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PubMedDate not supplied

Active client participation: an examination of self-empowerment in HIV/AIDS case management with women.

Case management has become increasingly popular as a means to alleviate the difficulties associated with accessing health care and social services. However, little information exists regarding models of case management specifically intended for work with HIV-positive women. This article explores the practices currently in use at an HIV/AIDS service agency to further define empowering practices employed by case managers working with HIV-positive women. Although a client's active participation in service plan development and delivery is widely regarded as the pathway to empowerment, findings indicate that "active participation" is not so readily defined; empowerment exists on a dynamic continuum with increasing levels of client participation. A model is presented that demonstrates the relationship of particular behaviors to client self-empowerment. Because the needs of clients with HIV/AIDS are continually fluctuating, and because case managers' behaviors will need to adapt accordingly, this model also incorporates the concept of balance as it pertains to HIV/AIDS case management.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Census trends in AIDS specialty units.

As HIV disease evolves into a chronic and manageable disease, monitoring trends in HIV/AIDS inpatient use will become an important tool clinicians can use to analyze the need for organizational changes in patient care delivery. Monitoring census trends can assist nurses in developing plans of care and evaluating outcome in HIV patients. Nurse managers of AIDS Specialty Units (ASUs) are at the forefront of identifying current inpatient use trends. This article investigates census trends in selected ASUs from the perspective of ASU nurse managers and describes the factors that nurse managers believe to have influenced census trends. Implications for further research are provided.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Eruptive abnormalities in orthodontic treatment.

In the course of orthodontic practice, it is inevitable that one will encounter what is termed here eruptive abnormalities. These abnormalities include teeth that are impacted, ectopically erupting, or transposed. Hyperdontia and hypodontia are also included for consideration. The treatment plans developed to address these anomalies must take into account the space needs of the patient and how one can best gain, maintain, or redistribute that space. Also, soft tissue reactions to the movements also should be considered.

Anodontia↗

PubMed2003

Spontaneous mutations in the Helicobacter pylori rpsL gene.

Several studies have revealed that the Helicobacter pylori genome differs markedly from strain to strain, perhaps as a result of mutations arising during persistent infection and/or related to the observed variation in virulence. The development of a detection system for mutations in H. pylori genes might therefore help us to develop a better understanding of its mutability, and in this way help us to develop plans for investigating the relationship between its genomic variability and the pathogenesis of various gastric and duodenal diseases associated with the long-term H. pylori infections. We have therefore begun a study of H. pylori mutability using the endogenous rpsL gene as a marker. Spontaneous mutant frequencies were measured and compared among H. pylori strains, after incubation on plates containing 50 microg/ml of streptomycin for 10 days as a selection procedure. The rpsL gene of each streptomycin-resistant (Str(r)) mutant was amplified by polymerase-chain-reaction (PCR) and sequenced. All of the mutations we characterized were localized at codons 43 or 88 of the rpsL gene and were base transitions from A to G, replacing lysine with arginine. This is in contrast to the spontaneous Str(r) mutants isolated from Escherichia coli, which resulted from either A to G transitions at lysine codons 42 and 87, or A to T or C transversions at lysine codon 42. The spontaneous mutant frequencies of the rpsL gene in H. pylori were of the order of 10(-9), and there were significant differences in spontaneous mutant frequencies among the strains tested. This mutation detection system might be of value in screening clinical isolates for H. pylori mutator phenotypes.

Drug Resistance, Bacterial↗

PubMed2006

Actions and implementation strategies to reduce suicidal events in the Veterans Health Administration.

BACKGROUND: Veterans possess many risk factors for suicide, making suicide prevention in the Veterans Health Administration (VHA) a particular challenge. METHODS: An analysis was conducted of 94 aggregated root cause analyses (RCAs) for parasuicidal behavior and 43 single-case suicide RCAs submitted from 75 VHA facilities to determine primary root causes for suicide and parasuicidal behaviors and to gain information about action plans, success factors and obstacles to improvement. Telephone follow-up interviews were conducted with each facility. RESULTS: The aggregate reviews included 775 individual cases of parasuicidal behavior. The top root causes of parasuicidal behavior were poor assessment and communication of patient risk, patient stressors, and need for staff and patients training. Forty-eight percent of the action plans developed to address the root causes involved a policy change, 30% involved staff training, and 14% involved making a specific clinical change. Eight-eight percent of the actions adequately addressed the root cause, of which 68.1% were fully implemented. DISCUSSION: There is little agreement on the definition of "parasuicide," and it is likely the case that parasuicide behaviors are underreported in our system. To encourage reporting, patient safety staff should collaborate with providers and use a more inclusive definition of parasuicide.

Hospitals, Veterans↗

PubMed2004

Situation analysis of prenatal diagnosis technology utilization in China: current situation, main issues, and policy implications.

OBJECTIVES: The purpose of this study is to describe the situation with the distribution and utilization of prenatal diagnosis technology in China, to identify some important barriers to prenatal diagnosis use, and to suggest changes to improve the present situation. METHODS: The study uses cross-sectional surveys to capture quantitative data from both providers and consumers. Qualitative information based on focus group discussions is also presented. RESULTS: A mail survey of the provincial Bureaus of Health (BOHs) reveals that sixteen provincial prenatal diagnosis centers and twelve city level centers were accredited by the BOHs by July of 2001. These centers were located in thirteen provinces, of thirty in all of China. Of 147 selected institutions surveyed separately, 90.5 percent offer ultrasound examination, 72.1 percent provide pathogen tests (mainly Toxoplasma, rubella virus, cytomegalovirus, and herpes simplex or TORCH), 57.1 percent do biochemical tests, 21.8 percent have genetic counseling, 13.6 percent do karyotype testing, 7.5 percent do enzymology testing, and 5.4 percent carry out molecular genetic testing. Chromosome diseases, congenital diseases, and several gene diseases are the target diseases. According to qualitative data, macromanagement for prenatal diagnosis, supplier provision of tests, and population demand are the main influences on prenatal diagnosis use. CONCLUSIONS: From the quantitative and qualitative analysis, it is clear that the technology of prenatal diagnosis is not diffusing well throughout China and is apparently not appropriately used. The situation of prenatal diagnosis has implications for policy-makers, including identification of priorities, regulation of prenatal diagnosis, strategic planning, development of guidelines based on health technology assessment, and consumer orientation.

China↗

PubMed2002

How to launch a national Internet-based panel study quickly: lessons from studying how American are coping with the tragedy of September 11, 2001?

This article reports on the planning, development, and implementation of a large national Internet-based panel study of how Americans are coping with the terrorist attacks of September 11, 2001. The study was designed to determine predictors and correlates of risk and resilience, both cross-sectionally and longitudinally. In order to acquire timely and meaningful data, we developed/adapted an extensive set of measures, obtained human subjects approval, and posted a research Web site just 17 days after the attacks. This article describes the major hurdles we confronted and the guidelines we recommend regarding these topics, including the methodological trade-offs inherent in Internet-based research, information technology requirements and tribulations, human subjects issues, selection of measures and securing permission for their use, and the challenges of participant recruitment. We also discuss issues that we did not anticipate, including the survey intervention. We focus not on findings, but on the concrete procedural, administrative, technical, and scientific challenges we encountered and the solutions we devised under considerable time and resource pressures.

Journal Article↗

PubMed1998

Harnessing the imagination. Mental simulation, self-regulation, and coping.

Mental simulation provides a window on the future by enabling people to envision possibilities and develop plans for bringing those possibilities about. In moving oneself from a current situation toward an envisioned future one, the anticipation and management of emotions and the initiation and maintenance of problem-solving activities are fundamental tasks. In the program of research described in this article, mental simulation of the process for reaching a goal or of the dynamics of an unfolding stressful event produced progress in achieving those goals or resolving those events. Envisioning successful completion of a goal or resolution of a stressor--recommendations derived from the self-help literature--did not. Discussion centers on the characteristics of effective and ineffective mental simulations and their relation to self-regulatory processes.

Adaptation, Psychological↗

PubMedDate not supplied

Exemplary efforts in psychology to recruit and retain graduate students of color.

Many psychology departments are striving for a greater representation of students of color within their graduate preparation programs with the aim of producing a more diverse pool of psychological service providers, scientists, and educators. To help improve the minority pipeline in psychology, the authors identify and describe recruitment and retention strategies used at 11 departments and programs considered to be making exemplary efforts to attract and retain minority students of color. The strategies most consistently used included engaging current minority faculty and students in recruitment activities, offering attractive financial aid packages, having faculty members make personal contacts with prospective students, creating linkages with historical institutions of color, having (or approached having) a critical mass of faculty and students of color, offering a diversity issues course, and engaging students in diversity issues research. Despite the similarities, the programs and departments were each distinctive and innovative in their overall approaches to student recruitment and retention. Highlighting the strategies used at successful institutions may help others develop plans for improving the minority pipeline within their own departments and programs.

Education, Graduate↗

PubMed2004

Nodal antagonists regulate formation of the anteroposterior axis of the mouse embryo.

Patterning of the mouse embryo along the anteroposterior axis during body plan development requires migration of the distal visceral endoderm (DVE) towards the future anterior side by a mechanism that has remained unknown. Here we show that Nodal signalling and the regionalization of its antagonists are required for normal migration of the DVE. Whereas Nodal signalling provides the driving force for DVE migration by stimulating the proliferation of visceral endoderm cells, the antagonists Lefty1 and Cerl determine the direction of migration by asymmetrically inhibiting Nodal activity on the future anterior side.

Animals↗

PubMed1998

Becoming ADEPT (Applying Diagnosis, Etiology, Prognosis, and Therapy Programme): delivering distance learning on evidence-based medicine for librarians.

Evidence-based medicine (EBM) brings new challenges and opportunities for librarians. However, their ability to respond to this agenda is constrained by their difficulties in acquiring the requisite new skills and techniques while continuing to work in a busy information practice setting. The authors describe a joint initiative, between a specialist evidence-based healthcare information unit and a regional library network, to deliver training materials using a mixed workshop and distance learning format. The Applying Diagnosis, Etiology, Prognosis, and Therapy filters (ADEPT) Programme draws upon research conducted at McMaster University, Canada and, using techniques adapted from the teaching evidence-based medicine paradigm, seeks to equip health care librarians with the skills and techniques required to support evidence-based practice locally. The authors describe the thinking behind the programme, its main features, the extensive evaluation mechanisms incorporated into the course, the results of the evaluation and the lessons learnt. They conclude with a description of the way forward for participants on the programme who are adapting their newly acquired knowledge to their work situations. Further planned developments from the course's designers are also outlined briefly.

Cooperative Behavior↗

PubMed1994

Training and education for nurses working in neonatal care.

The issue of nurse education and training in the context of providing a high-quality service for sick and small babies and their families is a paramount concern. As part of a large-scale study of neonatal nursing in the United Kingdom, data were collected on nurses' educational background, professional qualifications, experience, orientation, appraisal and update. The results reveal a qualification in specialty (QIS) rate for trained nurses of 53% and large variation not directly related to size or type of unit. The proportion of nurses having appraisal interviews (47% in the last year) and professional development plans (19%) was low and a clear gap existed between policy and practice. The implications of the findings are discussed and the need for management training, targeting of neonatal units with low QIS rates, and more flexible education programmes are emphasized.

Adult↗

PubMed2001

The feasibility of a nurse practitioner-led primary health care clinic in a school setting: a community needs analysis.

AIM: The aim of this New Zealand study was to determine the feasibility of establishing a nurse practitioner-led, family focused, primary health care clinic within a primary school environment as a means of addressing the health needs of children and families. A secondary aim was to ascertain whether public health nurses (PHNs) were the most appropriate nurses to lead such a clinic. METHOD: Utilizing a community needs analysis method, data were collected from three sources --known demographic data, 17 key informant interviews and two focus group interviews. Questions were asked regarding the health needs of the community, the perceptions of participants regarding the role of the PHN, and the practicalities of establishing a clinic including the services participants would expect a clinic to provide. Analysis was exploratory and descriptive. RESULTS: Findings included the identification of a wide range of health issues. These included asthma management and control issues, the need to address poor parenting, and specific problems of the refugee and migrant population. Findings also demonstrated that participant understanding of the role of the PHN was less than anticipated and that community expectations were such that for a PHN to lead a primary health care clinic it would be likely that further skills would be required. Outcomes from investigating the practicalities of establishing a nurse practitioner-led clinic resulted in the preparation of a community-developed plan that would serve to address the health needs of children and families in the area the study was undertaken. Services that participants identified as being appropriate included health information, health education, health assessment and referral. CONCLUSION: Overall findings indicated that the establishment of a nurse practitioner-led, family focused, primary health care clinic in a primary school environment was feasible. While a PHN may fulfil the role of the nurse practitioner, it was established that preparation to an advanced level of practice would be required.

Adolescent↗

PubMed2000

What is action research and can it promote change in primary care?

Improving the quality of health care is an international priority. However, research has shown that methods of altering clinician's behaviour or implementing organizational change are often ineffective. Action research has been used successfully to facilitate change and improve service provision in industry, education and more recently in health care. In this paper, action research methodology and why it should be successful in promoting change are outlined. Recently published studies using action research in the primary health care team setting in the UK are discussed. They demonstrate that action research improves clinical care, teamwork, communication and administration. It also encourages practice teams to audit their work and identify their educational needs. The main problems encountered were the amount of time and effort required to maintain collaboration with participants, staff turnover and completing the research process in a short time scale. Action research should be a useful means of improving quality in health care and could be used more widely. In the UK, government strategy has called for individual- and team-based development plans based on individual learning needs. Action research could be a useful method of transforming these from theory to practice.

Family Practice↗

PubMed1999

Job satisfaction and stress in staff working in a specialist psychiatric unit for the elderly following relocation from a traditional psychiatric hospital setting.

AIM: This study examines self-reported stress and job satisfaction of staff working in a specialist psychiatric unit for the elderly (n = 79) following relocation from a traditional psychiatric hospital setting (n = 66). The levels of reported stress were examined in relation to the two staff groups before and after the relocation, and in relation to data available for similar occupational groups. METHODS: Stress and job satisfaction levels were surveyed using the Occupational Stress Indicator. The analysis of data included t-test for independent groups. FINDINGS: The results suggested that that there were no significant changes in the patterns of the staff groups' experience of stress at the traditional psychiatric hospital and later at the new purpose-built unit. However, it was felt that there may have been different factors contributing to staff stress at the two time-points. The staff groups in this survey reported similar, and in some areas more positive levels of occupational stress than both community and other health authority samples. However, it was felt that, due to the limited response rate of staff at both times (63 and 59%), the results may be an underestimate of stress levels. In the absence of a measure of general health and symptomatology it was not possible to assess the impact of stress levels on the psychological well-being of staff. CONCLUSIONS: Routine audit of staff stress would be beneficial to identify potential for staff training, and individual professional development plans. This is particularly important in view of the current difficulties both locally and nationally in the recruitment and retention of qualified staff in this speciality.

Adaptation, Psychological↗

PubMed2001

Complementary and alternative medicine (CAM) in the undergraduate medical curriculum: the Southampton experience.

OBJECTIVE: We describe the planning, development and evaluation of a special study module (SSM) on Complementary and Alternative Medicine (CAM) as part of the Southampton Medical School undergraduate curriculum. AIM: To address how the module was received by students, the themes that emerged, the effect on student attitudes to CAM and how the teaching aims developed into learning objectives. METHOD: Student feedback questionnaires and regular teaching staff meetings over a period of 3 years. RESULTS: The course resulted in a significant change in student attitudes to CAM and was well received by the students. It offered a reflective insight into conventional medicine. We have developed and validated core teaching objectives. CONCLUSIONS: We hope that our well validated and well received core teaching objectives will provide a broadly applicable base for those who wish to run similar courses.

Complementary Therapies↗

PubMed2003

General practitioners, revalidation and appraisal: a cross sectional survey of attitudes, beliefs and concerns in Lincolnshire.

BACKGROUND: All general practitioners (GPs) are expected to have an appraisal from 2002 and the first cohort will experience revalidation in 2005. Although there is a link between appraisal and revalidation, this has yet to be clarified. OBJECTIVE: To investigate the knowledge, attitudes and beliefs of GPs towards revalidation and appraisal. DESIGN: Cross sectional survey. SETTING: Lincolnshire, UK. PARTICIPANTS: General practitioners. METHOD: In 2000 a self-administered postal questionnaire survey was sent to all 343 GP principals on the list of Lincolnshire Health Authority. The questionnaire consisted of 47 attitudinal statements on appraisal and revalidation. It also included open questions on concerns about appraisal and revalidation and questions on attributes of responders. RESULTS: Of the 343 GPs sent questionnaires, 272 (79%) replied. Lincolnshire GPs had more positive attitudes towards appraisal than towards revalidation. They welcomed appraisal provided that it had local ownership and took into account their views and concerns on the process. Other factors that correlated with a positive attitude towards appraisal included agreement that the purpose of appraisal is educational and that it should result in an agreed development plan. Those who had a positive view of appraisal were more likely to agree set objectives. Previous experience of appraisal either as an appraiser or appraisee was associated with a positive attitude towards appraisal. General practitioners who felt they had more control over the process tended to be more positive. General practitioners who were in favour of appraisal were also more likely to be in favour of revalidation and agree that appraisal formed part of the revalidation process. They were less likely to feel that there was a hidden agenda on the part of government and more likely to agree that revalidation would provide evidence of acceptable care being provided to patients. Time involved and lack of resources were the two main concerns. CONCLUSIONS: A better understanding of knowledge, beliefs and attitudes towards appraisal will ultimately help in setting up a successful appraisal system for GPs. The current emphasis on appraisal as an educational tool will help to foster positive attitudes. The relationship between appraisal and revalidation needs to be clarified. Concerns relating to lack of time and resources for appraisal and revalidation need to be addressed by primary care organisations.

Adult↗

PubMed1999

A time-motion study of digital radiography at implementation.

With increasing budgetary restraints on the health system, it is apparent that the main contribution that radiology departments can make to significant cost reduction in hospitals is to decrease the length of time between requesting an X-ray examination and receiving the report (and images). Digital radiography (DR) was introduced into the Radiology Department at the Royal Adelaide Hospital as a pilot project to research the cost-benefits and efficiency of the system, and to determine future directions for planning a digital department. The business plan developed prior to implementation of this pilot project predicted a saving of one bed-day per inpatient when a fully digital department with a picture archiving and communication system (PACS) is installed. This initial study comparing DR and conventional radiography (convR) provides baseline data and shows encouraging results for more rapid transmission of reports to clinicians.

Cost-Benefit Analysis↗