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At least 109 records · Page 6Linked to original sources

Adverse outcomes of planned and unplanned pregnancies among users of natural family planning: a prospective study.

OBJECTIVES: The purpose of this study was to determine prospectively whether unplanned pregnancies are associated with adverse pregnancy outcomes among users of natural family planning. METHODS: Women who became pregnant while using natural family planning were identified in five centers worldwide: there were 373 unplanned and 367 planned pregnancies in this cohort. The subjects were followed up at 16 and 32 weeks' gestation and after delivery. The risks of spontaneous abortion, low birth-weight, and preterm birth were estimated after adjustment by logistic regression. RESULTS: The women with unplanned pregnancies were more likely to be at the extremes of age, to report more medical problems before and during the index pregnancy, and to seek antenatal care later in gestation than the women with planned pregnancies. However, women with planned pregnancies reported a higher rate of spontaneous abortion in previous pregnancies (28.8%) than did women with unplanned pregnancies (12.9%). There were no significant differences in the rates of spontaneous abortion, low birthweight, or preterm birth between the two groups. CONCLUSIONS: No increased risk of adverse pregnancy outcomes was observed among women who experienced an unplanned pregnancy while using natural family planning.

Abortion, Spontaneous↗

Population based planning as a tool for health plan development.

Population based planning is an appealing methodology for the development of a people-oriented health systems plan. By focusing on the identification and minimization of the social, behavioral, and environmental risks to ill health, population based planning is compatible with the growing understanding of the social origins of health and disease. Models of both population based and resource based planning are presented and used to define the concepts and contrast the two methodologies. To strengthen the population based planning model, Kessner's tracer methodology is incorporated into the technique. Finally, the benefits (focus on the social origins to disease) and the drawbacks (extensive time and data requirements) of population based planning are highlighted.

Health Planning↗

[Implementation of AUGE plan for chronic renal failure patients. The implementation of Universal Access and Explicit Guaranties Plan (AUGE), generates longer waiting lists among patients with chronic renal failure].

BACKGROUND: An opportune, efficient and low cost medical attention should be provided to all patients, without discrimination. When the need for medical attention outweighs the available resources, permanently increasing waiting lists are generated. The aim of the Universal Access and Explicit Guaranties Plan (AUGE) is to attend selected patients in periods predefined by the health authority. AIM: To describe the first six months of implementation of AUGE plan for chronic renal failure in a public hospital of Santiago. MATERIAL AND METHODS: As a health care quality monitoring system, the lapse between the generation of a nephrological consultation and the specialist assessment, is registered periodically. These lapses were evaluated before and after the AUGE plan implementation, for eligible and non eligible patients for the plan. Results were modeled according queue theory. RESULTS: After three months of implementation, the AUGE plan prolongs waiting periods and increases the number of all patients seeking for nephrological attention. CONCLUSIONS: According to these results AUGE plan will be successful only if its present functioning is modified and receives more financial resources.

Evaluation Studies as Topic↗

[The collaborative nursing care plan: integration of the clinical pathway with the traditional nursing care plan].

The nursing care plan is a commonly used teaching tool in nursing education. By developing individualized nursing care plans for specific clients, students practice use of nursing process and making clinical judgments and decisions. However, the system of managed care has impacted current clinical practice, and many health care agencies have shifted their emphasis from requiring the traditional columnar nursing care plans to use of clinical pathways and standards of care. As result of this trend, nursing educators are faced with the problem of preparing students to cope with today's reality in clinical practice. In response to this problem, this article reexamines the practical utility of the traditional nursing care plan in nursing education. The article also introduces a collaborative nursing care plan, the integration of the clinical pathway with the traditional nursing care plan, and its application in teaching.

Critical Pathways↗

Where grasps are made reveals how grasps are planned: generation and recall of motor plans.

The end-state comfort effect (Rosenbaum et al. 1990, 1992, 1993, 1996) predicts that people will grasp an object for transport in a way that allows joints to be in mid-range at the end of the transport. When participants in the present study took hold of a vertical cylinder to move it to a new position, grasp heights on the cylinder were inversely related to the height of the target position, as predicted by the end-state comfort effect. This demonstrates that where people grasp objects can give insight into the planning of movement. In the computational model of motor planning developed by Rosenbaum et al. (1995, 2001) it is assumed that goal postures are planned by a two-stage process of recall and generation. The distinction between recall and generation had not so far been tested. In the present study, the pattern of grasp heights in successive transports was consistent with the view that participants generated a plan the first time they moved the cylinder between two points, and that they subsequently recalled what they had done before, making small adjustments to that recalled plan. This outcome provides evidence for distinct effects of recall and generation on movement planning.

Adolescent↗

Planned cesarean versus planned vaginal delivery at term: comparison of newborn infant outcomes.

OBJECTIVE: The purpose of this study was to examine neonatal outcomes among women with a planned cesarean and a planned vaginal delivery at term. STUDY DESIGN: This prospective survey was conducted on 18,653 singleton deliveries that represent 24 maternity units during a 6-month period. The data were retrieved from the Medical Birth Registry of Norway and analyzed according to intended mode of delivery. RESULTS: Compared with planned vaginal deliveries, planned cesarean delivery increased transfer rates to the neonatal intensive care unit from 5.2% to 9.8% (P < .001). The risk for pulmonary disorders (transient tachypnea of the newborn infant and respiratory distress syndrome) rose from 0.8% to 1.6% (P = .01). There were no significant differences in the risks for low Apgar score and neurologic symptoms. CONCLUSION: A planned cesarean delivery doubled both the rate of transfer to the neonatal intensive care unit and the risk for pulmonary disorders, compared with a planned vaginal delivery.

Adult↗

Quantitative EEG analysis for assessment to 'plan' a task in amyotrophic lateral sclerosis patients: a study of executive functions (planning) in ALS patients.

An attempt has been made to study the ability of patients with amyotrophic lateral sclerosis (ALS) to 'plan' a task. Electroencephalogram (EEG) data corresponding to 'planning of a movement task' is analyzed in comparison with a normal relaxed state. The study was conducted on 12 patients with ALS (6 males, 3 females, mean age 46.75 years) and on same number of controls (10 males, 2 females, mean age 48.75 years) to evaluate a difference in the ability to 'plan' a movement task between them. Patients with ALS were divided in two groups defined by unclear/clear speech. It has been observed that patients with ALS having unclear speech (Group I) showed considerable reduction (p<0.0001) in 'planning' a movement task, whereas patients with ALS having clear speech (Group II) showed no deficit in 'planning' a movement task (p=0.0577), both in comparison with age-matched controls. Apart from supporting the earlier reports of a possible extended neuronal degeneration across wide area of the frontal lobes, the findings reveal a possible reduction in planning, an executive function of the prefrontal cortex of brain, and also reveal that speech impairment may be associated with cognitive deficits in patients with ALS.

Adult↗

Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in The Netherlands.

OBJECTIVE: To investigate the relation between the intended place of birth (home or hospital) and perinatal outcome in women with low risk pregnancies after controlling for parity and social, medical, and obstetric background. DESIGN: Analysis of prospective data from midwives and their clients. SETTING: 54 midwifery practices in the province of Gelderland, Netherlands. SUBJECTS: 97 midwives and 1836 women with low risk pregnancies who had planned to give birth at home or in hospital. MAIN OUTCOME MEASURE: Perinatal outcome index based on "maximal result with minimal intervention" and incorporating 22 items on childbirth, 9 on the condition of the newborn, and 5 on the mother after the birth. RESULTS: There was no relation between the planned place of birth and perinatal outcome in primiparous women when controlling for a favourable or less favourable background. In multiparous women, perinatal outcome was significantly better for planned home births than for planned hospital births, with or without control for background variables. CONCLUSIONS: The outcome of planned home births is at least as good as that of planned hospital births in women at low risk receiving midwifery care in the Netherlands.

Choice Behavior↗

Patients presenting with birth plans in a military tertiary care hospital: a descriptive study of plans and outcomes.

OBJECTIVES: This study evaluates what type of patient prepares a birth plan, identifies common requests made, and determines how closely these are followed during labor. METHODS: Patients who were admitted in labor with birth plans during a 3.5-year period were identified. Birth plans were analyzed, and common requests were recorded. Delivery records were reviewed, and outcomes were recorded. This study was approved by the hospital institutional review board. RESULTS: Sixty-seven birth plans with delivery outcomes were available for review. The mean maternal age was 31 years, the median parity was 0, and 70% of patients had a college degree. The most common requests were to walk during labor (84%), to avoid episiotomy (82%), and to have no epidural (62%). Seventy-five percent of patients had spontaneous vaginal deliveries, and 19% had cesarean sections; the epidural use rate was 59%. CONCLUSIONS: Patients with birth plans were generally older and well-educated and, despite plans to avoid an epidural, most patients changed their minds.

Adult↗

The effects of disseminating performance data to health plans: results of qualitative research with the Medicare Managed Care plans.

OBJECTIVE: To assess the information needs and responses of managed care plans to the Medicare Managed Care Consumer Assessment of Health Plans Study (MMC-CAHPS). DATA SOURCES/STUDY SETTING: One hundred sixty-five representatives of Medicare managed care plans participated in focus groups or interviews in the spring of 1998, 1999, and 2000. STUDY DESIGN: In 1998 focus groups were conducted with representatives of managed care plans to develop and test a print report of MMC-CAHPS results. After the reports were disseminated focus groups and interviews were conducted in 1999 and 2000 to identify perceptions, uses, and potential enhancements of the report. DATA COLLECTION/EXTRACTION METHODS: The study team conducted a total of 23 focus groups and 12 telephone interviews and analyzed the transcripts to identify major themes. PRINCIPAL FINDINGS: In 1998 participants identified the report content and format that best enabled them to assess their performance relative to other Medicare managed care plans. In 1999 and 2000 participants described their responses to and uses of the report. They reported comparing the MMC-CAHPS results to internal surveys and presenting the results to senior managers, market analysts, and quality-improvement teams. They also indicated that the report's usefulness would be enhanced if it were received within six months of survey completion and if additional data analysis was presented. CONCLUSIONS: Focus group results suggest that the MMC-CAHPS report enhances awareness and knowledge of the comparative performance of Medicare managed care plans. However, participants reported needing additional analysis of survey results to target quality-improvement activities on the populations with the most reported problems.

Attitude↗

Abbreviated report of the WHO Western Pacific Region Workshop on National Plans of Action for Nutrition: key elements for success, constraints and future plans.

A workshop on National Plans of Action for Nutrition: Constraints, Key Elements for Success, and Future Plans was convened and organized by the WHO Regional Office for the Western Pacific in collaboration with the Institute for Medical Research Malaysia and co-sponsored with FAO and UNICEF from 25-29 October 1999. It was attended by representatives of 25 countries in the region and resource persons, representatives from WHO and other international agencies. The objectives of the workshop were to review the progress of countries in developing, implementing and monitoring national plans of action for nutrition (NPANs) in the Western Pacific Region and to identify constraints and key elements of success in these efforts. Most of the countries have NPANs, either approved and implemented or awaiting official endorsement. The Plan formulation is usually multisectotal, involving several government ministries, non-governmental organizations, and international agencies. Often official adoption or endorsement of the Plan comes from the head of state and cabinet or the minister of health, one to six years from the start of its formulation. The NPAN has stimulated support for the development and implementation of nutrition projects and activities, with comparatively greater involvement of and more support from government ministries, UN agencies and non-governmental agencies compared to local communities, bilateral and private sectors and research and academic institutions. Monitoring and evaluation are important components of NPANs. They are, however, not given high priority and often not built into the plan. The role of an intersectoral coordinating body is considered crucial to a country's nutrition program. Most countries have an intersectoral structure or coordinating body to ensure the proper implementation, monitoring and evaluation of their NPANs. The workshop identified the constraints and key elements of success in each of the four stages of the NPAN process: development, operationalization, implementation, and monitoring and evaluation. Constraints to the NPAN process relate to the political and socioeconomic environment, resource scarcity, control and management processes, and factors related to sustainability. The group's review of NPAN identified successful NPANs as those based on recent, adequate and good quality information on the nutritional situation of the country, and on the selection of strategies, priorities and interventions that are relevant to the country and backed up by adequate resources. Continued high level political commitment, a multisectoral approach, and adequate participation of local communities are other key elements for success. The participants agreed on future actions and support needed from various sources for the further development, implementation, monitoring and evaluation of their NPANs. The recommendations for future actions were categorized into actions pertaining to countries with working NPAN, actions for countries without working NPAN and actions relevant to all countries. There was also a set of suggested actions at the regional level, such as holding of regular regional NPAN evaluation meetings, inclusion of NPAN on the agenda of regional fora by the regional organizations, and strengthening of regional nutrition networks.

Guideline Adherence↗

Mind-mapped care plans: a remarkable alternative to traditional nursing care plans.

Nursing care plans have helped students learn problem solving for nursing practice, but creativity and the interrelationship of patient problems are not stimulated by their linear nature. Joining mind mapping with care planning forces connections, engages whole brain thinking, and stimulates creativity. The authors describe mind mapping, infusion of mind-mapped care plans into the curriculum, the teaching/learning process of mapped care plans, and the positive outcomes of mind mapping nursing care plans.

Colorado↗

Integrating strategic environmental assessment with industry planning: a case study of the Pasquai-Porcupine forest management plan, Saskatchewan, Canada.

Strategic environmental assessment (SEA) is gaining widespread recognition as a tool for integrating environmental considerations in policy, plan, and program development and decision-making. Notwithstanding the potential of SEA to improve higher-order decision processes, there has been very little attention given to integrating SEA with industry planning practices. As a result, the benefits of SEA have yet to be fully realized among industrial proponents. That said, SEA practice is ongoing, albeit informally and often under a different label, and is proving to be a valuable tool for industry planning and decision-making. Based on a case study of the Pasquai-Porcupine forest management plan in Saskatchewan, Canada, this paper illustrates how an integrated approach to SEA can contribute to industry environmental decision-making and can enhance the quality and deliverability of industry plans.

Canada↗

Attitude towards family planning in Dharan, east Nepal: implications for the family planning programme.

A survey of the knowledge, attitude and practice of family planning was conducted in Dharan, Nepal. The town offers a full range of family planning services free of charge. There was a strong desire to limit family size; 52.5% of couples were currently using some modern method of family planning. Of the current users, 62.3% had been sterilized, including 92.3% of those in the lowest socioeconomic group. Health risks and incompleteness of the family were the most common reasons for non-use of contraception, the latter reason reflecting ignorance of the temporary nature of some methods. There was a strong preference for male children and couples rarely used contraception until at least one so had been born. Even in this prosperous town where couples were highly motivated towards family planning and all methods were readily available, there was heavy reliance on sterilization. This is typical of Nepal and has largely been responsible for the failure of the family planning programme--as most couples choosing sterilization are in the older age group and have completed a relatively large family. If Nepal is to succeed in meeting its target of reducing the total fertility rate (i.e., births per woman) from the current 5.8 to 4 by the year 2000 it will need not only to expand services but actively to promote temporary methods of contraception, particularly the more reliable longer acting reversible methods such as Depo-Provera, Norplant and intrauterine contraceptive devices.

Adolescent↗