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At least 1,063 records · Page 59Linked to original sources
PubMed2003

Incorporating the views of obstetric clinicians in implementing evidence-supported labour and delivery suite ward rounds: a case study.

OBJECTIVES: To implement evidence-supported delivery suite ward rounds using strategies to overcome barriers. DESIGN: Qualitative case study to identify barriers and a quantitative assessment of outcomes on ward rounds. METHOD: After an introduction to the proposed evidence-supported delivery suite ward round reactions were elicited from 15 clinicians. Responses were categorized into barriers related to knowledge, skills, attitudes and behaviour. Using strategies to overcome these barriers, a weekly evidence-supported ward round was established. During patient-centred discussions, clinical questions were formulated. Following literature searches, evidence was acquired and appraised. RESULTS: Clinicians had limited awareness about the potential benefits of a clinical librarian's support during ward rounds. They were unsure of their skills in evidence-based practice. There was scepticism, fear of loss of autonomy, poor motivation and resistance to change. Clinicians identified several factors that could impinge on their practice. Using appropriate strategies when evidence-supported ward rounds were conducted, 67 questions were raised. However only seven articles were appraised in time to affect decisions on that ward round. CONCLUSIONS: Knowledge of barriers was helpful in developing plans for implementation of evidence-supported ward rounds. The pilot study indicates the feasibility of this approach.

Attitude of Health Personnel↗
PubMed2002

Attitudes toward working on interdisciplinary healthcare teams: a comparison by discipline.

Interdisciplinary teams are important in providing care for older patients, but interdisciplinary teamwork is rarely a teaching focus, and little is known about trainees' attitudes towards it. To determine the attitudes of second-year post-graduate (PGY-2) internal medicine or family practice residents, advanced practice nursing (NP), and masters-level social work (MSW) students toward the value and efficiency of interdisciplinary teamwork and the physician's role on the team, a baseline survey was administered to 591 Geriatrics Interdisciplinary Team Training participants at eight U.S. academic medical centers from January 1997 to July 1999. Most students in each profession agreed that the interdisciplinary team approach benefits patients and is a productive use of time, but PGY-2s consistently rated their agreement lower than NP or MSW students. Interprofessional differences were greatest for beliefs about the physician's role; 73% of PGY-2s but only 44% to 47% of MSW and NP trainees agreed that a team's primary purpose was to assist physicians in achieving treatment goals for patients. Approximately 80% of PGY-2s but only 35% to 40% of MSW or NP trainees agreed that physicians have the right to alter patient care plans developed by the team. Although students from all three disciplines were positively inclined toward medical interdisciplinary teamwork, medical residents were the least so. Exposure to interdisciplinary teamwork may need to occur at an earlier point in medical training than residency. The question of who is ultimately responsible for the decisions of the team may be an "Achilles heel," interfering with shared decision-making.

Attitude of Health Personnel↗
PubMed2001

[Public health departments acting as a public authority and partner in developing a sound environment and healthy living conditions].

The general draft "Health for All" for the European region of the World Health Organization (WHO) describes 21 objectives for a new global health policy in the 21(st) century. This policy aims at promoting and protecting public health from the cradle to the grave. The public health services, responsible for the control and co-ordination of the entire system, have their own scope of procedures. Objective 10 - A healthy and safe natural environment - specifies how environment-related health hazards are to be reduced considerably by improving the quality of air and water and minimising waste production, noise pollution and exposure to radiation, and by sustainable protection of the soil as the source of wholesome and plentiful nutrition. The work of the public health service is based on the laws on health care adopted by the German Federal states, the law on protection against infections, Federal laws and decrees clearly related to health as well as the resolutions of the conferences of health ministers. The public health departments, acting as a public authority, should make available the expert medical knowledge and experience of their staff and contribute comprehensively to regional and development planning procedures. In addition, they should focus on health compatibility testing of projects to ensure efficient preventive health protection.Implementing the EC Directive on Environmental Compatibility Inspection should engender a revision of the pertinent German law. The German National Association of NHS Physicians stipulated that health compatibility testing should be included in the text of the law, and public health departments should be involved on principle in the process of health compatibility testing.This should ensure that health-related issues are given more attention in the future when decisions are made on potential locations for urban building projects, industrial production facilities, large-scale animal husbandry projects, shopping centres or wind farms. The legal situation is exemplified in Saxony-Anhalt, where public health departments are involved in health compatibility testing procedures.

Environmental Health↗
PubMedDate not supplied

[The hollow prosthesis. Reflections on cementless hip endoprosthesis anchorage].

Hollow prostheses appear to represent a promising approach for the durable fixation of cementless hip-joint endoprostheses. The goal of the planned development is the design-engineering, quality-assured production and clinical testing of hollow prostheses displaying largest possible interior space and optimized wall thickness. With hollow prostheses the possibility exists for the first time of filling both the interior space of the prosthesis and cavities between the prosthesis bearing and the prosthesis with spongiosa. Theoretical considerations indicate that this should result in early and durable secondary stability. First results from animal experiments show that the canine femora operated on display a stress distribution closely approximating the natural stress distribution in the bone and exhibit the expected ingrowth of spongiosa into the interior space of the hollow prosthesis. The choice of suitable materials and particularly of wall thickness and cross-sectional shape has a decisive bearing on the elastic behaviour of the prosthesis. Compared with a solid prosthesis of the same geometry, a hollow prosthesis exhibits reduced flexural rigidity and hence higher elasticity. The dynamic tests performed on hollow prostheses in line with DIN 58,840 have shown that--given careful design and manufacture as well as effective quality-assurance measures--fatigue failure is not to be expected in the case of hollow prostheses.

Animals↗
PubMed2004

Confronting the epidemic: the need for global solutions.

The growth in the global epidemic of obesity is fundamentally linked to economic factors. The rising prevalence of overweight and obesity has occurred during a period when the real cost of the main components of many processed foods has declined significantly,partly due to state subsidies in the protected markets of Western economies. It is suggested that the vigorous promotion of foods high in fats and sugars, and intensive marketing to children, have aggravated the problems of obesity. The metabolic syndrome, a recent feature of the epidemic, now is a marker for the health impact of obesity both in the US and other countries. The IOTF suggests that global populations will continue to become progressively heavier if present consumption forecasts are sustained, with obesity imposing a burden of social and economic costs that no country, least of all developing countries with limited resources, can afford. Commitments to deliver effective action are needed from non-health sectors such as culture and education, commerce and trade, development,planning, and transport. Only a comprehensive and integrated international approach, based on an effective implementation of the WHO global strategy on diet, physical activity and health, offers any real hope of arresting the public health catastrophe unfolding throughout the world.

Adult↗
PubMedDate not supplied

A program on complementary therapies for long-term care nursing assistants.

Nursing assistants (NAs) receive insufficient support in the face of heavy workloads and challenging job demands. This article describes a course on complementary therapies (CTs) intended to improve NAs' quality of life by helping them plan, develop, implement, and evaluate CTs. Future studies may examine the impact, if any, such courses have on recruitment and retention.

Adult↗
PubMedDate not supplied

Comprehensive management of urinary incontinence through quality improvement efforts.

This article provides a comprehensive examination of eight factors to analyze the potential and contributing causes of urinary incontinence (UI) in long-term care facilities. These factors can guide quality improvement committees to reduce the prevalence of UI. The eight factors--evidence-based practice, assessment, environment, education, staffing, communication, involvement, and evaluation/feedback--were identified through an analysis of 70 quality improvement plans developed by Minnesota nursing facilities and substantiated by the research literature.

Aged↗
PubMed2003

Pregnancy outcomes associated with intrauterine growth restriction.

OBJECTIVE: This study was undertaken to examine the incidence of intrauterine growth restriction (IUGR) and neonatal outcomes of pregnancies delivered from 26 to 41 weeks' gestation. STUDY DESIGN: A retrospective review of a linked database of all deliveries in California in 1994 through 1996 that were reported to the Office of Statewide Health and Planning Development. MATERIAL AND METHODS: A database of maternal and neonatal discharge summaries linked to birth and death certificates were examined for gestational age at delivery, diagnosis of IUGR, respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), length of stay, and hospital charges (CHA). More than 1.4 million singleton deliveries were examined by week of gestation and separated into the presence or absence of IUGR and then examined for adverse neonatal outcomes. RESULTS: The frequency of IUGR was increased in the preterm newborn infants compared with those at 40 weeks' gestation (26 = 8.9%, 27 = 7.7%, 28 = 9.8%, 29 = 10.5%, 30 = 12.3%, 31 = 9.1%, 32 = 7.5%, 33 = 6.6%, 34 = 5.6%, 35 = 5.0%, 36 = 4.4%, 37 = 3.7%, 38 = 2.3%, 39 = 1.5%, 40 = 1.1%). Up to 28 weeks' gestation, the incidence of RDS was higher for infants without IUGR compared with infants with IUGR (not significant). Starting at 29 weeks' gestation, RDS was higher for infants with IUGR. Initially not significant, this difference was statistically significant starting from 34 weeks. The findings were similar for IVH, NEC, and length of stay. The threshold at which the relationship between the presence of IUGR and the outcome flipped was 30, 28, and 29 weeks, whereas significance was observed at 34, 35, and 30 weeks, respectively. CHA were always higher for those patients with IUGR but became significantly higher after 29 weeks. CONCLUSION: IUGR was increased with prematurity and may represent an important risk factor to check for in women who present with preterm labor. Prematurity associated with adverse neonatal outcomes (RDS, IVH, NEC, CHA) were largely unaffected by IUGR until the third trimester. From then on, all adverse outcomes were increased compared with normally grown premature infants, suggesting a need for closer surveillance for IUGR in the third trimester.

Adult↗
PubMed2003

Endothelial cell diversity revealed by global expression profiling.

The vascular system is locally specialized to accommodate widely varying blood flow and pressure and the distinct needs of individual tissues. The endothelial cells (ECs) that line the lumens of blood and lymphatic vessels play an integral role in the regional specialization of vascular structure and physiology. However, our understanding of EC diversity is limited. To explore EC specialization on a global scale, we used DNA microarrays to determine the expression profile of 53 cultured ECs. We found that ECs from different blood vessels and microvascular ECs from different tissues have distinct and characteristic gene expression profiles. Pervasive differences in gene expression patterns distinguish the ECs of large vessels from microvascular ECs. We identified groups of genes characteristic of arterial and venous endothelium. Hey2, the human homologue of the zebrafish gene gridlock, was selectively expressed in arterial ECs and induced the expression of several arterial-specific genes. Several genes critical in the establishment of left/right asymmetry were expressed preferentially in venous ECs, suggesting coordination between vascular differentiation and body plan development. Tissue-specific expression patterns in different tissue microvascular ECs suggest they are distinct differentiated cell types that play roles in the local physiology of their respective organs and tissues.

Cells, Cultured↗
PubMed2003

Hox cluster duplications and the opportunity for evolutionary novelties.

Hox genes play a key role in animal body plan development. These genes tend to occur in tightly linked clusters in the genome. Vertebrates and invertebrates differ in their Hox cluster number, with vertebrates having multiple clusters and invertebrates usually having only one. Recent evidence shows that vertebrate Hox clusters are structurally more constrained than invertebrate Hox clusters; they exclude transposable elements, do not undergo tandem duplications, and conserve their intergenic distances and gene order. These constraints are only relaxed after a cluster duplication. In contrast, invertebrate Hox clusters are structurally more plastic; tandem duplications are common, the linkage of Hox genes can change quickly, or they can lose their structural integrity completely. We propose that the constraints on vertebrate Hox cluster structure lead to an association between the retention of duplicated Hox clusters and adaptive radiations. After a duplication the constraints on Hox cluster structure are temporarily lifted, which opens a window of evolvability for the Hox clusters. If this window of evolvability coincides with an adaptive radiation, chances are that a modified Hox cluster becomes recruited in an evolutionary novelty and then both copies of duplicated Hox clusters are retained.

Animals↗
PubMed1996

Role for cells in the presupplementary motor area in updating motor plans.

Two motor areas are known to exist in the medial frontal lobe of the cerebral cortex of primates, the supplementary motor area (SMA) and the presupplementary motor area (pre-SMA). We report here on an aspect of cellular activity that characterizes the pre-SMA. Monkeys were trained to perform three different movements sequentially in a temporal order. The correct order was planned on the basis of visual information before its execution. A group of pre-SMA cells (n = 64, 25%) were active during a process when monkeys were required to discard a current motor plan and develop a plan appropriate for the next orderly movements. Such activity was not common in the SMA and not found in the primary motor cortex. Our data suggest a role of pre-SMA cells in updating motor plans for subsequent temporally ordered movements.

Animals↗
PubMed1998

Higher temporal variability of forest breeding bird communities in fragmented landscapes.

Understanding the relationship between animal community dynamics and landscape structure has become a priority for biodiversity conservation. In particular, predicting the effects of habitat destruction that confine species to networks of small patches is an important prerequisite to conservation plan development. Theoretical models that predict the occurrence of species in fragmented landscapes, and relationships between stability and diversity do exist. However, reliable empirical investigations of the dynamics of biodiversity have been prevented by differences in species detection probabilities among landscapes. Using long-term data sampled at a large spatial scale in conjunction with a capture-recapture approach, we developed estimates of parameters of community changes over a 22-year period for forest breeding birds in selected areas of the eastern United States. We show that forest fragmentation was associated not only with a reduced number of forest bird species, but also with increased temporal variability in the number of species. This higher temporal variability was associated with higher local extinction and turnover rates. These results have major conservation implications. Moreover, the approach used provides a practical tool for the study of the dynamics of biodiversity.

Journal Article↗
PubMed2003

Problems with the use of cladistic analysis in palaeoanthropology.

Cladistic analysis is a popular method for reconstructing evolutionary relationships on the human lineage. However, it has limitations and hidden assumptions that are often not considered by palaeoanthropologists. Some researchers who are opposed to its use regard cladistics as the preferred method for taxonomic "splitters" and claim it has lead to a revitalisation of typology. Typology remains a part of human evolutionary studies, regardless of the acceptance or use of cladistics. The assumption/preference for "splitting" over "lumping" in cladistics (alpha) taxonomy and the general failure to evaluate (post-hoc) such taxonomies have served to reinforce this assertion. Researchers have also adopted a number of practices that are logically untenable or introduce considerable error. The evolutionary trend of human encephalisation, apparently isometric with body size, and concurrent reduction in the gut and masticatory apparatus, suggests continuous cladistic characters are biased by problems of body size. The method suffers a logical weakness, or circularity, leading to bias when characters with multiple states are used. Coding of such characters can only be done using prior criteria, and this is usually done using an existing phylogenetic scheme. Another problem with coding character states is the handling of variation within species. While this form of variation is usually ignored by palaeoanthropologists, when characters are recognised as varying, their treatment as a separate state adds considerable error to cladograms. The genetic proximity of humans, chimpanzees and gorillas has important implications for cladistic analyses. It is argued that chimpanzees and gorillas should be treated as ingroup taxa and an alternative outgroup such as orangutans should be used, or an (hypothetical) ancestral body plan developed. Making chimpanzees and gorillas ingroup taxa would considerably enhance the biological utility of anthropological cladograms. All published human cladograms fail to meet standard quality criteria indicating that none of them may be considered reliable. The continuing uncertainty over the number and composition of fossil human species is the largest single source of error for cladistics and human phylogenetic reconstruction.

Animals↗
PubMed2002

Factors influencing intent to get pregnant in HIV-infected women living in the southern USA.

This descriptive study sought to identify factors that influence HIV-infected women's intent to get pregnant. Interviews were conducted with a convenience sample of n = 322 HIV-infected women at risk for pregnancy. Participants were predominantly African-American (84.4%), single (57.9%), and ranged in age from 17 to 48 years. Forty per cent (n = 128) of the women had been pregnant since becoming HIV-positive. Potential factors influencing intent to get pregnant that were examined included demographic characteristics, HIV-related factors and personal beliefs and attitudes. In simple logistic regression models, younger age, increased motivation for child bearing, decreased perceived threat of HIV, decreased HIV symptomatology, higher traditional gender role orientation, and greater avoidance coping were all associated with greater intent to get pregnant. Following a model selection procedure, motivation for child bearing (OR = 16.05, 95% CI 7.95, 30.41) and traditional sex roles (OR = 4.49, 95% CI 1.44, 13.55) were significantly associated with greater intent to get pregnant. Traditional gender role orientation and motivation for childbearing are significant factors in predicting intent to get pregnant among HIV-infected women. These factors, as well as other non HIV-related factors, need to be routinely assessed by health care providers in developing plans of care for HIV-infected women.

Adaptation, Psychological↗
PubMed2004

Policy approaches to support local community control over the supply and distribution of kava in the Northern Territory (Australia).

The health consequences of kava abuse in Arnhem Land Aboriginal populations in the Northern Territory (NT) and the persistence of an illegal kava trade with its associated social harms have been a cause for concern for 20 years. Despite these concerns, some Arnhem Land groups seek to continue using kava and to control its sale, distribution and the profits from the enterprise. In response, policy makers in the NT have embraced principles of harm reduction and created regulatory mechanisms to address broader public concerns and to support local management of kava supply while reinforcing control over the consequences of its use. This paper describes the kava regulatory system now being implemented in the NT which features kava management plans developed in consultation between Aboriginal communities and licensing authorities. It complements the earlier Harm Reduction Digest 9 by McDonald & Jowitt which looked at Kava in the South Pacific.

Catchment Area, Health↗
PubMedDate not supplied

The quality management system as a tool for improving stakeholder confidence.

The Corps of Engineers works with local restoration advisory boards (RAB) to exchange information and develop plans for restoration of closed military bases for civilian reuse. Meetings of the RAB to discuss progress in environmental assessment and restoration of former defense sites can be contentious due to the complex technical nature of the information to be shared and the personal stake that the members of the community have in ensuring that contentious areas are restored for safe use. A prime concern of community representatives is often the quality of the data used to make environmental decisions. Laboratory case narratives and data flags may suggest laboratory errors and low data quality to those without an understanding of the information's full meaning. RAB members include representatives from local, state, and tribal governments, the Department of Defense, the Environmental Protection Agency, and the local community. The Corps of Engineers representatives usually include project technical and management personnel, but these individuals may not have sufficient expertise in the project quality assurance components and laboratory data quality procedures to completely satisfy community concerns about data quality. Communication of this information to the RAB by a quality assurance professional could serve to resolve some of the questions members have about the quality of acquired data and proper use of analytical results, and increase community trust that appropriate decisions are made regarding restoration. Details of the effectiveness of including a quality assurance professional in RAB discussions of laboratory data quality and project quality management are provided in this paper.

Community Participation↗
PubMed2006

Decomposing socioeconomic inequality in infant mortality in Iran.

BACKGROUND: Although measuring socioeconomic inequality in population health indicators like infant mortality is important, more interesting for policy purposes is to try to explain infant mortality inequality. The objective of this paper is to quantify for the first time the determinants' contributions of socioeconomic inequality in infant mortality in Iran. METHODS: A nationally representative sample of 108 875 live births from October 1990 to September 1999 was selected. The data were taken from the Iranian Demographic and Health Survey (DHS) conducted in 2000. Households' socioeconomic status was measured using principal component analysis. The concentration index of infant mortality was used as our measure of socioeconomic inequality and decomposed into its determining factors. RESULTS: The largest contributions to inequality in infant mortality were owing to household economic status (36.2%) and mother's education (20.9%). Residency in rural/urban areas (13.9%), birth interval (13.0%), and hygienic status of toilet (11.9%) also proved important contributors to the measured inequality. CONCLUSIONS: The findings indicate that socioeconomic inequality in infant mortality in Iran is determined not only by health system functions but also by factors beyond the scope of health authorities and care delivery system. This implies that in addition to reducing inequalities in wealth and education, investments in water and sanitation infrastructure and programmes (especially in rural areas) are necessary to realize improvements of inequality in infant mortality across society. These findings can be instrumental for the recent 5 year Economic, Social and Cultural Development Plan of Iran, which identified the reduction of inequalities in social determinants of health.

Adolescent↗