions of the new Russian Federation. They are designed to introduce elements of market relations into a highly bureaucratic system. The main features and the impact of the experiments are discussed. Then the new model of finance, which is based on a transition from tax-financed to the health insurance system, is presented.

Economic Competition↗
PubMed1988

Development of a hospital-based proton beam treatment center.

Radiation oncologists recognize a continuing need to improve the radiation dose distribution between a cancer and the surrounding normal tissue. A most promising method of accomplishing this goal is the use of charged particle beam irradiation, the clinical use of which has been investigated for the past 40 years. Since the first clinical studies began at the Lawrence Berkeley Laboratory in 1954, more than 5,000 patients have been treated with protons, using accelerators designed for physics laboratories. Superior results are reported for the control of selected diseases by the ten facilities which are currently investigating proton radiation therapy. The findings have resulted in expansion plans in several of these facilities, and in the formulation of plans for two new facilities. We report on the planned development of a new facility at Loma Linda University, which has contracted with Fermi National Accelerator Laboratory for the design and fabrication of a 250 MeV synchrotron and its beam transport and delivery systems. This facility will be the first in the world to employ a proton accelerator dedicated to medical service and research. As such, it will be available as an international resource to develop and improve the modality.

California↗
PubMed1995

Bridging the "med-ed gap" for students with special health care needs: a model school liaison program.

A successful school experience is critical to the development of all children, particularly in the areas of academic achievement, regular school attendance, and social competency. Vulnerabilities in achieving each of these three goals have been documented among students with special health care needs (SSHCN), and ascribed to the influence of their health-related disabilities. Despite recognition of these vulnerabilities, barriers still exist to successful integration of SSHCN into educational settings. A key barrier to successful integration involves poor linkages between the health and education systems. This article describes a model linkage system--the School Liaison Program at Texas Children's Hospital, developed as a U.S. Dept. of Health and Human Services Maternal and Child Health Bureau Special Project of Regional and National Significance. The program provides educational liaison services between the largest pediatric hospital in the United States and school districts in the fourth largest city. A description of the linkage system emphasizes interdisciplinary staffing by both special educators and health providers. The model for educational liaison service delivery presented includes the elements of eligibility, assessment of the educational implications of illness, plan development and referral, involvement in educational placement, and monitoring. Resources for integrating SSHCN into educational settings are suggested.

Adolescent↗
PubMed1982

The environmental health matrix: information for use in planning.

Environmental and Health planners and policy makers would benefit from a presentation of the casual relationships and the use of that information for plan development and priority setting. The concept of the Environmental-Health Matrix provides a simple structure for constructing data base of environmental-health research information. The Matrix is organized so that it can be used by either environmental or health planners. Entries in the cells of the Matrix assess the nature of the research evidence and direct the user to summaries of research findings. The initial application of the Matrix as both a guide for a literature review and a data base for planning is discussed.

Environment↗
PubMed2000

Children in hospital: a design question.

Holistic medicine is the global trend in medical care. It involves not only the highest possible standard of diagnosis and treatment, but also designing the whole experience of being ill and that of hospitalization. In such a frame, planning and designing for children has to be considered in such a way that a child will be helped to withstand the effects of illness, the separation from home and family and the entrance into an unusual, unfamiliar and strange world. Although the wellbeing and happiness of children in hospital is the concern of the nursing staff and of the parents, many other factors have to be satisfied also. A young ill child who has to be treated in hospital has to adjust to a number of environmental and treatment conditions which may be upsetting and may have far-reaching effects. Because of all these, much effort has been made, over the last fifty years, to develop planning and design aspects, which will make a child's life in hospital less unnatural. Furthermore, it will reduce the unavoidable and inevitable discomfort, disease, pain and misery experienced by children. These aspects include avoidance of admission of children into hospital whenever possible, operations on a daily basis, unrestricted visits, encouraging of parents to visit or to stay with their children, the provision of suitable playing facilities, materials, equipment etc. This paper will seek to explore and develop: a change in philosophy in child care, its influence on the various types of facilities, the importance of the family, the psychological needs as design factors such as security, social contacts, personal space, movement, comfort, independence, outdoor spaces and others. Factors relating to design parameters and standards will also be explored. The meaning and importance of scale is highlighted since it is felt that children are not miniature adults, but individuals with their own particular capacities.

Architecture↗
PubMedDate not supplied

The utility of CPD for older adult mental health nurses.

AIM: To investigate how mental health nurses working with older adults perceive the benefits and realities of developing the outcomes of current continuing professional development training into actual clinical practice. METHOD: A structured questionnaire was used with a convenience sample of nursing staff. Qualitative analysis was performed using a grounded theory approach in order to identify emergent themes, concepts and categories of data. Four randomly selected nurses were subjected to a voluntary semistructured interview using the questionnaire as a basis for information gathering. RESULTS: The main reason for attending courses was developing skills. Of those attending courses, 42 per cent of qualified and 35 per cent of unqualified staff had a personal development plan (PDP) or individual performance review (IPR). Significantly, all unqualified staff who had not been on a course had no PDP or IPR. Learning was described as applicable to practice by 85 per cent of unqualified and 70 per cent of qualified staff. However, 28 per cent of unqualified staff and 20 per cent of qualified staff felt their practice had not changed as a result of their learning. CONCLUSION: CPD can be a positive experience, providing nurses with the opportunity to direct their professional development.

Aged↗
PubMedDate not supplied

A global perspective on disability: a review of efforts to increase access and advance social integration for disabled persons.

Disability has emerged as a major public health problem worldwide, common to nations presenting disparate levels of socioeconomic development. Failure to integrate social welfare programmes within national development planning exacerbates difficulties arising from limited resources, with a disproportionate impact on disabled persons and other vulnerable groups. Such policy failure allows flagrant inequalities and social injustice to persist. Strategies are emerging, however, that are useful for solving common international problems. Community-based disability prevention and rehabilitation is one emerging solution that has attracted considerable attention worldwide, including in the United States. Following a review of global estimates of disability, which reveal the magnitude of the problem and provide background information for this report, I will summarize major international initiatives designed to prevent disability and ensure comprehensive rehabilitation for disabled persons. I will also analyse the relationships between health, socioeconomic development, and disability. Finally, I will describe community-based rehabilitation, an innovative approach evolving from the World Health Organization's Global Strategy for Health for All by the Year 2000, an approach with potential to eliminate barriers to equal opportunities and social integration for disabled persons.

Community Health Services↗
PubMed1992

The structure and process of AIDS case management.

This article presents observations of case management in the Robert Wood Johnson Foundation AIDS Health Services Program. Case management is discussed in terms of assessment, care plan development, client links with services, monitoring, and advocacy. Recommendations are proposed to ensure that AIDS case management is delivered in a standard and equitable manner that can be monitored by quality assurance agencies.

Acquired Immunodeficiency Syndrome↗
PubMed2001

NCI image archive management workshop: a preliminary report.

The National Cancer Institute organized a workshop entitled "Image Archive Management" that was presented on August 28 and 29, 2000, at the Natcher Conference Center on the National Institutes of Health (NIH) campus. The purpose of this workshop was to solicit expert input for the planned development of an archival system to make imaging databases readily accessible by the broad scientific community. The specific goals were to (a) define the technical requirements for a virtual archive of images used in oncology, (b) define the policy issues for access to these images, (c) recommend a process and phases for implementation of a robust imaging archival system, (d) review how this effort could be expanded and coupled with other ongoing efforts by NIH and other organizations interested in imaging, and (e) form an overall plan and policy to allow interoperability of image data archives. Representatives who attended the workshop came from academia, government agencies, and large and small businesses. A preliminary report was generated, as outlined herein, and additional reports are anticipated from the steering committee being organized as one of this workshop's recommendations, which is expected to be active by summer 2001. Additional information, including the list of participants in this workshop, is available at the Biomedical Imaging Program Web site (http://www.nci.nih.gov/bip/).

Humans↗
PubMed1993

The oral health status among residents of the Magadan Oblast, Russian Far East.

In April 1991, an oral health situation analysis team comprising oral health professionals from the Alaska Area Native Health Service, the World Health Organization, and the Moscow Medical Stomatological Institute visited the Magadan region of the Soviet Far East at the request of the Ministries of Health of both the Russian Republic and the then-Soviet Union. As few oral health data had been available specific to the Magadan region, the purpose of the trip was to gather data concerning oral diseases epidemiology, demography, and health systems of the communities of Magadan, Seymchan, and Provideniya as the basis for recommendations and plan development. The data were collected using standard WHO methodology. The analysis team examined children in the age cohorts of 3-5, 6-7, 12, and 15 years. In addition, adults aged 35-44 and 65-74 years were examined in Magadan and Seymchan. Both caries and periodontal rates are high, with a rate of 4.3 DMFT among 12-year-olds in the total region, but up to 5.4 DMFT in one location. Specific findings and recommendations have been forwarded to local community and health officials. The project is ongoing, and plans are underway to provide continuing assistance in designing and implementing an effective program for the prevention and treatment of oral diseases.

Adolescent↗
PubMed2006

Peer-professional workgroups in palliative care: a strategy for advancing professional discourse and practice.

BACKGROUND: As part of a comprehensive national effort to improve care at the end of life, the Promoting Excellence in End-of-Life Care program of The Robert Wood Johnson Foundation convened "national peer-professional workgroups" of recognized authorities or leaders to advance palliative aspects of practice in their respective specialties or fields. OBJECTIVE: The conveners' goals were to establish research and practice agendas to integrate palliative care within selected fields and health care settings, and to expand delivery of palliative care to special patient populations that have been underserved by palliative care. We hypothesized that leading professionals within specific fields, chartered to achieve clear goals, and then provided with sufficient administrative and logistical support, could develop recommendations for expanding access to, quality of and financing for palliative care within their disciplines. DESIGN: Staff at the national program office of Promoting Excellence in End-of-Life Care convened eight disease-based, specialty-based or issue-based workgroups (the selected workgroup topics were amyotrophic lateral sclerosis, cost accounting, critical care, end-stage renal disease, human immunodeficiency virus/acquired immune deficiency syndrome [HIV/AIDS] disease, Huntington's disease, pediatric care, and surgical palliative care). The national program office implemented a small group process design in convening the groups, and provided coordination, oversight and administrative support, along with funds to support meetings (telephone and in-person). A workgroup "charter" guided groups in determining the scope of efforts and set specific, time-limited goals. From the outset, the workgroups developed plans for dissemination of workgroup recommendations to defined stakeholder audiences, including health care providers, policy-makers, payers, researchers, funders, educators, professional organizations and patient advocacy groups. SETTING AND SUBJECTS: Groups averaged 25 members and met for an average of 24 months. Promoting Excellence leadership chose workgroup topic areas that addressed patient populations underserved for palliative care, and corresponding professional specialties with demonstrated interest and readiness to improve education, evidence base, and professional expertise in palliative aspects of care. RESULTS: Each workgroup was highly productive and advanced changes in respective fields through developing and disseminating recommendations to their respective fields regarding practice, education, clinical and health service research and policy. Beyond their chartered responsibilities, workgroups also developed educational programs and curricula and a wide array of resources. The workgroups also authored articles for publication, intended to stimulate professional discourse and influence clinical norms and culture. CONCLUSIONS: The national peer-professional workgroup model exceeded original expectations and produced well-considered Recommendations to the Field as well as a body of resources for professionals in expanding access to and quality of palliative care. Results of this experimental venture in professional change suggest that the workgroup model may be a useful, cost-effective, rapid-change strategy for quality improvement in other areas of professional practice and service delivery.

Foundations↗
PubMed1980

A short method to ensure nutritional adequacy of food served in nursing homes. II. Development of a model food plan.

A model food plan was developed to serve as a short method to ensure nutritional adequacy of food served to nursing home residents. Criteria were that the food plan provide 100 per cent of 1974 Recommended Dietary Allowances (RDAs) for fourteen nutrients without exceeding 110 per cent of allowances for calories. To meet the criteria, an increase in pounds of meat, fish, and poultry; dried beans, peas, and nuts; green leafy vegatables; bananas; and dry cereals over actual food issues was required. The model plan is presented in the form of pounds of food, per sixteen food groups, required for 100 persons, per day.

Aged↗