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At least 955 records · Page 53Linked to original sources
PubMed1997

Automating and improving the data quality of a nursing department quality management program at a university hospital.

BACKGROUND: The development and implementation of a relational database program for nursing quality management at a university hospital was stimulated by a lack of consistent data management and analysis tools in the existing noncomputerized program. PROGRAM DEVELOPMENT AND IMPLEMENTATION: An initial software prototype implemented in the critical care service included data collection instruments for five areas: medication errors, patient falls, returns to an intensive care unit within 48 hours, hospital-acquired skin breakdown, and unplanned extubations. Access to the database was limited and paper reports only were disseminated on a scheduled basis. In a second phase, the database is being deployed throughout the nursing department using a local area network. Nurse managers will enter and interact with the quality database online and have access to graphics, reports, and action plan development. POSSIBLE ERRORS: A wide range of potential errors influences decisions on how to collect, store, retrieve, and process quality management data. Each type of error affects the nurse manager's ability to identify significant patterns or trends that are amenable to intervention. There is no right way of constructing and implementing a quality improvement database; only an optimum balance between cost, complexity, and efficacy. SUMMARY AND CONCLUSIONS: Initial feedback from end uses has been positive. A three-year experience with a personal computer database suggests that the personal computer-based information technology is appropriate for small to medium applications and can support departmentwide CQI efforts. A case scenario using simulated data is included to illustrate the use of computerized reports in assessing and taking action on an increase in falls.

Accidental Falls↗
PubMedDate not supplied

Impact of an electronic meeting system on the group decision-making process.

Traditional face-to-face meetings are effective for many meeting formats; however, there are occasions when communication needs to be conducted in a more open, anonymous style. When the discussion centers on controversial and/or emotional issues, such as curriculum planning, the need for a nontraditional style may even be greater. Our nursing program decided to utilize a new campus resource called the Group Decision Center to facilitate undergraduate curriculum planning. The Group Decision Center is an electronic meeting system in which the discussion takes place in a face-to-face electronic format. The advantages of an electronic meeting system format include participant anonymity, equal and increased participation by group members, increased productivity and efficiency, automated record keeping, group synergy, and a more structured meeting. The disadvantages include the potential for inappropriate or hostile conversations, loss of acknowledgment for individual idea generation, breakdown of linear conversation, and lack of the nonverbal communication that often influences the meaning within a traditional conversation. The process of developing, planning, and participating in the electronic meeting and the automated record are discussed.

Curriculum↗
PubMed2006

Phase II clinical trial design: methods in translational research from the Genitourinary Committee at the Eastern Cooperative Oncology Group.

Given the increase in novel agents and difficulty with planning and completing many phase III studies, various phase II trial design options should be considered to more effectively guide phase III trial plans. The need for novel phase II trial designs has increased, given the number of novel molecular targeted therapies now available for testing, an abundance of cytostatic agents, and limited resources to conduct phase III studies for all interesting agents or combinations. This review will focus on options for phase II trial designs. We review randomized phase II designs with placebo control, randomized selection designs, and randomized discontinuation designs. As agents become available for testing in the clinic, the strengths and weaknesses of different phase II trial designs should be considered to optimize a trial development plan that guides phase III trial decisions more effectively.

Advisory Committees↗
PubMed1999

Care and feeding of a staff for filmless radiology.

Texas Children's Hospital, a definitive care pediatric hospital located in the Texas Medical Center, has been constructing a large-scale picture archival and communications system (PACS) including ultrasound (US), computed tomography (CT), magnetic resonance (MR), and computed radiography (CR). Developing staffing adequate to meet the demands of filmless radiology operations has been a continuous challenge. Overall guidance for the PACS effort is provided by a hospital-level PACS Committee, a department-level PACS Steering Committee, and an Operations Committee. Operational Subcommittees have been formed to address service-specific implementation, such as the Emergency Center Operations Subcommittee. These committees include membership by those affected by the change, as well as those effecting the change. Initially, personnel resources for PACS were provided through additional duties of existing imaging service personnel. As the PACS effort became more complex, full-time positions were created, including a PACS Coordinator, a PACS Analyst, and a Digital Imaging Assistant. Each position requires a job description, qualifications, and personnel development plans that are difficult to anticipate in an evolving PACS implementation. These positions have been augmented by temporary full-time assignments, position reclassifications, and cross-training of other imaging personnel. Imaging personnel are assisted by other hospital personnel from Biomedical Engineering and Information Services. Ultimately, the PACS staff grows to include all those who must operate the PACS equipment in the normal course of their duties. The effectiveness of the PACS staff is limited by their level of their expertise. This report discusses our methods to obtain training from outside our institution and to develop, conduct, and document standardized in-house training. We describe some of the products of this work, including policies and procedures, clinical competency criteria, PACS inservice topics, and an informal PACS newsletter. As the PACS system software and hardware changes, and as our implementation grows, these products must to be revised and training must be repeated.

Biomedical Engineering↗
PubMed2003

[Theoretical and methodological research on the comprehensive development of agricultural model zone in waterlogged area].

The searching for a proper land reclamation and utilization method adapted to the regional natural conditions and economical level is a prime subject in the waterlogged area of Southern China. Choosing a dish-like micro-zone, one of the typical waterlogged areas deprived from a reclaimed lake as the studying region, its biophysical characteristics and developmental models was investigated, aiming at making a comprehensive development plan to this area. The results showed that with the successive change in altitude across the sector of the land, the soil type, soil profile structure, underground water level, and soil temperature were characterized by five step divergence steps. The analysis on the site and area of the individual divergences showed that the low land was unsuitable for rice planting, and the land between upland and paddy should be increased for rotation and needed to be reclaimed better. After an engineering consolidation to the land, the original five divergence steps were rehabilitated into four steps, and a utilization model of "development in a step way" focused on comprehensively agricultural development and improvement in farming systems was developed, which leaded to a great advance in economic profit of this area.

Agriculture↗
PubMed2002

Globalization and its challenges for water management in the developing world.

Water management in developing countries is significantly affected by the processes of globalization: primarily the rapidly acting market-oriented changes that aim to improve economic efficiency through competition and trade. The various impacts of market forces enable 3 categories of developing country to be differentiated: those rapidly integrating into the global economy; those that are not attractive to international investment and become increasingly marginalized; and those countries where both tendencies are powerful, leading to internal divisions and instabilities. Broad framework national development plans are needed that are sensitive to the different circumstances in these countries and that enable the possible actors to collaborate optimally. Often the business sector can take a leading role, but its role is severely limited in other countries. In all cases however the long-term commitment of local communities is essential even when it is hard to secure.

Commerce↗
PubMed1978

The politics of health care regulation: the case of the National Health Planning and Resources Development Act.

This paper examines the political and bureautic dynamics of health regulation under the National Health Planning and Resources Development Act and, to a lesser extent, the Carter Cost Proposal now before Congress. A number of underlying issues that affect the day-to-day exercise of health planning are considered, including the contest between state and local and federal government for program control, jurisdictional conflict between state and local planning agencies, and the unsettled roles to be played by professional planners, consumers, and providers. When we assess regulatory policy in health, these complicating factors must be added to the long list of handicaps that already exist. One important finding is that local planning agencies have embraced the task of health regulation somewhat more fully than had generally been expected. A number of explanations for this are offered. In short, the controlling factors in health planning are political, not technical, and there is more occurring at the state and local levels than many had predicted, although any impact is not likely to be dramatic.

Costs and Cost Analysis↗
PubMedDate not supplied

Improving outpatient diabetes management through a collaboration of six competing, capitated Medicare managed care plans.

This report addresses diabetes care in the managed care setting and improvement in care brought about by collaboration between 6 Medicare managed care plans (MCPs) and a Peer Review Organization (PRO). The objective was to improve the quality of care of outpatient diabetes patients provided by primary care physicians through the mutual collaboration of 6 Medicare managed care plans and a Medicare Peer Review Organization. The design involved pre-post intervention trial based on 2 random samples, a baseline sample drawn in 1995 and a remeasurement sample drawn in 1996. Medical records of patients in both samples were reviewed by the PRO to determine provision of 14 quality indicator services over a 1-year period. The setting was 6 Arizona Medicare managed care plans comprising approximately 40% of the Arizona Medicare population. Two random samples were drawn from type 2 diabetes patients continuously enrolled in the same managed care plan for at least 1 year. The intervention was comparative feedback of baseline data by the PRO, enabling each plan to compare itself to any other plan on any or all indicators. Each plan developed and implemented its own intervention in response to the 1995 baseline results. The main outcome measures were mean HbA1c, the proportion of HbA1c values below 8%, and positive change in provision of 14 quality indicator services. At postintervention remeasurement, mean HbA1c values fell from 8.9 +/- 2.2 to 7.9% +/- 2.1, and the proportion of patients with HbA1c values below 8.0% rose from 40% to 61.6%. The proportion of the 14 indicator services provided to patients rose from 35% to 55%. The mean number of physician office visits fell 13% and the number of services provided per visit doubled. We conclude that improving the process of care improves glycemic control. Better outpatient diabetes management in competing, capitated managed care plans is an attainable goal when mediated through a neutral third party such as a PRO.

Ambulatory Care↗
PubMed1987

Research information systems are path to high-quality healthcare.

Research is the key to dealing with the major issues facing the healthcare industry. And an information system for organization and management research is a necessary component in healthcare organizations. Research information systems should support action, not theory. Their purpose is to educate information users about their system of services; provide data for planning, developing, directing, and evaluating both technical and management work; and provide a basis for "steering" the program. Four key subjects for a research information system are service activities, patient characteristics, costs and budget, and outcomes. The goal in developing a research information system is to integrate the various types of information into a format that provides the information for management use at a given time. Development of a research information system requires concentrating on the design and the process of developing and using the data for action research. Each design step requires an analysis of existing and future research requirements, of what clinical and managerial leaders would like to know. Identifying users is important, since they will ultimately judge the adequacy of the system. Each user has to make decisions based on the data. Such decisions include setting goals, forming policy, organizing activities, and budgeting.

Computer Systems↗
PubMed2003

The development and application of a public health skills assessment tool for use in primary care organisations.

The public health skills assessment instrument described in this paper was developed to provide a key group of UK primary care practitioners (health visitors) with a personal development planning tool and researchers with a robust assessment tool for use in evaluations of innovative local public health programmes. Pilot testing with over 120 practitioners has provided evidence of its reliability and validity as a research instrument as well as yielding useful insights for public health educators, practitioners and policy-makers. Factor analysis confirms 10 core competency domains for health visitors which are remarkably consistent with those recently identified for UK public health specialists, interpreted here as grounds for optimism in the greater co-ordination between strategic and front-line approaches to public health work in primary care. However, results also confirm earlier findings indicating low levels of skill amongst health visitors in tackling health inequalities through interventions such as community development, raising questions about their capability to work effectively in new roles proposed by the Department of Health.

Community Health Nursing↗
PubMed1990

[The RX-PLAN--a computer system for planning radiation treatment].

The authors presented a system of radiation treatment design (RT)--RX-PLAN developed at the N. N. Burdenko Main Military Hospital in 1988 on the basis of a PC of DVK-3M type. The use of the PC with a graphic interface made it possible to meet the following specific requirements: input, imaging, processing and output of graphic data and to make an automated working place of low cost for radiologists (a physicist and a physician).

Humans↗
PubMedDate not supplied

Improving the continuity of care between general practitioners and public hospitals.

OBJECTIVE: To improve the quality of clinical care through better continuity of services between the public hospital and general practitioners (GPs), focusing on expediting discharge of patients from hospital through improved use of resources provided by GPs. DESIGN: Stage 1: Participant observation during ward rounds and unstructured interviews to gain an understanding of the perceptions of hospital staff and GPs of the GP's role in the discharge process. Stage 2: Semi-structured interviews with registrars and GPs of 30 patients (who were admitted to a medical ward and discharged to the care of their GP) to get the participants' views of each other's roles in providing continuity of care. RESULTS: There was a general lack of trust on both sides, and poor communication owing to several structural and perceptual problems. Registrars focused on specialist care and outpatient follow-up, being almost oblivious to GP functions, apart from monitoring the management plan developed in the hospital; they made no use of GPs' knowledge of the case or their experience in treating patients within their families and social milieu, and frequently wished to do everything within the hospital. GPs, on the other hand, often felt alienated from the hospital system, although they had much to offer by being able to contribute details of the patient's background and by using their special skills, which went well beyond passively monitoring progress. RECOMMENDATIONS: 1. Information about the patient's GP should be made available to hospital staff. 2. Interns should make telephone calls to GPs after admission and when the discharge date is known. 3. Early-discharge summaries should be forwarded and include: (i) reasons for giving or altering medications; (ii) specific plans after discharge; (iii) information conveyed to the patient and family about the illness; and (iv) a summary of the case by the consultant. 4. Registrars and interns should be educated about the appropriate involvement of GPs in the discharge process and throughout the patient's stay in hospital. 5. Direct involvement of the GP with the patient during hospital stay should be encouraged. 6. A pilot study should be set up to investigate the role of a liaison person in overcoming problems of the transition of care of hospitalised patients to the community.

Australia↗
PubMed2005

[Computerization and the importance of information in health system, as in health care resources registry].

The possibilities of creating a health care resources registry and its operating in Croatia as well as the importance of information in health system are described. At the Croatian Institute of Public Health, monitoring of human resources is performed through the national Health Workers Registry. It also covers basic data on all health units, bed capacities of health facilities included. The initiated health care computerization has urged the idea of forming one more database on physical resources, i.e. on registered medical devices and equipment, more complete. Linking these databases on health resources would produce a single Health Care Resources Registry. The concept views Health Care Resources Registry as part of the overall health information system with centralized information on the health system. The planned development of segments of a single health information system is based on the implementation of the accepted international standards and common network services. Network services that are based on verified Internet technologies are used within a safe, reliable and closed health computer network, which makes up the health intranet (WAN--Wide Area Network). The resource registry is a software solution based on the relational database that monitors history, thus permitting the data collected over a longer period to be analyzed. Such a solution assumes the existence of a directory service, which would replace the current independent software for the Health Workers Registry. In the Health Care Resources Registry, the basic data set encompasses data objects and attributes from the directory service. The directory service is compatible with the LDAP protocol (Lightweight Directory Access Protocol), providing services uniformly to the current records on human and physical resources. Through the storage of attributes defined according to the HL7 (Health Level Seven) standard, directory service is accessible to all applications of the health information system. Directory service does not follow the history of attribute changes, and is optimized for a large number of authorizing inquiries. With it, one follows the following objects and attributes: persons, groups of people (patients, physicians, other personnel), roles (right of access and administrator permissions), organizational units, unit locations, devices and services (according to the list of services and procedures). One can add to the Health Care Resource Registry such attributes as are nonessential for inclusion in the directory service, but are of public health value. Authentication, authorization and digital signature are done by means of Smart Cards, which are used as protective elements against access to system functions, and simultaneously as a physical medium for the storage of the official certificate with which documents are signed digitally. As FINA (state financial control agency) has completed a system for certificate issuance and verification, the option of official digital signature is also available as a computer network service. Any changes taking place in the directory service are transferred by XML messages to a separate part of the Registry that reads them and automatically modifies records in the relational database. Because data input and data changes are made in health units, this makes the data updated and directly connected with health working operations. This avoids all one-time data collection campaigns using form filling about the devices and equipment in the future. As it is very difficult to monitor from a central standpoint how accurate and update the information is, it is necessary to delegate the permissions and duties associated with making changes to the directory service. By this organizational setup, the time needed to ensure data quality control is reduced. In the case described, the Health Care Resource Registry becomes an indicator of change, acquiring certain characteristics of an analytical system. An analysis of topical data renders possible proactive action and makes more effective the planning and utilization of available resources. Providing answers on the current data quickly could also be important to solution-seeking in emergencies. The present proposal to establish the Registry is intended to facilitate the future process of planning and striking a balance between investments in human and physical resources. For health expenditure control, having reliable information related to the use and purchase of new medical technology is particularly important. World Health Organization and European Union have also emphasized the need to develop new indicators in this area.

Croatia↗
PubMed1995

[More than a century of international immigration into Argentina].

"From the second half of the 19th century, Argentina was, along with the United States and Brazil, one of the main destinations that attracted European emigration to America.... The arrival of more that six million people between 1869 and 1930 resulted in radical changes in the socioeconomic structure of the country. After the crisis of the 1930s the impact of a development plan based on the export of agricultural products waned and the economic growth accompanied with political instability generated a slowing decline of migratory flows, despite a new wave between 1945 and 1952. The decrease of international migration comes along with an important change in the composition by places of origin.... The article analyses the successive migratory policies of Argentina's government as well as the migrants' spatial distribution and their incorporation in the labor market." (SUMMARY IN ENG AND SPA)

Acculturation↗
PubMed2006

Building bridges with decision-makers: rules for rural and remote health researchers.

CONTEXT: Until recently, rural and remote health researchers have undertaken predominantly investigator-driven research. In Canada and elsewhere, major health research funding agencies have begun to expect researchers to incorporate into funding proposals, a well-developed plan for sharing research findings with decision-makers, those who can incorporate relevant findings into clinical practice, programs and services. ISSUE: The research arising from the interests of investigators, although frequently relevant to communities, too often has resulted in data extraction that parallels resource extraction from resource-based rural or remote communities. Such research can result in non-usable findings, and in the non-use of research findings by decision-makers. LESSONS LEARNED: In order that useful and usable knowledge is created, bridges need to be built between researchers and decision-makers. Six 'rules for researchers' are proposed to help build bridges with decision-makers: Rule 1. Engage the right decision-makers; Rule 2. Determine what's in it for you and for them; Rule 3. Develop a sustained relationship; Rule 4. Live in their world once in a while; Rule 5. Think of doing research differently; Rule 6. Build integrative research infrastructures.

Canada↗
PubMed2001

FDA review practices and priorities for drugs used in cancer treatment.

The Federal Food, Drug, and Cosmetic Act and related regulations (21 U.S.C. 301 et seq.) give FDA staff the legal authority and responsibility to review the safety and effectiveness of drugs and biological products (including products used in cancer treatment), from preclinical testing through all phases of clinical research and marketing. FDA review activities in the oncology arena can be divided into five major categories: (1) initial review of investigational new drug (IND) applications; (2) ongoing review of premarketing research (including new research protocols submitted to existing INDs and IND safety reports describing adverse events with the new drug); (3) discussions with commercial sponsors regarding their clinical development plans, including the design and conduct of key studies that are intended to support initial marketing approval for a new product or to support the addition of new indications to the prescribing information for currently marketed products; (4) review of submitted new drug applications (NDAs) or biological licensing applications (BLAs); and (5) continuing review of the safety and effectiveness of marketed products. Through these review activities, FDA staff work to ensure that products approved for marketing for cancer treatment are effective and adequately safe for their intended uses and to ensure that the quality, effectiveness, and safety of products on the market are preserved or enhanced, so patients and physicians may use these products with confidence and with adequate safety. Because these review activities generally fall into a chronologic sequence, the following discussion parallels the development course of a typical new drug.

Antineoplastic Agents↗
PubMed2006

International immersion programs in baccalaureate nursing education: professor and student perspectives.

This article presents the dual perspectives of professor and student in relation to the explicit need for nurses to become acutely conscious of cultural competence through self-awareness and how this influences nursing care. Mary Anne Levine, Professor of Nursing, discusses the development, planning, implementation, and evolution of the International Immersion Program (IIP) at Humboldt State University. The student experience, integration, and evaluation of IIP and its impact on one's professional and personal life are described by Elizabeth Perpetua, currently a practicing RN, who participated in the program in Nakhodka, Russia.

Attitude of Health Personnel↗
PubMed1998

An efficient sampling technique used to detect four foodborne pathogens on pork and beef carcasses in nine Belgian abattoirs.

The method presented in this paper should prove useful in assessing the effectiveness of HACCP plans developed in slaughterhouses. Samples were collected by swabbing well-defined areas of pork and beef carcasses with sterile gauze. Between 160 and 420 half-carcasses were swabbed in each of nine pork or beef slaughterhouses. Swabs from five carcasses were placed in the same sterile Stomacher bag, constituting a single composite sample. Standard or validated analytical methods were used to isolate and characterize four foodborne pathogens. Salmonella spp., Listeria monocytogenes, Campylobacter spp., and verocytotoxin-producing E. coli were detected, respectively, in 27, 2, 2, and 14% of the pork samples and 0, 22, 10, and 5% of the beef samples. Of the 10 samples positive for E. coli O157, only one yielded an isolate confirmed to be enterohemorrhagic. Since Salmonella spp. appear as the main contaminant port (27%) and L. monocytogenes as the main containment of beef (22%), any slaughterhouse sampling plan should include testing for the former in the case of pork carcasses and for the latter in the case of beef carcasses. One should also test regularly for the presence of E. coli O157 and Campylobacter spp. in pork and beef abattoirs. The method presented here is an easy way to assess the contamination rate of carcasses at the end of the slaughtering process.

Abattoirs↗