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At least 1,081 records · Page 60Linked to original sources
PubMed2006

The use of the life course paradigm and life course charts to explore referral for family history of breast cancer.

BACKGROUND: Life course research methodologies are used extensively in historical and social science research. In 1998 the life course paradigm was introduced to provide a way of tracing the interplay of person and setting. The method has had a very limited use in nursing research, but in this study it was utilized as a way of capturing dynamic change by placing the individual within a context of four domains; location in time and place, linked lives, human agency and timing of lives. OBJECTIVE: To describe the paradigm, review its use in healthcare research and provide a specific example of its use in healthcare. DESIGN: This paper discusses a novel method of creating life course charts for a qualitative study exploring the differing experiences of women referred from primary care to specialist services due to a family history of breast cancer. SETTING: A nurse-led breast cancer family history clinic in the UK. PARTICIPANTS: Twenty-two women. METHODS: Life charts were used in conjunction with a grounded theory approach to analyse data collected from semi-structured interviews. FINDINGS: Twenty-two life charts were created and the ability to layer the charts of multiple women to visualise similarities and differences aided the analysis. The life charts were a useful tool in the development of theoretical understandings and the psychosocial process of realisation of risk emerged as central to the initiation of referral. This was often apparent when approaching the age of an affected relative (anticipated onset) or when current circumstances emulate past experience (generational transference). CONCLUSIONS: This approach to charting complex psychological, social and contextual factors throughout the life course was methodologically beneficial and could have a wider utility in nursing and healthcare research. As a research tool it enhanced a holistic approach to patient care issues and was helpful as an aid to understanding health behaviours linked to familial risk.

Adaptation, Psychological↗
PubMed2006

Recent advances in the development of screening tools for mental health in young offenders.

PURPOSE OF REVIEW: To describe recent advances in the development of mental health needs screening tools for use with young offenders and implications for this vulnerable group. RECENT FINDINGS: The literature shows that young offenders in North America and Europe have high levels of diverse needs that often go unmet because of lack of methods for recognizing and assessing them. Effective screening could play an important role in improving recognition of these needs. Substantial developments have been occurring in the United States, England and Wales and the Netherlands in developing screening tools for this purpose and for this population. Now, the literature is beginning to provide a broad understanding of the optimal psychometric properties, utility and limitations of the screening tools that are required. SUMMARY: Several centres are engaged in work to construct mental health screening and assessment tools for use with young offenders. Psychometric measures are being used to determine their validity and reliability. The work has highlighted deficiencies in the healthcare of young persons involved in criminal justice systems but should assist policymakers, healthcare strategists, planners and commissioners to come to better informed decisions about how to utilize most appropriately the limited mental health expertise that is available and how to enhance awareness of nonhealth professionals of basic mental health risks, problems and disorders.

Adolescent↗
PubMedDate not supplied

A hospital-based, hazardous materials decontamination and treatment unit: utilization patterns over a nine-month period.

Federal [U.S.] law and the Joint Commission on the Accreditation of Healthcare Organizations mandate plans and mechanisms for response by hospitals to hazardous material incidents/accidents be developed and implemented. This paper describes the response of the University Hospitals of Cleveland to these regulations and to the anticipated needs of the community and local industry. The physical plant constructed and its relationship to the emergency department personnel for staffing this unit are described. Utilization patterns since implementation of this program are presented.

Decontamination↗
PubMed2006

The effect of neurohormonal antagonists in reducing heart failure hospitalizations.

OBJECTIVE: Heart failure (HF) is a major health problem facing the US and studies suggest that the incidence of this condition will rise significantly over the next 10 years. Limiting the incidence or duration of HF hospitalizations would, therefore, have a major impact on healthcare costs. The purpose of this review is to establish and discuss the proposed neurohormonal mechanisms by which HF can occur along with pharmacologic treatments designed to antagonize these pathological states in order to aid in the reduction of HF hospitalization. METHODS: A Medline search (to December 200) was performed to compile published literature and assess numerous large-scale studies regarding the use of neurohormonal antagonists in the treatment of HF. In addition, evaluation of statistics and figures from various organizations dedicated to the improvement of HF care was utilized as aids in understanding the impact of these therapies on hospitalization and healthcare. RESULTS: Heart failure is the most costly cardiovascular disease in the United States, with an estimated annual expenditure in excess of $20 billion. The frequency and duration of HF-associated hospitalizations are the key contributors to this pronounced economic burden. Use of pharmacologic interventions designed to specifically antagonize the renin-angiotensin-aldosterone system and the adrenergic system has had a significant impact on limiting hospitalization with regard to HF. However, the ever burdensome level of re-hospitalization rates for these patients is still problematic and appears to be based on a disconnect between established procedures to effectively treat these patients and the inability to accurately measure performance standards by managed care organization and hospital accreditation bodies. As a consequence, these antagonists, beta-blockers in particular, are still underutilized in the treatment of HF. Studies have shown that many of these hospitalizations could have been avoided had healthcare providers followed effective HF management programs. CONCLUSIONS: Current evidence supports the benefits of neurohormonal blockade in decreasing hospital admissions due to HF. Appropriate use of these agents plus agreed-upon guidelines for treatment can continue to significantly decrease total HF-related hospitalizations and costs. Inclusion of beta-blockers as a performance measure in quality-of-care HF indicators should be considered as an important instrument to increase their utilization and to improve overall HF care.

Adrenergic beta-Antagonists↗
PubMed2005

Stability of response characteristics of a Delphi panel: application of bootstrap data expansion.

BACKGROUND: Delphi surveys with panels of experts in a particular area of interest have been widely utilized in the fields of clinical medicine, nursing practice, medical education and healthcare services. Despite this wide applicability of the Delphi methodology, there is no clear identification of what constitutes a sufficient number of Delphi survey participants to ensure stability of results. METHODS: The study analyzed the response characteristics from the first round of a Delphi survey conducted with 23 experts in healthcare quality and patient safety. The panel members had similar training and subject matter understanding of the Malcolm Baldrige Criteria for Performance Excellence in Healthcare. The raw data from the first round sampling, which usually contains the largest diversity of responses, were augmented via bootstrap sampling to obtain computer-generated results for two larger samples obtained by sampling with replacement. Response characteristics (mean, trimmed mean, standard deviation and 95% confidence intervals) for 54 survey items were compared for the responses of the 23 actual study participants and two computer-generated samples of 1000 and 2000 resampling iterations. RESULTS: The results from this study indicate that the response characteristics of a small expert panel in a well-defined knowledge area are stable in light of augmented sampling. CONCLUSION: Panels of similarly trained experts (who possess a general understanding in the field of interest) provide effective and reliable utilization of a small sample from a limited number of experts in a field of study to develop reliable criteria that inform judgment and support effective decision-making.

Consensus Statements as Topic↗
PubMedDate not supplied

Healthcare reform through rationing.

Currently, the U.S. government cannot afford to pay for or ensure access to healthcare without limitations for all its citizens, as healthcare has become so expensive. Therefore, implementation of a rationing program is likely in the future for the U.S. healthcare system. Key stakeholders in such an initiative include citizens, healthcare providers, and the government. Americans expect to have unlimited access to care, but they do not like its high cost. Healthcare providers focus on giving the highest quality of care, with costs as a secondary concern. As a payer, the government wants to provide broader access to healthcare and, at the same time, reduce healthcare expenditures. The current debate over healthcare rationing surrounds three key questions: (1) can medically necessary procedures be ethically denied, (2) do Americans have a right to unlimited access to healthcare regardless of the costs, and (3) what is the limit on the availability of healthcare resources for those with the ability to pay. Proposals for rationing include developing a program similar to the Oregon Health Plan, using the quality-adjusted life years method, promoting self-rationing to consumers, or encouraging healthcare providers to actively and openly participate in bedside rationing. These proposals are evaluated based on their economic efficiency, fairness, and utility. The Oregon Health Plan is recommended among these proposals as it benefits the stakeholders through the explicit and equitable allocation of scarce healthcare resources.

Health Care Rationing↗
PubMed2006

Simulating staffing needs for surgical instrument distribution in hospitals.

Timely and accurate delivery of surgical instruments to operating rooms is critical for success in surgical operations in hospitals. The National Hospital of Singapore was facing several problems in the process of surgical instrument distribution on ad hoc orders from operating rooms. To solve the problems, the Hospital management considered adopting a new process of surgical instrument distribution on ad hoc orders that involves staffing new healthcare assistants for delivery of surgical instruments to operating rooms. Using computer simulation, this study assessed the efficiency of the new process and recommended the optimal number of healthcare assistants needed for delivery of surgical instruments on ad hoc orders, at which healthcare assistants as well as surgical instruments could be most efficiently utilized. The results show that computer simulation is an effective tool supporting decisions on staffing needs for surgical instrument distribution in hospitals.

Computer Simulation↗
PubMed2003

The clinical thrombosis center and clinical thrombologist: a new US health systems paradigm for the management of venous thromboembolic disease.

New paradigms for the diagnosis, prophylaxis, acute treatment, and ongoing management of patients with venous thromboembolic disease (VTE), a better understanding of the genotypic and phenotypic mechanisms of thrombophilic states, and the possibility of a greatly expanded armamentarium of antithrombotic therapies are necessitating a more formalized and systematic approach to VTE management. This has required many US healthcare institutions to develop piecemeal approaches in management models for VTE utilizing local champions from a variety of subspecialties. Development of a formalized Clinical Thrombosis Center from an already established Anticoagulant Management Service utilizing a clinical thrombologist, a new role for a physician who has developed expertise in anticoagulation and VTE management, presents a new paradigm in which this disease may be approached at a formalized, institutional level. Thus the clinical thrombologist working through a Clinical Thrombosis Center can develop a system-of-care approach to link the rapid advances in the field of thromboembolism to clinical applications, formulate evidence-based disease management guidelines, and conduct patient-oriented translational clinical research in VTE.

Cardiology↗
PubMed2002

Methodological strategies for the identification and synthesis of 'evidence' to support decision-making in relation to complex healthcare systems and practices.

This paper addresses the limitations of current methods supporting 'evidence-based health-care' in relation to complex aspects of care, including those questions that are best supported by descriptive or non-empirical evidence. The paper identifies some new methods, which may be useful in aiding the synthesis of data in these areas. The methods detailed are broadly divided into those that facilitate the identification of evidence and those that enable the interpretation of the data retrieved. To illustrate some of the issues involved, reference is made to a multimethod review recently completed by the authors, which aimed to identify factors that promote continuity in the transition from child to adult health and social care. It is argued that as healthcare organisations are becoming increasingly preoccupied with the evidence base of practice, such methods may help ensure that aspects of care and approaches that are outside the dominant pharmaco-medical domain maintain a prominent position on the healthcare agenda while remaining open to external scrutiny. Healthcare professionals who use such approaches need to know their relative utility and benefits to inform clinical decisions, so as to ensure that best practice is observed.

Adolescent↗
PubMed2006

The long-term cost-effectiveness of cardiac resynchronization therapy with or without an implantable cardioverter-defibrillator.

AIMS: Cardiac resynchronization therapy (CRT-P) is an effective treatment for patients with heart failure and cardiac dyssynchrony with moderate or severe symptoms despite pharmacological therapy. The addition of an implantable cardioverter-defibrillator (ICD) function may further reduce the risk of sudden death. We assessed the cost-effectiveness of CRT-P compared with medical therapy (MT) alone, and the cost-effectiveness of CRT-ICD + MT compared with CRT-P + MT, on incremental cost per quality adjusted life year (QALY) and life year using data from two landmark clinical trials. METHODS AND RESULTS: A Markov model with Monte Carlo simulation to assess costs, life years, and QALYs associated with CRT (+/- ICD) and MT in patients with heart failure and cardiac dyssynchrony, on the basis of a UK healthcare perspective was constructed. NYHA class distribution and transitions, associated health utilities, rates and cause of hospitalization and death were estimated from individual patient data from the CArdiac REsychronization in Heart Failure (CARE-HF trial). The estimated additional benefit on survival of an ICD was based on results from COMPANION. The base case analysis used 10 000 individual life-time simulations assuming a battery life of 6 years for CRT-P and 7 years for CRT-ICD. From a life-time perspective in a 65-year-old patient, the incremental cost-effectiveness of CRT-P compared with MT is 7538 euros (95% CI 5325-11,784 euros) per QALY gained and 7011euros (95% CI 5346-10,003 euros) per life year gained. The incremental cost-effectiveness of CRT-ICD compared with CRT-P is 47,909 euros (95% CI 35,703-79,438 euros) per QALY gained, and 35,864 euros (95% CI 26,709-56,353 euros) per life year gained. CONCLUSION: Long-term treatment with CRT-P appears cost-effective compared with MT alone. From a life-time perspective, assuming a reasonable life expectancy when receiving effective treatment for heart failure, CRT-ICD may also be considered cost-effective when compared with CRT-P + MT.

Adolescent↗
PubMed1997

The use of administrative data to risk-stratify asthmatic patients.

In this article, a simple methodology to risk-stratify asthmatics is presented and validated. Such a model can be used to identify those high risk and more severely ill asthmatics who could benefit the most from case management and increased educational efforts. Using logistic regression, the model was created to predict the probability of an asthma-related admission among all asthmatics who were members of a large HMO during calendar year 1994 (N = 54,573). The model used data from pharmacy, laboratory, and specialist claims, as well as encounter and demographic data available in U.S. Healthcare's administrative database. A member's prior asthma-specific utilization patterns, pharmaceutically determined severity of illness, and length of enrollment in the managed care organization had the most influence on the equation. A cross-validation of the model confirms how administrative data can be used to accurately risk-stratify those with a chronic disease. Finally, some additional research possibilities associated with the identification of high risk subscribers using only administrative data are outlined.

Adult↗
PubMed2002

Using the STS and multinational cardiac surgical databases to establish risk-adjusted benchmarks for clinical outcomes.

One of the purposes of collecting data on cardiac surgical procedures, at a national level is to enable individual surgeons to improve quality and benchmark their own practice by making more accurate prospective prediction of outcome of each individual patient by using risk stratification based on previous local and national experiences. The past decade has seen a dramatic increase in the development of national cardiac surgical initiatives in many countries around the world. The size and extent of these databases has successfully allowed their use for patient risk stratification and preoperative risk modeling in four main aspects: patient selection and informed consent, coherent analysis of the determinants of patient outcomes, rationalizing unit management, and negotiations with external agencies. Approximately 610 cardiac surgical units presently contribute their patient data, containing pre-operative risk factors, to centralized national registries. There are currently nine different datasets used throughout the world to collect patient information. To harmonize the considerable diversity among these source materials, an International Dataset has been developed by a collaborative process among more than 50 cardiac surgeons around the world. Constructed around the Society of Thoracic Surgeons (STS) data format, the International Dataset brings in key elements from all the other datasets, allowing the sharing of data and cross-analysis, thus greatly expanding the pool of patients, and national sources, from which risk-stratifed outcomes can now be analyzed and unified. Unlike the STS dataset, the International Dataset incorporates EuroSCORE, a simple-to-use, validated patient risk stratification system, which has been rapidly adopted by large numbers of centers around the world for patient risk stratification, outcomes assessment, and improving patient informed consent. There are several benefits to collecting and centralizing national and international data: (1) understanding and defining basic demographics of patients undergoing cardiac surgery; (2) patient risk stratification and risk prediction at both a national and center-by-center level; (3) unit benchmarking, and development of effective nationally oriented and center-oriented quality improvement programs; (4) understanding and rationalizing resource utilization; and (5) use of data to leverage governments and other healthcare providers to affect policy. Cardiac surgical registries will soon attempt to track patients for longer follow-up periods after discharge in order to identify surgery-related deaths for more extended periods of time following surgery, thereby improving the monitoring and prediction of patient outcomes.

Benchmarking↗
PubMedDate not supplied

Resource utilization in home health chronic obstructive pulmonary disease management.

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in this country, with a total annual cost of approximately $23 billion. This study examined the impact on total resource utilization when a pulmonary specialty team manages the in-home healthcare of the patient suffering from advanced COPD. Following implementation of the pulmonary specialty team, the use of hospital, emergency department, and skilled nursing facility resources decreased while home healthcare resource use increased. The overall costs were reduced on average by more than $13,000 per patient.

Emergency Service, Hospital↗
PubMed2005

Telehealth for wound management in long-term care.

Telehealth facilitates provision of healthcare services at distant sites using electronic communications. A pilot project utilizing telehealth was initiated in a long-term care community to assess the wounds of geriatric residents. Over a 1-year period, nine patients requiring a total of 21 visits were evaluated by an offsite University of Virginia Health System wound nurse practitioner via telecommunication. Traditionally, frail elders are seen in the local wound care clinic, necessitating often costly and physically strenuous transport. The technology in this program incorporated use of a videoconferencing device, television monitor, and a patient camera. Average round trip cost savings for transporting immobile residents was $650; hence, substantial cost containment was achieved. In addition, quality of care improved because residents were not required to leave their facility for the 3 to 4 hours required to travel to and from the clinic. Although no formal satisfaction surveys were administered, resident and family response to the service was favorable. With continued documentation of patient satisfaction and cost savings, this service eventually may be available to other long-term care facilities in the area.

Aged↗
PubMedDate not supplied

Evidence-based practice needs evidence-based implementation.

Clinical pathways have been designed to provide an effective interface between evidence and practice in healthcare. Strong evidence supports the assertion that when clinical pathways are utilized they improve outcomes. However, published evidence measuring the uptake of clinical pathways by health professionals remains sparse. This article presents a study evaluating the degree of documented compliance with the clinical pathway chart used for patients diagnosed with an acute myocardial infarction (AMI) in a major Australian regional hospital. The relationships between compliance and demographic and illness were also examined. Data were collected from 124 records with the result that the level of documented compliance was 16.5%. Clients with private health insurance had significantly higher documented compliance with the clinical pathway than those with no private health insurance. There were also significant variations in documented compliance according to the type of AMI recorded. Recommendations to improve compliance with clinical pathways are included along with recommendations for future research.

Adult↗
PubMed2005

Overcoming barriers and promoting the use of research in practice.

OBJECTIVES: To identify changes in nurse attitudes toward research utilization and the organization's research environment preimplementation and postimplementation of a multifaceted intervention to promote the use of research in practice. BACKGROUND: Nursing practice based on research evidence has been shown to promote positive patient outcomes. Personal characteristics such as positive attitudes and involvement have been positively correlated with research utilization. Organizational culture is a determinant of nurses' use of research in practice. Healthcare organizations must develop a supportive environment in an effort to attract nurses who share a similar philosophy to positively influence the organization's research culture and ultimately the care patients receive. METHODS: A descriptive, cross-sectional, presurvey and postsurvey design was used to identify inpatient nurses' personal and professional characteristics, perceptions of organizational culture, and the effectiveness of organizational strategies. Baseline and post implementation data were collected using the BARRIERS to Research Utilization Scale and the Research Factor Questionnaire. RESULTS: There was improvement in nurses' perception of barriers and organizational culture postimplementation of the multifaceted intervention. Journal club participation was one of the key strategies that facilitated research utilization. CONCLUSIONS: Moving research findings into practice is important for the nursing profession. Barriers to the use of research findings in practice must be modified. A dialogue between administration and staff about how to remove the barriers is critical.

Adult↗
PubMed2005

Navigating the information technology highway: computer solutions to reduce errors and enhance patient safety.

Standardized, seamless, integrated information technology in the health-care environment used with other industry tools can markedly decrease preventable errors or adverse events and increase patient safety. According to an Institute of Medicine (IOM) report released in 1999, preventable errors have caused between 44,000 and 98,000 deaths per year. Following the report, President Bill Clinton requested that the Agency of Healthcare Research and Quality, a government agency, look into the issue and fund, at the local or state level, processes that can reduce errors. Funding subsequently was made available for research that utilizes best practice tools in clinical practice to increase patient safety. The Joint Commission on Accreditation of Healthcare Organization has placed a great deal of emphasis on strategies to reduce patient identification errors. Fragmented systems tout the individual as well as enhanced safety applications. These applications, however, are related to prevention in specific conditions and in specific health-care settings. Systems are not integrated with common reference data and common terminology aggregated at a regional or national level to provide access to patient safety risks for timely interventions before errors and adverse events occur. Standardized integrated patient care information systems are not available either on a regional or on a national level. This article examines tangible options to increase patient safety through improved state-of-the-art tools that can be incorporated into the health-care system to prevent errors.

Accreditation↗
PubMed2000

Review of the methodologies and applications of scoring systems in neonatal and pediatric intensive care.

Scoring systems and risk prediction rules quantitate the severity of clinical conditions and stratify patients according to a specified outcome. In intensive care medicine, the complexity and number of clinical scoring systems is increasing as their utility in both health services research and clinical medicine broadens. We anticipate that with increasing healthcare costs and competition, the demand for risk adjusted outcomes and institutional benchmarking will increase. As academicians and clinicians, it is vital to be knowledgeable regarding the methodologies and applications of these scoring and risk prediction systems to ensure their quality and appropriate utilization.

Journal Article↗