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PubMed2002

Cross-boundary working: a macro-political analysis of the impact on professional roles.

This paper reviews the policy developments impacting on professional roles and boundaries in health and social care. A macro-political analysis is used to offer a challenging critique to many of the assumptions associated with cross-boundary working. It explores issues such as: whether or not new nursing roles are truly being developed to meet need; the myths and realities of interprofessional working; how competence can be assured; the need for new forms of professional regulation; the implications for professional education of initiatives such as national occupational standards and shared learning; planning the future health care workforce; and the need for rigorous and robust evaluation of service and role developments. Through this exploration the likely consequences of political and professional initiatives for both cross-boundary working and the profession of nursing itself are illuminated.

Clinical Competence↗
PubMed1989

Economic considerations that influence health policy and research.

Cardiovascular conditions account for more medical costs than any other diagnostic category in the United States. Increasingly, economic constraints will shape policy related to health care and research. Hypertension is the most common cardiovascular condition, and despite low unit health care costs, the aggregate costs are considerable. However, the unit and aggregate costs of the complications of hypertension are fourfold greater and, in this economic perspective, aggressive approaches are warranted to prevent complications. Treatment and research strategies should be identified that could have considerable potential economic impact. Several strategies are suggested as a prospective guide to policy development. Economic considerations will be important and should be incorporated in the planning of hypertension care and research.

Antihypertensive Agents↗
PubMed2003

An example of the use of systematic reviews to answer an effectiveness question.

Systematic reviews assist nurses, other health care providers, decision makers, and consumers in managing the explosion of health care information by synthesizing valid data and reporting the effects of interventions. Nurses are increasingly using systematic reviews to guide their practice and develop policy. The purpose of the article is to outline the steps involved in conducting a systematic review with examples taken from a systematic review titled "Strategies to Manage the Behavioral Symptoms Associated With Alzheimer's Disease." The steps of a systematic review include: (a) formulating a well-defined question, (b) developing relevance and validity tools, (c) conducting a comprehensive search to retrieve published and unpublished reports, (d) assessing the reports using relevance and validity tools, (e) data extraction, (f) synthesis of the findings, and (g) report writing. Understanding the steps involved in a systematic review will assist nurses in critically appraising reviews and in conducting their own reviews.

Humans↗
PubMed2003

Lay experts and the politics of breast implants.

This paper discusses the controversy around breast implants in the United States and Europe. It focuses on the emergence of consumer and support groups for women and offers an analysis of the role they have played in recent policy developments in UK and Europe. The politics of breast implants is seen as a politics of knowledge in which scientific expertise has consistently been deployed in ways that minimize the credibility and legitimacy of women's accounts of their bodies and illness experiences. These women have been doubly disadvantaged in a policy debate that turns on scientific controversy and uncertainty. This implies a gendered dynamic to the changing relations of knowledge and expertise. The paper contributes to an understanding of the relations between regulators, manufacturers, users, and clinicians in the global medical device industry and to wider debates around the public understanding of science.

Breast Implants↗
PubMed1996

People with AIDS as residents: preparedness and acceptance by Connecticut long-term care facilities.

The management of AIDS has become an issue of chronic care as well as acute treatment. As the number of people with AIDS increases, the demand for ongoing care and support, both informal and formal, is expected to increase. The present study is based on a survey of all licensed nursing homes in the state of Connecticut with respect to prevailing attitudes toward the admission of residents with AIDS, and the level of staff, resident and procedural preparedness that exists. Both positive attitudes among the various LTC constituent groups as well as the level of preparation in a number of areas are correlated with the admission of residents with AIDS. Implications are discussed and recommendations are offered for policy development.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Education for management in the new public health.

The new public health movement has developed over the last decade and is emerging as an alternative to traditional concepts in Europe, Canada, and Australia, but not in the U.S.A. Fundamental principles, evolved mainly by the World Health Organization under the banner of the "Health for All by the Year 2000" Strategy, include community participation in health policy development and implementation of programs, emphases on primary health care and health promotion, and inter-sectoral cooperation involving agencies whose influence impinges on health. Little attention has been given to organizational and management activities. Decentralized organization of public health activities appears to be an absolute requirement, along with firm political commitment to new public health concepts. Typically, however, health authorities have tended to develop separate bureaus for new public health activities rather than integrate the latter with traditional administrative structures. It is evident that a new style of management is needed with emphases on flexibility and interactional skills. Formal attempts to incorporate new public health principles in graduate educational programs are currently underway in Europe, where all nations are committed to the concepts. The European M.P.H., which includes an as-yet-undefined component of management education, will have a core curriculum based on the new public health. Although there has been considerable activity in Australia, uncertainty remains over the viability of the new movement due to the creation of separate bureaus operating parallel to traditional health departments and their reliance mainly on a single source of funding from the federal government.

Australia↗
PubMed1998

[Coordination or competence: an emerging problem in the development of network treatment for alcoholics].

The author recognizes the significance and relevance of the network treatment for alcoholics is such a way as an effort to respond not only to the medical needs but also to social service needs, in order to support the recovery of alcoholics. Consequently we are faced to an indispensable task to look back historically the developmental process of the treatment service for alcoholics in Japan. A recent policy development in the alcohol treatment is stimulating the shift from the overweight medical approach to a more comprehensive approach including social services. This innovation is bringing about not only a wider treatment options but also a newly emerging problem of "coordination or competence" as well. It was implied in this paper that a concept of "shared function" is promising to consider this new problem.

Alcoholism↗
PubMed1992

Evaluating policy change in physician manpower planning.

The decade of the 1980s witnessed a revitalization of free-market interest in the use of incentives and voluntary participation to promote activities in a wide range of fields. Because of its history of decentralized control over physician residency training, the state of New Jersey found such an approach appealing when it sought to restructure its graduate medical education system. Two statewide task forces spent a year developing policy changes designed to produce voluntary changes in such areas as the size and growth of the state system. However, a 2-year follow-up survey of the directors of state residency programs revealed little perceivable change.

Education, Medical, Graduate↗
PubMed2004

Physicians' interactions with third-party payers: is deception necessary?

Published reports indicate that physicians sometimes use deceptive tactics with third-party payers. Many physicians appear to be willing to deceive to secure care that they perceive as necessary, particularly when illnesses are severe and appeals procedures for care denials are burdensome. Physicians whose practices include larger numbers of Medicaid or managed care patients seem more willing to deceive third-party payers than are other physicians. The use of deception has important implications for physician professionalism, patient trust, and rational health policy development. If deception is as widespread as these studies suggest, there may be serious problems in the medical profession and the health care financing systems at the interface between physicians and third-party payers. Deception may be a symptom of a flawed system, in which physicians are asked to implement financing policies that conflict with their primary obligation to the patient.

Deception↗
PubMed1986

New federalism and health care policy: states and the old questions.

The New Federalism that evolved under the Reagan administration tends to grant states more discretion in the implementation of health care programs. It thereby rekindles old concerns about the commitment, capacity, and progressivity of the states. This paper reviews recent policy developments and reconsiders state performance from the vantage point of the mid-1980s. While hard evidence remains elusive, a plausible case exists that any gap between the states and Washington on commitment, capacity, and progressivity has diminished. State administrative capacity in particular has probably increased. The continued presence of substantial variation among the states needs to be underscored, however. Moreover, the relentless imperative of economic development, or migration, theory sets severe limits on how far states can go in adopting redistributive measures to assure adequate medical care for the poor. Given current federal laws, the most optimistic, plausible scenario envisions the rise of a technical politics of efficiency in the states. In spite of state limitations, health policy reformers need to pay increased attention to their potential role.

Costs and Cost Analysis↗
PubMed2005

Evaluation of asthma management policies in New York City public schools.

The aim of this study was to investigate asthma management policies and protocols in Bronx, New York, public elementary schools in light of the National Heart, Lung, and Blood Institute (NHLBI) Resolution on Asthma Management in Schools. An anonymous survey was conducted in November 2001 of principals, teachers, counselors, and nurses at five Bronx elementary schools. The response rate was 62%, and the majority of respondents (84%) were teachers; 51% of respondents learned of a student's asthma only through informal conversation with the student or parent, 28% said they were usually not informed of a student's asthma status, and only 10% learned of a child's asthma through existing school protocols; 21% of respondents did not know whom in the school was responsible for supervising the health needs of children with asthma, and 30% did not know how asthma inhalers were supposed to be handled at their school. Only 1.6% of teachers were "very familiar" with Board of Education asthma policies. The results are interpreted as showing poor adherence to the NHLBI recommendations. They also reflect a lack of consistent strategies for communication of a child's asthma diagnosis and for management of the disease in the schools. Ongoing efforts to improve asthma management in public schools through teacher education and policy development should be supported and evaluated for outcomes in teacher knowledge and student health.

Asthma↗
PubMed2003

Restrictive visitor policies: feedback from healthcare workers, patients and families.

With the hospital-based transmission of Severe Acute Respiratory Syndrome (SARS) in Ontario, acute care hospitals severely restricted visitor access. Now that the SARS outbreak is under control, hospitals struggle with the balance between adhering to patient- and family-centred care models, and addressing the future threat of infectious diseases. To evaluate the effect of visitor restrictions and to guide future visitation policies, the Ottawa Hospital conducted a preliminary survey of patients, next of kin, staff, physicians and volunteers. Ninety percent of staff surveyed supported some form of visitor restrictions, while 71% indicated that they felt comfortable asking visitors to leave if they had exceeded current restrictions. The majority of patients (80%) and next of kin (76%) were at least moderately satisfied with current restricted limiting hours. A disproportionate number of positive comments on current visiting restrictions were received from both patients and staff. In the absence of evidence on which to base future visitor policy development, objective input from healthcare workers, patients and families is invaluable.

Attitude of Health Personnel↗
PubMedDate not supplied

Health care provision: the six key players.

The new language of health care tends to assume a duality between purchasers and providers. This article argues that, in fact, a plurality of groups are involved with health services. These include not only purchasers and providers, but politicians, policy developers, practitioners and punters. The author suggests that attention should be focused on the true experience of health services, where practitioners and punters meet.

Delivery of Health Care↗
PubMed2004

Improving population health or the population itself? Health technology assessment and our genetic future.

The province of British Columbia (BC), Canada is developing its first population-wide prenatal genetic screening program, known as triple-marker screening (TMS). TMS, initiated with a simple blood test, is most commonly used to screen for fetuses with the chromosomal abnormality known as Down syndrome or neural tube disorders. Women testing TMS-positive are offered diagnostic amniocentesis and, if the diagnosis is confirmed, selective second-trimester abortion. The project described in this study was initiated to address the broad range of issues arising from this testing technology and provides an example of the new type of health technology assessment (HTA) contribution emerging (and likely to become increasing necessary) in health policy development. With the advent of prenatal genetic screening programs, would-be parents gain the promise of identifying target conditions and, hence, the option of selective abortion of affected fetuses. There is considerable awareness that these developments pose challenges in every dimension (ethical, political, economic, and clinical) of the health-care environment. In the effort to construct an appropriate prenatal screening policy, therefore, administrators have understandably sought guidance from within the field of HTA. The report authors concluded that, within the restricted path open to it, the role of government is relatively clear. It has the responsibility to maintain equal access to prenatal testing, as to any other health service. It should also require maintenance of medical standards and evaluation of program performance. At the same time, policy-makers need actively to support those individuals born with disabilities and their families.

British Columbia↗
PubMed2004

European framework to decrease the burden of TB/HIV.

Tuberculosis (TB) in Europe is declining in countries in western and central Europe, but the burden is still high and increasing in eastern Europe. HIV/AIDS is increasing dramatically in eastern Europe. HIV-related tuberculosis (TB/HIV) morbidity and mortality are expected to accelerate significantly in the future. This framework aims to guide European countries in developing their national plan for reducing TB/HIV morbidity and mortality. It results from an extensive consultation process undertaken by the World Health Organization Regional Office for Europe and by those responsible for HIV/AIDS and TB programmes and their partners. It builds on strategies developed globally and in Europe for TB control and for HIV/AIDS prevention and care. This framework sets out the rationale for effective collaboration between HIV/AIDS and tuberculosis national programmes. It identifies five strategic components (political commitment, collaborative prevention, intensified case-finding, coordinated treatment and strengthened surveillance) and eight key operations (central coordination, policy development, surveillance, training, supply management, service delivery, health promotion and research).

Europe↗
PubMedDate not supplied

Impact of HIV infection/AIDS on social service agencies serving children and youth in Toronto.

There are few data on how HIV infection/AIDS affects social service agencies serving children and youth. We conducted a survey of 24 provincially funded agencies in the Metro Toronto area and discovered that 36 clients and 9 staff members were HIV-infected. Our data strongly suggest that these agencies were ill equipped to cope with issues surrounding HIV infection/AIDS. Inadequacy or absence of policy and procedures resulted in confusion regarding issues such as HIV testing, need to know, confidentiality, duty to warn, staff and client education, and universal precautions for infection control. In order to effectively deal with the psychosocial, legal, ethical and education needs of clients and staff, agencies must be pro-active in developing policy and procedure.

AIDS Serodiagnosis↗
PubMed2026

Open and sustainable AI: challenges, opportunities and the road ahead in the life sciences.

Artificial intelligence (AI) has seen transformative breakthroughs in the life sciences, expanding possibilities to interpret biological information at an unprecedented capacity. To maximize return on growing investments and accelerate progress, it is urgent to address long-standing research challenges arising from the rapid adoption of AI methods. We review the erosion of trust in AI outputs driven by poor reusability and reproducibility, and highlight their impact on environmental sustainability. Furthermore, we discuss the fragmented components of the AI ecosystem and lack of guiding pathways to support open and sustainable AI model development. In response, this Perspective introduces practical open and sustainable AI recommendations mapped to over 300 ecosystem components and provides guiding implementation pathways. Our work connects researchers with relevant AI resources, facilitating the implementation of sustainable, reusable and reproducible AI. Built upon community consensus and aligned to existing efforts, these outputs will aid future policy development and structured pathways for guiding AI implementation.

Artificial Intelligence↗
PubMed2006

Studying social policy and resilience to adversity in different welfare states: Britain and Sweden.

Is poverty more damaging to health in Britain than in Sweden, and if so, why? Following previous research by the authors that suggested such an effect, a new comparative study is examining whether there are aspects of the social and policy context in Britain that add to and reinforce the health-damaging experience of being poor. Conversely, are there other aspects of living in Sweden that are supportive for people in poverty, which make the experience of poverty less stressful and health-damaging? Stemming from this ongoing study, the aim of this article is to present a framework for understanding the context in which social welfare policies are formed and operate in Britain and Sweden. It then uses the framework to consider the "upstream" influences of ideology, culture, and values on policy development in the two countries and what these developments might mean for the health and well-being of people facing financial adversity in the two societies.

Employment↗