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PubMed2001

Use of innovative technologies in the evaluation of Nashville's REACH 2010 community action plan: reducing disparities in cardiovascular disease and diabetes in the African American community.

Ethnic minorities in the United States suffer disproportionately from chronic diseases such as cancer, heart disease, AIDS, and diabetes. A nationally-funded initiative known as Racial and Ethnic Approaches to Community Health (REACH) has designated 26 communities to implement demonstration projects to reduce health disparities in targeted minority populations. This article presents two methods of integrating innovative technologies into the program's evaluation plan: (1) a Web-based data entry system for recording project activity and (2) geographic information systems (GISs) for developing visual maps of project targets. These technologies can assist other programs in managing and measuring community-based public health initiatives.

Black or African American↗
PubMed2001

[How does a lawyer evaluate the introduction of a new treatment method (the so-called learning curve)].

In the interest of our patients and advancement in medicine and with the guarantee by law of the freedom to select methods of treatment, we may and must try out new strategies even in the face of initially unknown risks, side effects, and consequences. Every innovation assumes, however, that the advantages and disadvantages, potential complications, and burden to the patient have been weighed against those of conventional methods. The risks that a pioneer takes must be justified and presented comprehensively and clearly to the patient. Otherwise the threat is posed of civil and criminal accusations of negligence in responsibility or in the obligation to fully inform patients. Patient protection and safety must always be the first priority.

Diffusion of Innovation↗
PubMed1996

Mini-coronary artery bypass grafting.

Perioperative nursing has been impacted by a multitude of changes as medical technology continues its rapid advance. What may prove to be a major innovation in coronary artery bypass surgery is currently being performed in the United States, Europe and South America. Mini-coronary artery bypass grafting (CABG) is a minimally invasive procedure in which the surgery is performed through small incisions made in the chest wall, eliminating the need to "crack" the chest. This method reduces the pain and trauma to the patient and shortens the time required for hospitalization and recovery.

Coronary Artery Bypass↗
PubMedDate not supplied

The critical response nurse role: an innovative solution for providing skilled trauma nurses.

Critically injured patients benefit from the care of experienced, knowledgeable nurses. The state of Oregon addressed this need by requiring nurses to be a component of the trauma resuscitation team in trauma centers throughout the state. A description of how one level I trauma center created a unique position that would ensure that properly trained nurses were available for trauma patients is presented. The process of developing the position and the progress that the nurses have made is discussed.

Clinical Competence↗
PubMed1999

German military medicine: missions and innovations.

The German military medical service's foremost task in peacetime is to train and prepare medical personnel for their tasks in wartime. To this end, six medical subservices have been formed. They provide inpatient and outpatient care for the assigned military formations. Medical support for the reaction forces follows the principles of "operational medicine," which is provided in three qualitatively coordinated medical support levels. These support levels from the "lifesaving chain" for Bundeswehr soldiers deployed abroad, who are entitled to receive medical care that corresponds to the medical standard in Germany.

Diffusion of Innovation↗
PubMed2002

An international virtual medical school (IVIMEDS): the future for medical education?

The introduction of new learning technologies, the exponential growth of Internet usage and the advent of the World Wide Web have the potential of changing the face of higher education. There are also demands in medical education for greater globalization, for the development of a common core curriculum, for improving access to training, for more flexible and student-centred training programmes including programmes with multi-professional elements and for maintaining quality while increasing student numbers and working within financial constraints. An international virtual medical school (IVIMEDS) with a high-quality education programme embodying a hybrid model of a blended curriculum of innovative e-learning approaches and the best of traditional face-to-face teaching is one response to these challenges. Fifty leading international medical schools and institutions are participating in a feasibility study. This is exploring: innovative thinking and approaches to the new learning technologies including e-learning and virtual reality; new approaches to curriculum planning and mapping and advanced instructional design based on the use of 'reusable learning objects'; an international perspective on medical education which takes into account the trend to globalization; a flexible curriculum which meets the needs of different students and has the potential of increasing access to medicine.

Canada↗
PubMedDate not supplied

Staff nurse perceptions of the work environment: a comparison among ethnic backgrounds.

This study examined the relationship among ethnicity and perceptions of the work environment among staff nurses in a large urban hospital in Northern California. Moos' Work Environment Scale, System Maintenance and Change Dimensions, was used to investigate staff nurse perception of the work environment related to role clarity, managerial control, and innovation. Findings of this study suggest statistically significant differences in the way Caucasian and non-Caucasian nurses viewed the extent to which management used rules and pressures. The perception of control in the work environment is an important factor in retention and in maintaining a quality workplace.

Adult↗
PubMed1998

Impact of IT on health care professionals: changes in work and the productivity paradox.

Health care organizations are under increasing pressure to become more efficient while at the same time maintaining or improving the quality of care. Information technology (IT), with its potential to increase efficiency, accuracy and accessibility of information, has been expected to play an important role in supporting these changes. We report the impact of patient care information systems on health care professionals in five community hospitals. The study framework incorporated both quality of care in Donabedian's elements of structure-process-outcome and Grusec's three levels of IT impact: direct substitution, proceduralization and new capabilities. The study results suggest that, for specific tasks, IT increased efficiency and productivity--a single employee was able to complete more tasks. However, this produced other consequences not predicted. Participants noted this change did not 'free up time' to spend with patients, but meant there were potentially more opportunities to provide services and more tasks to complete. Other effects included: reduced job satisfaction as more time was spent on the computer; less frequent interactions with patients and for shorter duration; and an increasingly 'visible' accountability as performance was easily monitored. There were also changes in roles and responsibilities as the computer enabled tasks to be carried out from a number of locations and by a variety of personnel. When innovations are introduced into organizations there are both expected and unexpected consequences. Increased awareness of the interactive relationship between computer users and the technology helps organizations better understand why results do, or do not, occur. One must look beyond just simply increasing productivity by replacing manual tasks with automated ones, to examining how the changes influence the nature of work and relationships within the organization.

Attitude of Health Personnel↗
PubMed2005

Price sensitivity and innovativeness for fashion among Korean consumers.

Price sensitivity is how consumers react to price levels and to price changes. Consumer innovativeness is a tendency to welcome and to adopt new products. Researchers (e.g., R. E. Goldsmith & S. J. Newell, 1997) consider innovative consumers relatively more price insensitive than other consumers, so there should be a negative correlation between measures of these constructs. The results of the present study supported the psychometric soundness of a self-report measure of price sensitivity among 860 Korean consumers and replicated earlier findings of the negative correlation between the 2 constructs.

Adult↗
PubMed2001

[Conditions and success factors of telemedicine innovation].

Telemedicine and health telematics can play a significant role in improving the efficiency of health care systems. Currently, however, the potential of telemedical applications is far from being fully utilized. In the present study, an attempt has been made to identify factors that may aid the further dissemination and general acceptance of telemedical innovations. The results obtained suggest that apart from the factors under the sole control of legislation, and insurance providers, those that can be directly influenced by developers, manufacturers and providers of telemedical applications play an important role. Of particular importance for the successful and lasting use of such applications is the creation of promising business models, aspects of which are considered in the last part of the article.

Diffusion of Innovation↗
PubMed2001

New screening procedure signals risk of CVD at earlier stage.

Begin preventive treatment for CVD before it has a chance to do damage. How? With an innovative screening tool that can non-invasively gauge the elasticity of the small and large arteries--an accepted early marker for CVD. On the market since it was approved by the FDA earlier this year, physicians and managed care organizations have already begun to use the new tool, and hopes are high that it can revolutionize the way patients are screened for this deadly and costly disease.

Adolescent↗
PubMed1989

How study design affects outcomes in comparisons of therapy. II: Surgical.

We analysed the results of 221 comparisons of an innovation with a standard treatment in surgery published in six leading surgery journals in 1983 to relate features of study design to the magnitude of gain. For each comparison we measured the gain attributed to the innovation over the standard therapy by the Mann-Whitney statistic and the difference in proportion of treatment successes. For primary treatments (aimed at curing or ameliorating a patient's principal disease), an average gain of 0.56 was produced by 20 randomized controlled trials. This was less than the 0.62 average for four non-randomized controlled trials, 0.63 for 19 externally controlled trials, and 0.57 for 73 record reviews (0.50 represents a toss-up between innovation and standard). For secondary therapies (used to prevent or treat complications of therapy), the average gain was 0.53 for 61 randomized controlled trials, 0.58 for eleven non-randomized controlled trials, 0.54 for eight externally controlled trials, and 0.55 for 18 record reviews. Readers of studies evaluating new treatments, particularly for primary treatments, may consider adjustment of the gain according to the study type.

Clinical Trials as Topic↗
PubMed2001

[The fundamentals of precaution].

The precautionary principle appeared in the health vocabulary, especially in blood transfusion, at the beginning of the 1990s. It is applied to potential risks in case of scientific doubt and corresponds to an hypothesis of risk that must be completely distinguished from the case of an exceptional residual risk. This principle lies on two innovations: the breach of the link between scientific knowledge and decision, and the creation of a context for a new normative value. Because of their consequences, these innovations should generate a debate between professionals about the caution principle's foundations, its conditions of application, and its judicial drawbacks. This article, mainly dealing with the foundations of caution, will also present the social construction of the precaution, its judicial aspects, as well as the change in the relationship to risks induced by it.

Australia↗
PubMed2000

The paradox of physicians and administrators in health care organizations.

Rapidly changing times in health care challenge both physicians and health care administrators to manage the paradox of providing orderly, high quality, and efficient care while bringing forth innovations to address present unmet problems and surprises that emerge. Health care has grown throughout the past several centuries through differentiation and integration, becoming a highly complex biological system with the hospital as the central attractive force--or "strange attractor"--during this century. The theoretical model of complex adaptive systems promises more effective strategic direction in addressing these chaotic times where the new strange attractor moves beyond the hospital.

Clinical Medicine↗
PubMed2005

Innovation: Rescuing drug discovery: in vivo systems pathology and systems pharmacology.

The pharmaceutical industry is currently beleaguered by close scrutiny from the financial community, regulators and the general public. Productivity, in terms of new drug approvals, has generally been falling for almost a decade and the safety of a number of highly successful drugs has recently been brought into question. Here, we discuss whether taking an in vivo systems approach to drug discovery and development could be the paradigm shift that rescues the industry.

Animals↗
PubMed1995

Innovation and behavior change. Applied anthropology strategies for international health and cross-cultural medicine.

Most international health programs depend on individual behavior change. Cleverly catalyzing such change in populations requires knowledge of preprogram health behaviors and the web of culture in which they are suspended. This article reviews general medical anthropology perspectives and cases from the field. The current methods for defining baseline health knowledge, attitudes, and practices are reviewed to facilitate the development of benchmarks against which successful programmatic change can be measured.

Anthropology, Cultural↗
PubMed1996

Innovation where it counts: in the home.

Managed care and consumer preference have once again focused attention on care delivered in the home. The development of clinical technology has enabled the home care market to accept complex, "high-tech" patients. For advanced practice nurses (APNs) to have an integral part in shaping the emerging high-tech home care industry, they must have an understanding of the technology and its clinical and financial implications. APNs must define their roles in response to the needs created by the evolving home care market.

Case Management↗
PubMedDate not supplied

Sustainability: the elusive dimension of international health projects.

OBJECTIVE: The Canada-China Yunnan Maternal and Child Health Project (1997-2003) sought to improve the quality of village life and promote development of productivity and social prosperity in Yunnan province, China. PARTICIPANTS: The project targeted grassroots maternal and child health workers: new and in-service village doctors; traditional village midwives; doctors at township health centres; doctors at county maternal and child health hospitals; and provincial health staff. SETTING: Ten impoverished counties (population 2.2 million) in Yunnan province with high proportions of ethnic minority populations. INTERVENTION: There were three major innovations: training grassroots maternal and child health workers in participatory and community-based approaches and clinical skills; designing a model comprehensive referral system including provision of basic equipment; and introducing participatory monitoring and evaluation methods. Strategies to support sustainability were built into the project from the outset. OUTCOMES: Over 4,000 village, township, and county health workers received training. Maternal, infant, and under-five mortality rates declined over 30% in project counties. Project innovations were disseminated throughout the province, into other donor-funded initiatives, and integrated into national health projects by local partners. CONCLUSION: Maintaining the long-term benefits of international health interventions depends on sustaining innovations beyond short project timelines. Achieving sustainability poses a conundrum to implementing agencies. Three mechanisms influenced uptake in the Yunnan project: maintaining a good fit between core project elements and the existing health system; developing adequate organizational supports; and creating a handover plan from the outset. This project highlights some of the ways in which sustainability can be operationalized.

Adult↗