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When setting up an ICP, invite participation from all relevant healthcare professionals in both primary and secondary care. Gather all research and best practice using national guidelines or best available evidence. Consult patients: they often have knowledge unavailable to medical professionals.
Employers are recognizing the impact of lost productivity on total benefit costs. In a recent report based on 2002 benefit data, lost productivity represented 71% of the full cost of health/absence benefits (Integrated Benefits Institute, 2004). Occupational health nurse managers can develop FMLA leave management policies and programs to assure that leave is provided when appropriate, to help curb FMLA abuse and fraud, and to assist employers in defending adverse employment actions based on attendance. A review of employer policies and FMLA implementation also assesses compliance with the Act and provides the basis for appropriate responses in the case of legal actions and employee complaints to the U.S. Department of Labor.
OBJECTIVES: Clinical decision-support systems (CDSSs) are being recognized as important tools for improving quality of care. In this paper, we review the literature to find trends in CDSSs that were developed over the last few decades and give some indication of future directions in developing successful, usable clinical decision-support systems. METHODS: We searched PubMed for papers that were published during the past five years with the words Decision Support Systems appearing in the title and used our own knowledge of the field for earlier work. RESULTS: The goals of developers of modern CDSSs are to develop systems that deliver needed information and could be integrated with the healthcare's organizational dynamics. Such CDSSs form part of knowledge-management activities that healthcare organizations employ in order to excel. During the past few decades, we have witnessed a gradual maturation of knowledge representation formalisms and the needed infrastructure for developing integrated CDSSs, including electronic health record systems (EHR), standard terminologies, and messaging standards for exchange of clinical data. The demand for CDSSs that are effective and that will evolve as circumstances change gave rise to methodologies that guide developers on the construction and evaluation of CDSSs. CONCLUSION: Although there exist many approaches for representing, managing and delivering clinical knowledge, the design and implementation of good and useful systems that will last and evolve are still active areas of research. The gradual maturation of EHR and infrastructure standards should make it possible for CDSSs implementers to make major contributions to the delivery of healthcare.
Monitoring and surveillance are seen as statistical procedures that will help health authorities to achieve better health services with the existing resources-monitoring being an integrated system of making observations on health and environmental factors and of scrutinizing, storing, and retrieving those data, and surveillance being a closely associated system for collating and interpreting the data.Monitoring should be an action oriented activity and may encompass a wide range of health activities, for example, communicable and noncommunicable diseases, environmental pollutants, and specific problems in health care delivery systems. Both monitoring and surveillance systems have to be related to control measures, and, since the available resources are usually limited, a scale of priorities has to be developed by the statistician in cooperation with the competent authorities.MONITORING MAY BE PERFORMED ON EITHER THE INDIVIDUAL OR AGGREGATE LEVEL AND SHOULD BE PLANNED TO TAKE INTO ACCOUNT THE COURSE OF THE DISEASE UNDER CONSIDERATION: it is concerned with monitoring stimuli and events. Collection of data, for example, on exposure to a pollutant, may be continuous and automatically recorded, or regular or irregular through population sampling or registries. The statistical requirements of monitoring and surveillance systems are discussed and a checklist of features to be considered is given in an annex.
With the continued widespread abuse of marihuana and the potential use of marihuana as a therapeutic agent being widely discussed, it becomes important to assess the effects of marihuana and other cannabis preparations on the immune mechanisms and the genetic material. This chapter integrates recent findings with those in the Fifth Marihuana and Health Report (1975) to provide a wiser data base from which conclusions may be drawn. Animal studies and human studies are considered separately because it is not known to what extent, if at all, results from animal studies can be directly extrapolated to man.
The specification for a Chip Card-Based Medical Information System (CCMIS) for the treatment of patients with chronic diseases was developed to improve the communication in Health Care. Diabetes, which is a 'typical' chronic disease was chosen as an example. Patients with chronic diseases are treated at all levels of health care and in various health care sectors. Having a Portable Personal Medical Record (PPMR) on a chip card means that the necessary information of the patient is available at any time. Such a communication tool will thus have an important impact on the quality of health care and also contribute to cost reduction of European health budgets. As the main issues of the CCMIS the data security, data protection and privacy have been integrated. The system architecture allows an implementation into different networking environments and is covered by approved standards. A demonstrator has been developed to show medical applications and the security aspects.
Hospital mergers, like Godzilla's comeback movie, promise that bulk means marketplace brawn. Yet as the dust settles, the payoff isn't always so clear. Promised efficiencies from merging duplicated programs--even shutting down entire hospitals--often fail to materialize. In fact, cutting the deal may turn out to be the easy part.
Sustainable schistosomiasis control cannot be based on large-scale vertical treatment strategies in most endemic countries, yet little is known about the costs and effectiveness of more affordable options. This paper presents calculations of the cost-effectiveness of two forms of chemotherapy targeted at school-children and compares them with chemotherapy integrated into the routine activities of the primary health care system. The focus is on Schistosoma haematobium. Economic and epidemiological data are taken from the Kilombero District of Tanzania. The paper also develops a framework for possible use by programme managers to evaluate similar options in different epidemiological settings. The results suggest that all three options are more affordable and sustainable than the vertical strategies for which cost data are available in the literature. Passive testing and treatment through primary health facilities proved the most effective and cost-effective option given the screening and compliance rates observed in the Kilombero District.
Communication and co-operation in healthcare and welfare require a well-defined set of security services based on a standards-based interoperable security infrastructure and provided by a Trusted Third Party. Generally, the services describe status and relation of communicating principals, corresponding keys and attributes, and the access rights to both applications and data. Legal, social, behavioral and ethical requirements demand securely stored patient information and well-established access tools and tokens. Electronic signatures as means for securing integrity of messages and files, certified time stamps and time signatures are important for accessing and storing data in Electronic Health Record Systems. The key for all these services is a secure and reliable procedure for authentication (identification and verification). While mentioning technical problems (e.g. lifetime of the storage devices, migration of retrieval and presentation software), this paper aims at identifying harmonization and interoperability requirements of securing data items, files, messages, sets of archived items or documents, and life-long Electronic Health Records based on a secure certificate-based identification. It's commonly known that just relying on existing and emerging security standards does not necessarily guarantee interoperability of different security infrastructure approaches. So certificate separation can be a key to modern interoperable security infrastructure services.
For patients with mental health problems, de-institutionalization has meant a shift from institutional care to living in the community. However, several studies show that problems of stigmatization, loneliness and negative attitudes devalue the dignity and autonomy of these patients. The aim of this study was to gain a deeper understanding of how people with mental health problems experience living in an apartment of their own. The data collection method was focus group interviews. The constant comparative method revealed the main category 'preserving integrity'. The subcategories were: the need for control over information, similar relationships with both friends and neighbours (symmetrical contact), and 'My home is my castle'. Participants who lived in a group home had little or no contact with their neighbours. The participants experienced lack of acceptance and loss of autonomy when meeting people. Integrity was a necessary condition in order for them to become equal citizens, experience autonomy and dignity, and have the opportunity to develop social contacts.
The present work aimed at studying risk factor that affect people with back pain, identifying them and implementing an intervention proposal of a health education program based on self-care teaching, existential humanist philosophical projects and stress equalization approach line, skeletal-muscle reintegration activities, basic techniques on stress equalization and massage. It has been developed for a population of 42 (forty-two) clients. Two instruments which integrate nursing consultation protocol have been used in data collection. The results showed the existence of associated risk factors which are changeable according to health education programs. The assessment process has contributed for therapeutic measures focus, using non-conventional care methods for this approach providing an improvement to these clients life quality.
The New England Journal of Medicine 329 (1993) 977- The present paper describes two systems for communication, education, and decision support in patient-centred diabetes care. Both systems are developed under the assumption that while the clinical resources in the health care sector are limited, patients' resources and new information technology may be able to play a much more central role. With DiasNet patients can experiment with their own data. They can, retrospectively, adjust insulin doses or meals sizes, and thereby learn how to cope with various situations. DiabVision, brings together algorithms for detection of retinal lesions in digital images and for aligning time series of retinal images. While the former algorithms are aimed at automated procedures for screening for diabetic retinopathy, the latter can be used to enable motivated patients to see the actual retinal lesions in their own eyes, illustrating how the changes appear, and perhaps disappear, as a consequence of changes in lifestyle and glycaemic control. One of the long-term goals of our work is to assess the potential of integrating all health related information for patients with diabetes and other major chronic diseases. One solution to these problems would be to organise data and information as one virtual database, which then could be accessed by both health professionals and by patients. This structure would facilitate easy access, a clear overview, and quality control. A web site taking the first step in this process has been launched.
Genetic toxicology data are used worldwide in regulatory decision-making. On the 25th anniversary of Environmental and Molecular Mutagenesis, we think it is important to provide a brief overview of the currently available genetic toxicity tests and to outline a framework for conducting weight-of-the-evidence (WOE) evaluations that optimize the utility of genetic toxicology information for risk assessment. There are two major types of regulatory decisions made by agencies such as the Environmental Protection Agency (EPA) and the Food and Drug Administration (FDA): (1) the approval and registration of pesticides, pharmaceuticals, medical devices, and medical-use products, and (2) the setting of standards for acceptable exposure levels in air, water, and food. Genetic toxicology data are utilized for both of these regulatory decisions. The current default assumption for regulatory decisions is that chemicals that are shown to be genotoxic in standard tests are, in fact, capable of causing mutations in humans (in somatic and/or germ cells) and that they contribute to adverse health outcomes via a "genotoxic/mutagenic" mode of action (MOA). The new EPA Guidelines for Carcinogen Risk Assessment [Guidelines for Carcinogen Risk Assessment, USEPA, 2005, EPA Publication No. EPA/630/P-03/001F] emphasize the use of MOA information in risk assessment and provide a framework to help identify a possible mutagenic and/or nonmutagenic MOA for potential adverse effects. An analysis of the available genetic toxicity data is now, more than ever, a key component to consider in the derivation of an MOA for characterizing observed adverse health outcomes such as cancer. We provide our perspective and a two-step strategy for evaluating genotoxicity data for optimal use in regulatory decision-making. The strategy includes integration of all available information and provides, first, for a WOE analysis as to whether a chemical is a mutagen, and second, whether an adverse health outcome is mediated via a mutagenic MOA.
Integrated delivery systems (IDSs) that enter into risk contracts with payers need sophisticated data analysis and reporting capabilities to ensure proper payment and to manage utilization. An IDS can develop these capabilities by following a six-step process: It should develop an IDS data management structure, obtain all requisite data, review and refine the data, consolidate the data, create a relational database, and develop a reporting structure. The reporting structure should consist of a set of standard reports and the ability to generate additional targeted reports that facilitate analysis of specific aspects of utilization and financial performance.
This article illustrates how Paulo Freire's social change theory can be integrated with a cognitive and behavior change theory to develop a comprehensive health education program directed at both individual- and community-level change. Through discussion of ASAP, an alcohol and substance abuse prevention program for youth from high-risk communities in New Mexico, this article presents an interweaving of Freirian theory and protection-motivation cognitive change theory. Qualitative research data are provided on the processes of change, the interplay of personal and societal factors, and the potential outcomes as a result of using this integrated approach. Programmatic and evaluation implications for health education programs are discussed.
In a community sample of 394 elderly aged 61 years and older from East and West Germany, diseases, contacts with general practitioners and specialists, the use of medicine, attitudes regarding health and illness, the subjective health, psychic problems, social support, social integration, social burden, and socio-demographic variables were assessed. Based on these data the determinants for the contact of physicians and the use of medicine were analyzed. The results confirmed the frequency of multimorbidity in the elderly; on average we found three different diseases at the same time for each person. In nearly 10% of the sample we found seven diagnoses existing at the same time. 88% had contact with a general practitioner at least once a year, 97% had contact either with a general practitioner or with a specialist once a year. 55.8% took at least one medicine each day. The number of diseases existing at the same time was the most determining variable for the contact of physicians and the use of medicine. Furthermore, the elderly had more contact with physicians and took more medicine if they thought they were susceptible to diseases in a high degree, and if they rated their own health as poor. Fewer contacts with physicians and a lower use of medicine were found in those elderly that rated health behavior as little useful, that had low control beliefs regarding their own health, and that experienced only a low degree of health-related limitations in their everyday life. Furthermore, we found a higher use of medicine if there was little social support. There were no significant age-related or sex-related differences regarding the contact of practitioners or the use of medicine.
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