Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Informal Sector”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 991 records · Page 55Linked to original sources
PubMed1995

Re-engineering care delivery to improve the health outcome of asthmatics in Campbelltown, New South Wales.

The pilot study for this project was established in February 1993 under a Health Communications Network initiative to improve the treatment results for asthmatics in Campbelltown, New South Wales. A user specific, standardized information environment was implemented across the community and hospital sectors linking General Practitioners, Specialist Consultants, and hospital doctors and nurses. The pilot included 20 General Practitioners, four pediatricians and respiratory physicians, and the nurses and doctors of a district hospital. ¿A multi-disciplinary team implemented the pilot, consisting of men and women from Campbelltown Health Service, Ernst & Young Health Services Consulting, and a major systems vendor. The team used process modeling tools to document the required changes to the roles and responsibilities of the individual practitioners and the impact of these changes on the cost of providing services and patient flow. Significant cost savings were anticipated from moving care out of the hospital and into the community. In the re-engineered environment, the General Practitioner became the case manager, responsible for guiding and coordinating the management of the patient's asthma, in consultation with the appropriate specialist consultants. The hospital continued to provide acute/emergency care. The level of sophistication of the information systems solutions was determined by the level of technical awareness of the users. Fax based communications were chosen to support the flow of timely and relevant information between the practitioners. A VAX based system was used as a data repository for the information collected by hospital staff and General Practitioners. The data repository acted as a clinical record for asthmatics who participated in the pilot. The clinical history of an asthmatic could then be viewed when a patient sought treatment from Campbelltown's Emergency Department during periods when the General Practitioner was not available. If a patient did seek emergency treatment, a record of the patient's visit was faxed immediately to the General Practitioner upon discharge from the hospital. Specialist consultants are independent practitioners in Australia. They were provided with a custom built application for their own personal computers. A key feature of this application was the automatic generation of letters to the General Practitioner to assist them in the management of asthmatics. The Specialist Consultants also identified a sub-group of high risk patients for whom additional clinical information was stored in the data repository at Campbelltown Hospital. Analysis of the patient information formed a core component of the project. Clinical outcomes for individual patients were forwarded to the General Practitioners regularly to assist them in their case management duties. System implementation in this re-engineered environment yielded the following: Strategies for managing the responses of clinicians and patients to the use of technology and a standardized information sharing environment. A means of assessing the system's impact on both the clinician-patient relationship and the professionals' relationship with other clinicians; The evolution of clinical use of information regarding individual patient's health outcome for the management of asthma; The integration of the information systems with policy and planning cycles for the Area Health Service; and The establishment of effective links with vendors of health service applications.

Asthma↗
PubMed1993

Public information: a major tool in cancer prevention.

The methodology for an information campaign is discussed, detailing follow up in five stages: (1) assessment of needs: a good knowledge of behaviour patterns and the kind of information needed is the basic element to create the concept of a campaign. A pre-survey is an indispensable tool to secure this information; (2) basic scientific information: communication to the public has to be based on precise and recent scientific data; (3) comprehension of the information: communicating with the general public should be through texts that are clear and accessible to the greater part of the population; (4) production of supporting documents: each element of the campaign has to produce an impact on the person receiving the message; and (5) evaluating the impact of an information campaign. An evaluation can check whether objectives have been reached, and also correct errors and help prepare the next campaign even more professionally. These five stages are essential to set up a successful information campaign. We also give examples from our magazines Cancer-info and Smoke Buster-info. Through information public opinion can be mobilized to influence political decisions in the public health sector. One evidence for the importance of collective influence on political decision makers is our campaign to promote the total ban on tobacco advertising. As large-scale information campaigns need important financial resources it is essential to balance the cost to generate sufficient funds to finance further projects in the health sector; we discuss this matter as well as the impact on the image of the association.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

Using key performance indicators as knowledge-management tools at a regional health-care authority level.

The advantages of the introduction of information and communication technologies in the complex health-care sector are already well-known and well-stated in the past. It is, nevertheless, paradoxical that although the medical community has embraced with satisfaction most of the technological discoveries allowing the improvement in patient care, this has not happened when talking about health-care informatics. Taking the above issue of concern, our work proposes an information model for knowledge management (KM) based upon the use of key performance indicators (KPIs) in health-care systems. Based upon the use of the balanced scorecard (BSC) framework (Kaplan/Norton) and quality assurance techniques in health care (Donabedian), this paper is proposing a patient journey centered approach that drives information flow at all levels of the day-to-day process of delivering effective and managed care, toward information assessment and knowledge discovery. In order to persuade health-care decision-makers to assess the added value of KM tools, those should be used to propose new performance measurement and performance management techniques at all levels of a health-care system. The proposed KPIs are forming a complete set of metrics that enable the performance management of a regional health-care system. In addition, the performance framework established is technically applied by the use of state-of-the-art KM tools such as data warehouses and business intelligence information systems. In that sense, the proposed infrastructure is, technologically speaking, an important KM tool that enables knowledge sharing amongst various health-care stakeholders and between different health-care groups. The use of BSC is an enabling framework toward a KM strategy in health care.

Greece↗
PubMed1996

Legal issues in medical informatics: a bird's eye view.

The present paper is the result of a study investigating the legal issues, problems and obstacles which have arisen as a result of the R&D projects financed by the AIM Program 1991-94. Two parallel lines of investigation were adopted in this study. First of all, a questionnaire was sent to all project partners listed in the AIM 93 Report, with the objective of collecting information on the legal questions with which the individual projects were confronted in the course of their R&D work. This allowed for an initial mapping out of the legal aspects relevant in the field of medical informatics. Secondly, the actual projects were studied as to their legal content and in particular those which included a legal workpackage. This allowed for an assessment of further legal questions, some of which had as yet perhaps not been perceived as such. The present paper deals with five key aspects, describing the nature of the issues and the relevant law and case law or legal vacuum as it may be. It must be emphasised that, as pointed out in the title, this study offers an overview of the legal issues debate in medical informatics and is somewhat exploratory in nature. It is not intended to offer a critical analysis of existing picces of legislation or case law. This would call for more fundamental legal research. Instead the study restricts itself to a general description of existing legal principles and their relevance in the health care sector. As the reader will gather from this paper, legally speaking information technology is still a relatively new entity in the health care sector, which means that legal research and any resulting recommendations may have a real impact on the future course of the law in this field.

Computer Security↗
PubMed2000

Integration of target and body-part information in the premotor cortex when planning action.

To plan an action, we must first select an object to act on and the body part (or parts) to use to accomplish our intention. To plan the motor task of reaching, we specify both the target to reach for and the arm to use. In the process of planning and preparing a motor task, information about the motor target and the arm to use must be integrated before a motor program can be formulated to generate the appropriate limb movement. One of the structures in the brain that is probably involved in integrating these two sets of information is the premotor area in the cerebral cortex of primates. The lateral sector of the dorsal premotor cortex is known to receive both visual and somatosensory input, and we show here that neurons in this area gather information about both the target and the body part, while subsequent activity specifies the planned action.

Action Potentials↗
PubMed2002

Strategies to improve consumer health information services.

Consumer health information is important in two respects. It helps individuals improve their own health and creates pressure on the healthcare system to produce higher quality care. Initiatives to strengthen consumer health information services are underway in many public and private-sector organizations nationwide. This paper describes some trends in the field and opportunities to spur further progress nationally and at the community level over the next few years.

Consumer Advocacy↗
PubMed2003

[The underpaid nursing profession: myth or reality].

The originality of this research lies in its object, nurses salaries, a subject that is often discussed amongst professionals, yet rarely broached in writing. The concepts of salaries and salaried workers are examined, then, through literature, a list of salary data from 1845 to 1945 is made. The study of nursing personnel salaries from 1945 to 2001 begins with a reconstruction of salary charts, continuing with an internal analysis of the private and semi-public sector, then alternatively with the teachers. This work provides objective information on the aspect of this profession's salaries and uncovers numerous questions on the origins of wage increases.

Career Mobility↗
PubMed2000

Proprioceptive population coding of two-dimensional limb movements in humans: I. Muscle spindle feedback during spatially oriented movements.

The proprioceptive coding of multidirectional ankle joint movements was investigated, focusing in particular on the question as to how accurately the direction of a movement is encoded when all the proprioceptive information from all the muscles involved in the actual movement is taken into account. During ankle movements imposed on human subjects, the activity of 30 muscle spindle afferents originating in the extensor digitorum longus, tibialis anterior, extensor hallucis longus and peroneus lateralis muscles was recorded from the lateral peroneal nerve using the microneurographic technique. In the first part of the study, it was proposed to investigate whether muscle spindle afferents have a preferred direction, as previously found to occur in the case of cortical cells, and to analyze the neural coding of the movement trajectories using a "population vector model." This model is based on the idea that neuronal coding can be analyzed in terms of a series of vectors, each based on specific movement parameters. In the present case, each vector gives the mean contribution of a population of muscle spindle afferents within one directionally tuned muscle. A given population vector points in the "preferred sensory direction" of the muscle to which it corresponds, and its length is the mean frequency of all the afferents within that muscle. Our working hypothesis was that the sum of these weighted vectors points in the same direction as the ongoing movement. The results show that each muscle spindle afferent, and likewise each muscle, has a specific preferred sensory direction, as well as a preferred sensory sector within which it is capable of sending sensory information to the central nervous system. Interestingly, the results also demonstrate that the preferred directions are the same as the directions of vibration-induced illusions. In addition, the results show that the neuronal population vector model describes the multipopulation proprioceptive coding of spatially oriented 2D limb movements, even at the peripheral sensory level, based on the sum vectors calculated from all the muscles involved in the movement. In an accompanying paper, the coding of more complex 2D movements such as those involved in drawing rectilinear and curvilinear geometrical shapes was investigated.

Adult↗
PubMed2004

Use of outcomes information in acute inpatient rehabilitation.

OBJECTIVE: To describe the ways in which rehabilitation outcomes information is used in the acute inpatient rehabilitation industry and the industry's views on the topic of public disclosure of rehabilitation outcomes information. DESIGN: A mixed-methods approach, featuring data from 39 informational telephone interviews with rehabilitation industry stakeholders followed by a survey of 95 randomly sampled acute inpatient rehabilitation provider organizations. RESULTS: Both the informational interviews and survey findings revealed that there is currently little stakeholder demand for functional outcomes information. Outcomes information is primarily used within provider organizations to track the effectiveness of rehabilitation services. There is general consensus among rehabilitation provider organizations in favor of public disclosure of outcomes information. CONCLUSIONS: Outcomes information is not routinely shared with rehabilitation stakeholders (i.e., payers and consumers). Rehabilitation providers and industry stakeholders generally express favorable attitudes toward public disclosure of outcomes information. Stakeholders' perceptions of current barriers and facilitators of outcomes information provide insight into the steps that can be taken toward greater transparency in the rehabilitation industry.

Activities of Daily Living↗
PubMed2003

Working with the private sector for child health.

Private sector providers are the most commonly consulted source of care for child illnesses in many countries, offering significant opportunities to expand the reach of essential child health services and products. Yet collaboration with private providers presents major challenges - the suitability and quality of the services they provide is often questionable and governments' capacity to regulate them is limited. This article assesses the actual and potential contributions of the private sector to child health, and classifies and evaluates public sector strategies to promote and rationalize the contributions of private sector actors. Governments and international organizations can use a variety of strategies to collaborate with and influence private sector actors to improve child health - including contracting, regulating, financing and social marketing, training, coordinating and informing the public. These mutually reinforcing strategies can both improve the quality of services currently delivered in the private sector, and expand and rationalize the coverage of these services. One lesson from this review is that the private sector is very heterogeneous. At the country level, feasible strategies depend on the potential of the different components of the private sector and the capacity of governments and their partners for collaboration. To date, experience with private sector strategies offers considerable promise for children's health, but also raises many questions about the feasibility and impact of these strategies. Where possible, future interventions should be designed as experiments, with careful assessment of the intervention design and the environment in which they are implemented.

Child Health Services↗
PubMed2004

Does IT "cut the mustard" in primary care?

BACKGROUND: General practice faces something of a computer revolution with the appointment of new regional suppliers and the prospect of new and as yet untried systems being imposed upon it in the next few years. OBJECTIVE: To investigate the current use, acceptance of, and the real potential of information technology in the 23 general practices in one primary care trust. METHOD: Personal interview with the manager of computing in each practice. RESULTS: Apart from their perceived advantages in the clarity of records and help with prescribing, the use of computers has tended to follow demand from above for the provision of data. Very few practices have a strong attraction to the use of computers as a flexible tool and the ancillary staff that manage the systems are overworked, unsupported in most cases, and generally not well served by their system suppliers. Innovation tends to be tolerated rather than welcomed since the advantages to patients and daily users are seldom promoted. CONCLUSION: Despite the piecemeal way that computing was introduced into primary care it has achieved great success in the absence of significant external support and shows no sign, overall, of being helped by the new information technology (IT) strategy in the NHS as it applies to that sector.

Attitude of Health Personnel↗
PubMed1998

The health care reform in Italy: transition or turmoil.

Health care reform in Italy is transforming its centrally planned, vertically integrated National Health Service into a market-oriented system in which public funders contract directly with individual providers. A model is envisaged in which a plurality of public and private care providers compete for contracts with capitated health agencies responsible for assuring uniform levels of services for geographically defined populations. The ultimate goal of the reform is to guarantee universal coverage and secure global spending limits while, at the same time, promoting efficiency in the delivery of care and enhancing responsiveness to consumers. The emphasis upon incentives for the individual provider which will be introduced should, however, be considered against the quest for equity in health care which was the central tenet of the 1978 reform and is yet to be attained. The fragmentation of the National Health Service into many separate, competing delivery units might well damage the ability to plan strategically for addressing the substantial inequities in health status, health care utilization, and health service availability which still exist across the country. Competition between a plurality of providers and fee-for-service payment schemes add additional concerns about unnecessary care and supplier-induced demand. It creates the need for developing rules to make competition manageable and providing sound clinical and financial information that make enforcement possible. The poor record scored in managing the contractual relationships between the LHUs and the strong private health sector suggests that massive investment in promoting managerial skills and developing appropriate clinical and financial information systems are required. Careful experimentation in implementing the reform and continuous monitoring of its impact on the health care system are, therefore, the imperatives of the next two years.

Capitation Fee↗
PubMed1995

Implementation of a clinical workstation for general practice.

It is now well recognized that achieving international best practice in the primary health sector will require the development of methods based on a fundamental integration of communications and information technologies with clinical practice. This will have far reaching effects, both on the pattern of medical practice and domiciliary care and on patient outcomes. In the past, information and communications technology has been presented as a tool for management, rather than as a tool for supporting, improving, and making more efficient the professional practice of medicine and the delivery of health care to the patient and the community. In this paper, we propose that an essential element for the achievement of international best practice in the health sector is the development and widespread use of information, measurement, and communications technology targeted towards the clinical practice of medicine, the provision of health services and domiciliary care in the community, and the analysis of morbidity patterns and health care outcomes. A key element of this strategy is the development of an integrated Clinical Workstation specifically designed for the general practitioner, practice nurses, and domiciliary care nurses in their professional tasks of measurement, diagnosis, management, and delivery of health care to the community. We will present our work on the design of an integrated Clinical Workstation for Primary Health Care. The Workstation is Windows based, has a sophisticated user interface, and supports a wide range of computing platforms, from desktop to laptop to hand-held notebook computers. The Workstation will be modular and expandable, both in its software and hardware components, so that users may select only those modules appropriate to their own roles, clinical practice, and levels of expertise. The design will focus on the provision of clinical services and will integrate the following key components: Patient records and basic practice management; Clinical records. Based on ICD10, ICPC, or Read Code classifications; Clinical measurements. Blood pressure, spirometry, ECG, and basic hematology and biochemistry; Clinical decision support. Based on epidemiologic data, protocols, and medical expert systems; Domiciliary care and evaluation of the functional health status of the elderly; Communications and networks. Wireless LAN, modem, and fax; Clinical reporting. Morbidity profiles prescribing profiles, and laboratory services and procedures. Implementation of these requirements will ultimately take the form of an untethered, portable notepad computer supporting a communications link via modem, LAN, or wireless LAN, and removable instrumentation and clinical measurement modules.

Computer Systems↗
PubMedDate not supplied

[Calmette Hospital, Phnom Penh, Cambodia. Assessment of the implementation of the Medical Information System (SIM). Global analysis of the 1998 results].

Calmette is a national university hospital with 220 adult beds. It has emergency, surgical, medical and gynecology and obstetrics departments, along with a radiology unit, a laboratory for medical analyses, a central pharmacy and an outpatient clinic. This hospital has an unusual statute, with managerial autonomy and a system of cost recovery that currently provides 64% of the hospital's income. Since 1994, it has benefited from a French cooperation program. The French NGO, Médecins du Monde, has been present at Calmette since 1990, providing support for < >, the indigent sector of the medical department. The aim of the Medical Information System (SIM) is to develop a simple, reliable and reproducible system so that, for every action undertaken at the hospital (hospitalization, day hospital and outpatient clinic) the following pieces of information are recorded: 1) the disease; 2) the type of patient; 3) the type of management; 4) the means used to treat the patient; 5) the cost. Data are collected and analyzed using programs created with EPIINFO software (CDC, WHO), using the EPIGLUE module. In 1998, 10,814 admissions were recorded at Calmette Hospital, 7,811 (72.2%) of which were to the Emergency Department and 3,003 (27.2%) of which were direct admissions to other wards. We analyzed 10,603 (95%) computerized medical summaries (RMI). About 50% of beds were occupied in the maternity and gynecology ward whereas almost 90% of beds were occupied in the surgical and emergency wards. AIDS and tuberculosis were the conditions most frequently treated by the medical department, despite a marked increase in more specialized areas of medicine such as cardiology and diabetology. The surgical department reflected the concentration on emergency services of the hospital, with cranial traumatism the primary reason for admission for the hospital as a whole. The mean age of patients was 27 years for the maternity ward and 49 years for the medicine A ward. The mortality rate was about 5% for the medical wards (mainly due to AIDS) and almost 50% in the emergency department (cerebrovascular neurologic disease, cranial traumatism). The proportion of nonpaying patients was high (about 40% in terms of stays in hospital and about 50% of all days spent in hospital). The training of a Cambodian manager for the SIM is a key priority. The point of the SIM is to use the treated data it produces to improve management and decision-making. The data it produces should be used to define the profile of the patients treated, both from a medical point of view and in terms of their ability to pay. This is a fundamental step towards identifying activities that should receive priority as part of a development strategy for a structure evolving in a highly competitive environment. The SIM data are also invaluable for the short-term management of the hospital through the contribution they make to the development of effective analytical accounting, making it possible to evaluate costs and to adjust charges appropriately. Finally, the involvement of the SIM in the setting up and functioning of the Comité de Lutte Contre les Infections Nosocomiales (CLIN; the Hospital-Acquired Infections Committee) in 1999 to 2000 is not utopia, it is the logical continuation of improvements in the overall quality of care It involves, in particular, the training of nurses and head nurses, initiated by nurses acting as technical assistants in the French cooperation program. The definition of the role of the hygiene nurse and the selection of such a nurse from the trained head nurses are also part of this process.

Adult↗
PubMed2004

A management information system to plan and monitor the delivery of health-care services in government hospitals in India.

Governments all over the world are getting increasingly concerned about their ability to meet their social obligations in the health sector. In this paper, we discuss the design and development of a management information system (MIS) to plan and monitor the delivery of healthcare services in government hospitals in India. Our MIS design is based on an understanding of the working of several municipal, district, and state government hospitals. In order to understand the magnitude and complexity of various issues faced by the government hospitals, we analyze the working of three large tertiary care hospitals administered by the Ahmedabad Municipal Corporation. The hospital managers are very concerned about the lack of hospital infrastructure and resources to provide a satisfactory level of service. Equally concerned are the government administrators who have limited financial resources to offer healthcare services at subsidized rates. A comprehensive hospital MIS is thus necessary to plan and monitor the delivery of hospital services efficiently and effectively.

Decision Support Systems, Management↗
PubMed2000

The changing face of the leader.

Leadership theory has identified leadership as a process or skill of transformation of organizations and society. Managerial theorists have seen leadership as a role within management, and have argued from a distinctly organizational perspective. During the last decade, mental health executives have gravitated from the leadership is policy emphasis to one of management accommodation to major changes in the health environment. The most noteworthy of these changes has been the dominance of private markets in health and the introduction throughout the mental health services sector of management techniques of managed care. Leadership is once again ascendant as a result of the failure of several of these initiatives, notably prior authorization of care, and a renewed public policy emphasis on needs of persons who are mentally ill. Major opportunities confronting the contemporary leader/manager include advocacy, diversity, and information management.

Health Care Sector↗
PubMed1998

The AIDS pandemic: changes in the believability and use of information sources.

Over 20,000 Americans under 25 years old are infected with HIV every year. In 1994, AIDS was the number one killer of adults between the ages of 25 and 44 years old. Education concerning HIV is critical to the prevention of AIDS. Both the public and private sectors, including government agencies, cause-related organizations, medical professionals, and promotion specialists must determine the best information sources to educate young people. However, with many television shows that appeal to young adults condoning casual sex, it is increasingly difficult to generate motivation to act responsibly. This paper examines the effectiveness of information sources, sponsored by both the government and private organizations, about HIV. Given the impact of media publicity regarding the AIDS virus and the "hard-hitting" messages and public service announcements about AIDS, implications about ethical issues, public policy issues, and media strategies to educate the public about AIDS are discussed. While publicity and specific types of television programming were found to be the most believable and most often used information sources for health issues, there are many strategic implications concerning promotion strategies, targeting, and positioning for both the public and private sectors.

Acquired Immunodeficiency Syndrome↗