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PubMed1996

Eco-wellness nursing: getting serious about innovation and change.

Eco-wellness nursing represents a creative, challenging and empowering approach for facilitating a sustainable future for people and their environments, focusing beyond positivistic explanations and solutions, towards a more emancipating eco-centric praxis. Underlying this approach are the principles of 'wellness', 'holism', and a 'reflexive and sustainable eco-culture'. The goal is helping people understand how to sustain their wellness, including their environments. Negotiating or brokering change from a traditional nursing model will require a revision of focus in roles, attitudes, contexts and actions of nurses. Crucial in this transformation is greater nursing independence in the private marketplace, which may involve consultancies, collaborative ventures, utilization of new technologies such as multimedia communications, and targeted nursing oriented research and development.

Diffusion of Innovation↗
PubMed2003

Cultural innovation and transmission of tool use in wild chimpanzees: evidence from field experiments.

Chimpanzees (Pan troglodytes) are the most proficient and versatile users of tools in the wild. How such skills become integrated into the behavioural repertoire of wild chimpanzee communities is investigated here by drawing together evidence from three complementary approaches in a group of oil-palm nut- ( Elaeis guineensis) cracking chimpanzees at Bossou, Guinea. First, extensive surveys of communities adjacent to Bossou have shown that population-specific details of tool use, such as the selection of species of nuts as targets for cracking, cannot be explained purely on the basis of ecological differences. Second, a 16-year longitudinal record tracing the development of nut-cracking in individual chimpanzees has highlighted the importance of a critical period for learning (3-5 years of age), while the similar learning contexts experienced by siblings have been found to result in near-perfect (13 out of 14 dyads) inter-sibling correspondence in laterality. Third, novel data from field experiments involving the introduction of unfamiliar species of nuts to the Bossou group illuminates key aspects of both cultural innovation and transmission. We show that responses of individuals toward the novel items differ markedly with age, with juveniles being the most likely to explore. Furthermore, subjects are highly specific in their selection of conspecifics as models for observation, attending to the nut-cracking activities of individuals in the same age group or older, but not younger than themselves. Together with the phenomenon of inter-community migration, these results demonstrate a mechanism for the emergence of culture in wild chimpanzees.

Animals↗
PubMed2002

Needed: models of biotechnology intellectual property.

Although never uncontroversial, intellectual property rights in biotechnological innovation are once more the focus of intense debate. The debate has yet to reach any result, largely because of several important errors in the way that various disciplines approach it. These errors include making assumptions without empirical basis and conflating various intellectual property regimes. What is needed is a transdisciplinary integrated method to correct these errors. Such a method can be implemented through the construction of alternative models of intellectual property protection designed to balance the various social, ethical and economic constraints that affect biotechnology.

Biotechnology↗
PubMed2005

Organizational climate in air traffic control Innovative preparedness for implementation of new technology and organizational development in a rule governed organization.

A positive and innovative organizational climate is of great importance in order to manage and adapt to change. Such a climate seldom evolves in organizations closely governed by rules and regulations. Because of ongoing organizational and technical changes within the Swedish Air Navigation Services Provider, a study concerning the organizational climate for changes and innovations was conducted to investigate the organization's capacity to cope with changes. Study locations were the two Swedish main air traffic control centers and parts of the civil aviation administration headquarters. In the study 390 subjects took part and the CCQ questionnaire was used to measure the organizational climate. The results show that the organizational climate is quite positive despite the rule-governed work. The results also show that administrative personnel assess the organizational climate as more positive than operative personnel. Comparisons between management positions did not result in any differences.

Adult↗
PubMed2002

The socio-legal acceptance of new technologies: a close look at artificial insemination.

Heated debates often surround the introduction of an important new technology into society, as exemplified by current controversies surrounding human cloning and privacy protection on the Internet. Underlying these controversies are disruptions to central socio-legal values caused by these new technologies. Whether new technologies will eventually be accepted by society is often contingent on the reaction of the legal system. This mandates the formulation of a conceptual framework for understanding and structuring the way the law should react in cases surrounding the adoption of new technologies. By using the case study of artificial insemination this Article develops the tools for structuring the legal role in the acceptance process of new technologies. The three-century controversy surrounding the innovation of artificial insemination results from the innovations' disruption of the socio-legal value of the family. Artificial Insemination--although invented in the eighteenth-century--was rarely used until the 1930s, and only legalized in the 1960s. Its application to surrogacy and its use by unmarried women extends the controversy into the twenty-first century. The case study demonstrates the nature of the relationship among the technological, social and legal acceptance processes of new technologies, and analyzes the legal acceptance debate. The conceptual framework produced is useful in understanding and structuring the legal role in current debates surrounding the introduction and acceptance of new technologies.

Attitude↗
PubMedDate not supplied

Guidelines for reporting innovations in computer-based information systems for nursing.

Inconsistent, incomplete reporting of computer applications in nursing is a barrier to building a knowledge base in the field. Progress in building this knowledge base might be accelerated if system developers could use the available literature to build upon work previously done and to profit from lessons already learned. This article presents guidelines for developing articles and reports on computer applications in nursing. Important topics include statement of the problem, proposed solution, description of the system, system impact, relationship to previous work, problems encountered, lessons learned, professional issues, transferability, and future plans. A checklist is provided. The authors welcome comments on these guidelines.

Communication↗
PubMedDate not supplied

Innovations in central vascular access device insertion.

The new millennium has brought with it many technological advances that have affected every industry, especially healthcare and nursing. The key to success will be the ability of nurses to acclimate to these changes. To accomplish this, nurses need to advance their individual practice and skills, and to pursue and maintain an education in their respective fields. At no other time in healthcare history have so many changes taken place in such a short time, and nurses must remain abreast of changes to ensure career securement, advancement, and the safety of their patients. This article focuses on peripherally inserted central catheters and the changing technology for their insertion, maintenance, and training requirements.

Catheterization, Central Venous↗
PubMedDate not supplied

The Internet and managed care: a new wave of innovation.

Managed care firms have been under siege in the political system and the marketplace for the past few years. The rise of the Internet has brought into being powerful new electronic tools for automating administrative and financial processes in health insurance. These tools may enable new firms or employers to create custom-designed networks connecting their workers and providers, bypassing health plans altogether. Alternatively, health plans may use these tools to create a new consumer-focused business model. While some disintermediation of managed care plans may occur, the barriers to adoption of Internet tools by established plans are quite low. Network computing may provide important leverage for health plans not only to retain their franchises but also to improve their profitability and customer service.

Case Management↗
PubMed1990

Financing the correct rate of growth of medical technology.

This article suggests ways to preserve innovation while partially restraining the impressive growth rate in new medical technology. Health care will soon consume 12 percent of GNP. There is a wide range of opinions as to whether medical technology is a major or minor source of rising health care expenditures. Given our current fiscal problems, health care providers will be in direct competition with education and other domestic programs for a limited supply of R&D funds. More funding will have to come from the private sector. The challenge for prudent buyers of health care services is to control costs without eroding the biomedical capacity of the nation.

Diffusion of Innovation↗
PubMed1990

Guidelines for medical practice: 1. The reasons why.

Various external special interest groups are promoting attempts to better measure and control the performance of the medical profession, primarily to restrain costs. We can neither afford to ignore the rising costs nor reject efforts by provincial licensing authorities to improve supervision of the quality of care. Furthermore, there is increasing public interest in the outcome of medical treatment and a suspicion that some care may be unnecessary or inappropriate. Much of what physicians do is not based on impeccable or complete scientific evidence, and we have not established a method whereby science can consistently be translated into practice. Optimal practice patterns must be defined to improve the quality of care and to maximize the efficiency with which scarce resources are used. Careful scientific evaluation of data is particularly necessary with the arrival of new drugs and technology. Sensible, flexible guidelines produced by appropriate panels will help promote improved practice. Rigid standards must be avoided to allow for individual consideration and scientific innovation. The recognized difficulties of influencing clinical practice by precept or education and the problems imposed by rapidly changing scientific knowledge are two hurdles to be overcome. Licensing bodies must identify and enforce minimal standards, but optimal practice patterns are better devised by a broader segment of the profession. Intervention by third-party payers, as is prevalent in the United States, intrudes upon physician autonomy and reduces access to care. Physicians must support the development of guidelines for optimal medical practice based on the best existing data and focused on improving the quality of care.

Canada↗
PubMedDate not supplied

[Towards a new vaccine economy?].

When Jonas Salk announced in the mid-50s the availability of a new vaccine against poliomyelitis, the world had the impression that it was now controlling infectious diseases. In fact, the success of this vaccine has been considerable and although some innovations lead to the launch of vaccines against flu, measles, rubella or mumps, the world vaccine market remained remarkably stable till the mid-80s. However, since 1984 (launch of the hepatitis B vaccine) there have been very substantial changes and further change is expected in the next ten years in the world market. Today, big companies are making a concentrated supply: Pasteur Mérieux with its subsidiary Connaught, SmithKline Beecham who acquired the Belgian company RIT, and Merck & Co. who is joining its forces with Pasteur Mérieux. Medium sized and small companies remain and reflect the situation of the past, but must work hard to secure their long term existence eventhough the world demand is going to double before the year 2000. Very substantial technological innovations explain to a large extent the development of the supply: progress in molecular biology, and particularly genetic engineering, lead to recombinant vaccines of which hepatitis B is the best example with worldwide sales in the range of $600 million a year. Similarly, conjugation technologies have allowed the development of new vaccines against meningitis, particularly Haemophilus influenzae type b. More recently, an efficacious vaccine against hepatitis A has been launched and many new products will be marketed in the next years against herpes, Lyme disease, and agents of other meningitis, etc.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed2005

Medicare: making it a force for innovation and efficiency.

An aging population, the addition of a prescription drug benefit, and federal budget deficits require policymakers to continue to explore ways to improve Medicare. Because Medicare is such a large share of health care spending, initiatives to improve its efficiency and the quality of care it funds will potentially influence the health care system as a whole. Current strategies to improve the quality of care and efficiency of the program focus on getting beneficiaries to migrate to better-performing providers, or intervening more directly to encourage the system to provide higher quality, more efficient care. Some strategies try to increase information sharing overall, some focus primarily on providers or beneficiaries, while others target specific diseases.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2006

Innovative applications of epidemiology, evidenced based interventions and economic analyses of office related upper extremity disorders.

In September 2005 a small working conference was held to generate potential next steps in the generation of innovative approaches to work related upper extremity symptoms and disorders among those working in office environments. This special section of the Journal includes papers written by the presenters and their collaborators. These papers provide "state of the art" summaries of research in the areas of ergonomics, biobehavioral factors and interventions, economics and integrative interventions at the workplace. Invited speakers and participants from various stakeholder groups spent a second day discussing the implications of the research presented on day one for improving the understanding and management of these disorders. Practical considerations for generating new approaches and their implementation were also discussed.

Cost-Benefit Analysis↗
PubMed2006

Functional health: innovations in research on physical activity with older adults.

PURPOSE: This symposium was structured to provide two keynote addresses and recent innovations on the topic of physical activity interventions. OVERVIEW: In the first paper, Drs. W. Jack Rejeski and Lawrence R. Brawley combine the content of their two keynotes into a single integrative review. This paper is then followed by four studies that build on and extend the research reviewed in their keynotes. The first is a study that examines the measurement properties of a scale designed to assess older adults' desire for physical competence. The second is an experiment that tests the efficacy of a brief intervention for increasing older adults' motives to attend educational sessions on physical activity in the context of assisted living. The third involves a pilot study in older adults that explores the feasibility and efficacy of using a group-mediated intervention for psychological empowerment in conjunction with more traditional methods of strength training. The fourth examines an innovative intervention that was designed to link the abilities acquired during strength training to older adults' performance of activities of daily living. CONCLUSIONS: Physical activity interventions should be designed to promote collaborative relationships between interventionists and participants. Older adults bring with them symptoms, emotions, motives, and beliefs that are as important to adherence and to the outcomes of interventions as the physical training regimen itself. Furthermore, from the perspective of both behavior change and physical training, the design of physical activity programs for older adults should pay close attention to intended objectives.

Activities of Daily Living↗
PubMed2006

Cancer Care Ontario's computerized physician order entry system: a province-wide patient safety innovation.

More than one-third of all women and men in Canada will develop cancer during their lifetimes. Cancer patients typically require complex chemotherapy regimens, specific to their type and stage of disease, to slow or stop cancer cells from growing, multiplying, or spreading to other parts of the body. Despite the complexity of managing medication regimens for cancer patients and the associated risks to patient safety, current medical oncology practice throughout most of Canada is still to use paper-based tools, policies and procedures. To increase patient safety by reducing prescription errors and to offer clinical decision support to medical oncologists across the province, Cancer Care Ontario (CCO) developed and implemented Canada's first, cancer-specific computerized physician order entry (CPOE) system. This e-health innovation is currently in use in 11 cancer centres, and represents the largest ambulatory oncology CPOE implementation in Canada, with a 100% implementation success rate, and greater than 90% physician adoption. This paper describes the critical success factors in the design and implementation of CCO's CPOE system, including Web-based training and ease of administration to maximize physician adoption, incorporating point-of-care access to clinical practice guidelines into the tool, and the use of CPOE data to monitor and increase access to anti-cancer drugs and patient safety.

Cancer Care Facilities↗
PubMed2006

Preventing medication errors in hospitals through a systems approach and technological innovation: a prescription for 2010.

Medication errors in hospital settings are considered both widespread and costly to the American healthcare system; yet, it is tractable to available solutions. This article offers a novel prescription for the problem that could be implemented by 2010. It consists of a systems approach--failure mode effects analysis (FMEA)--in combination with emerging technologies, such as a decision support system (DDS) with integrated real-time medical informatics, electronic medical records (EMR), computer physician order entry (CPOE), bar coding, automated dispensing machines (ADM), and robotics. Cost and benefit analysis reveals that this proposed integrated solution will radically reduce medication errors in hospitals and save the lives of thousands of Americans who frequent such facilities on an annual basis, as well as reduce healthcare costs.

Diffusion of Innovation↗
PubMed2002

Innovation in early breast cancer surgery: radio-guided occult lesion localization and sentinel node biopsy.

The surgical management of non-palpable breast lesions remains controversial. At the European Institute of Oncology we have introduced a new technique, radio-guided occult lesion localization (ROLL) to replace standard methods and overcome their disadvantages. Regarding axillary dissection, probe-guided biopsy of the sentinel node (SN) is easy to apply, and the whole procedure is associated to a low risk of false negatives. We suggest that the SN technique should be widely adopted to stage the axilla in patients with breast cancer with clinically negative lymph nodes. Large-scale implementation of the sentinel node technique will reduce the cost of treatment as a result of shorter hospitalization times.

Breast Neoplasms↗
PubMed2003

Health technology assessment in its local contexts: studies of telehealthcare.

Health technology assessment (HTA) is one of the major research enterprises of late modernity, reaching into fields of previously autonomous professional practice, and critically interrogating the organisation and delivery of health care. The 'evaluation' of new health technologies within the field of HTA is increasingly a normative political expectation, as discourses of 'evidence-based' practice run through health policy in the UK and elsewhere. Despite its importance in governing the direction of innovation in health care delivery, there are hardly any empirical studies of HTA in practice. In this paper, we draw on two ethnographic studies of telehealthcare implementation and evaluation in the UK to explore the practical conduct of HTA, and we focus specifically on the social organisation and conduct of randomised controlled trials of these new technologies. The paper examines how evaluation forms a mediating set of practices that make the embedding or normalisation of a new technology possible; and present a simple model of the social and technical contingencies within the evaluation process.

Anthropology, Cultural↗