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At least 1,153 records · Page 64Linked to original sources
PubMed2004

Participatory research in rural primary care.

Translating research into practice will require researchers to develop new methods and approaches. Standard randomized control trials may help determine the efficacy of a test or treatment but are unlikely to help identify what will make it possible to implement that new test or treatment in everyday practice. Rural practices may have unique needs that are best addressed using a participatory research model that allows collaboration among the researchers and those being studied. This article gives one example of participatory research used to help translate asthma guidelines into primary care in rural Minnesota practices.

Asthma↗
PubMed2004

Infection control programs in Italian hospitals.

OBJECTIVE: To quantify the frequency and features of infection control programs implemented in Italian public hospitals. METHODS: In 2000, a questionnaire was mailed targeting all teaching and research hospitals and those with more than 300 beds, and a random sample of 50% of the district hospitals with fewer than 300 beds. RESULTS: The overall response rate was 80%. Fifty percent of the 428 respondent hospitals claimed to have an infection control committee, 43% an infection control physician (average, 1 infection control physician per 2,963 beds), and 33% an infection control nurse (average, 1 infection control nurse per 572 beds). Having an infection control committee, nurse, and physician occurred significantly more frequently in Northern and Central Italy, where the Regional Authority had implemented a regional infection control policy, and in larger hospitals. Thirty-nine percent of the hospitals claimed to have ongoing surveillance in place, mostly based on laboratory results. Eighty percent of the hospitals had defined at least one written protocol related to infection control policies, mostly for housekeeping, cleaning, disinfecting and sterilizing patient equipment, or standard precautions; on the contrary, policies aimed at preventing specific infections were less frequent. CONCLUSION: This national representative survey showed that the infrastructure for infection control is suboptimal when compared with the guidelines and surveys published in other countries.

Cross Infection↗
PubMed2002

[Analyzing the drug resistance of Mycobacterium tuberculosis in Russia's experimental areas introducing the WHO tuberculosis control programme].

The authentic data on the drug resistance of Mycobacterium tuberculosis can be obtained only provided that standard laboratory procedures and the unified standardized method for determining the resistance are used along with a compulsory outside quality control over the performance of this test. The supervisory activities of the researchers of the Central Research Institute of Tuberculosis (CRIT), Russian Academy of Medical Sciences, made in some regions of Russia included standardization of methods and their implementation quality control allowed them to reveal and to correct main errors in drug resistance testing. In this connection, this made it to record the true level of M. tuberculosis resistance to essential antituberculous agents in the areas investigated by the researchers of CRIT. Analyzing the data on the drug resistance of M. tuberculosis in the above areas leads to the conclusion that 2000 was marked by rather high rates of primary drug resistance; nearly a fourth of all new and prior cases of pulmonary tuberculosis studied for its drug resistance were carriers of a M. tuberculosis resistant to at least one antituberculous agent.

Bacteriological Techniques↗
PubMed2004

Implementation of the WHO Multicentre Growth Reference Study in Oman.

The World Health Organization (WHO) Multicentre Growth Study (MGRS) Middle East site was Muscat, Oman. A survey in Muscat found that children in households with monthly incomes of at least 800 Omani Rials and at least four years of maternal education experienced unconstrained growth. The longitudinal study sample was recruited from two hospitals that account for over 90% of the city's births; the cross-sectional sample was drawn from the national Child Health Register. Residents of all districts in Muscat within the catchment area of the two hospitals were included except Quriyat, a remote district of the governorate. Among the particular challenges of the site were relatively high refusal rates, difficulty in securing adherence to the protocol's feeding recommendations, locating children selected for the cross-sectional component of the study, and securing the cooperation of the children's fathers. These and other challenges were overcome through specific team building and public relations activities that permitted the successful implementation of the MGRS protocol.

Breast Feeding↗
PubMed2006

Influence of a new province-wide trauma system on motor vehicle trauma care and mortality.

BACKGROUND: Mature trauma systems have evolved to respond to high rates of major injury morbidity and mortality. Characterized by prehospital care, triage, transportation, aggressive resuscitation, surgery, and rehabilitation, trauma systems have been found to improve survival for seriously injured patients. In Nova Scotia, a province-wide trauma system was implemented between 1995 and 1998. This study investigated the influence of the province-wide trauma system on motor vehicle trauma care and mortality in its first 2 years of existence. METHODS: Subjects over the age of 15 years were identified using E-codes pertaining to motor vehicle traffic crashes from population-based hospital claims and vital statistics data. Individuals who were hospitalized or died because of a motor vehicle crash in 1993 through 1994, before trauma system implementation, were compared with those who were hospitalized or died in 1999 through 2000, after the trauma system was implemented. RESULTS: In the 2-year period after trauma system implementation, there was a 21% increase in the number of seriously injured individuals with a primary admission to tertiary care. This increase was both clinically and statistically significant even after adjustment for age, gender, multiple injuries, head injury, municipality of residence, and vital status at discharge (RR, 1.21, 95% CI, 1.05-1.35). There was no evidence that the probability of dying while in hospital significantly changed in the first 2 years after trauma system implementation. INTERPRETATION: These results indicate that individuals seriously injured in motor vehicle crashes in Nova Scotia are more likely to be admitted to tertiary care in the postimplementation period.

Accidents, Traffic↗
PubMed1997

Population-based care of depression: effective disease management strategies to decrease prevalence.

This paper reviews the concepts of population-based care and disease management of major depression. Population-based care and disease management strategies motivated by health care reform provide approaches for organizing health services to lower the prevalence of common medical and psychiatric illnesses in primary care populations. We apply these concepts to the organization of services for patients with major depression.

Cross-Sectional Studies↗
PubMed1996

Application of TQM to mental health: lessons from ten mental health centers.

BACKGROUND: The principles and techniques of total quality management (TQM) have only recently been applied to the field of mental health. This article reviews issues and offers some preliminary observations, based on the author's consultation and training work with ten state-operated mental health organizations in Missouri (Jul 1, 1994-Jun 30, 1995). CULTURAL DIMENSION: Since many mental health organizations have operated in the public sector as part of large, hierarchical state agencies, the legacy of bureaucratic structures and a command and control leadership style may pose additional challenges. TECHNICAL DIMENSION: Two types of training have proven helpful in the Missouri project: general overview or awareness training for all staff and specialized training for team leaders and facilitators. STRATEGIC DIMENSION: To be successful with TQM, mental health organizations should clearly delineate their governing ideas, continuously reinforce them with all staff, and use the ideas as a measuring stick for progress. Some of the organizations in the Missouri project link their governing ideas and strategic planning efforts with critical success factors and the measurement methodology to track them. STRUCTURAL DIMENSION: This dimension, which may include a quality council, a quality department, and quality improvement (QI) teams, also extends to the way in which facilities are organized and function. The structure evolving from a team-oriented, time-limited, data-based, and problem-solving approach can facilitate the functioning of the entire organization. CONCLUSIONS: The philosophy and techniques of TQM are as applicable to mental health as to health care in general--the question is one more of motivation than of fit.

Adult↗
PubMed2002

Factors associated with coverage in community-directed treatment with ivermectin for onchocerciasis control in Oyo State, Nigeria.

Community-directed distribution with ivermectin (CDTI) has been adopted by the African Programme for Onchocerciasis Control (APOC) as its main strategy for achieving sustained high coverage in endemic communities. This article describes the coverage results achieved when CDTI was introduced in four local government areas of Oyo State, Nigeria. Using a household survey after the second distribution, researchers documented that 68.6% of the community overall received the drug, and as did 85.0% of those who were eligible (not pregnant, not sick and at least 5 years of age). Six factors were associated with having received ivermectin. Four were personal characteristics: being male, being at least 35 years of age, belonging to the Fulani ethnic minority, having taken the drug at a previous distribution. Two village characteristics were smaller size, as measured by number of houses, and use of the central place mode of distribution as opposed to house-to-house. In-depth interviews with village leaders and volunteer community-directed distributors (CDDs) and focus group discussions among villagers provided qualitative data to help interpret the findings. Women in many villages felt excluded from decision making. The concerns of migrant farm workers living in Yoruba farm settlements were not well understood by health staff or the majority population. The main factor associated with receiving the ivermectin was having received it before, and qualitative comments about side-effects and beliefs about orthodox drugs indicated that issues of personal preferences, not addressed in a household coverage survey, need to be explored further. The findings can provide guidance in re-orienting health workers to the importance of fostering participation and cohesion among all segments of the community, especially the inclusion of women and minority groups.

Adolescent↗
PubMed1995

Health concept of older Hispanic immigrants.

The purpose of this study was to explore the health concept of older Hispanic immigrants. In tape-recorded home interviews, 54 respondents were asked to define health, describe the characteristics of a healthy older person, identify what contributes to good health, and report what they did to maintain their health. Responses were transcribed and then analyzed qualitatively for categories and themes. Based on the findings, a concept of health evolved that included six major themes: integrating physical, emotional, and spiritual aspects; possessing mental health; feeling well; enjoying independence; practicing self-care; and orienting toward family. These themes will be useful to nurses in planning and implementing health services for similar older Hispanic immigrants.

Age Factors↗
PubMedDate not supplied

Improving the quality of patient discharge from emergency settings.

This article describes a nurse-led telephone service that was introduced to improve the quality of patient discharge from the emergency assessment area (EAA) of a large NHS acute teaching trust. The service originated from concerns regarding the increasing volume of telephone enquiries received from patients after discharge. In addition, an audit of patients' discharge plans revealed a minimalist/cursory approach to documentation. To improve discharge practice, a nurse-led telephone follow-up was introduced for all patients within 24 hours of discharge from the EAA. Evaluation over the first 12 months demonstrated improvement in the quality of discharge documentation and more explicit discharge plans. The service has successfully addressed issues regarding follow-up arrangements, documentation, new prescribed medications and GP letters. For its second year of operation, the service has been refocused using criteria linked to a new 'patient-focused' discharge checklist before discharge, to determine who is most likely to need telephone follow-up.

Continuity of Patient Care↗
PubMedDate not supplied

Government directives and changes: the potential impact on clinical practice.

Since publication of The new NHS: modern, dependable we have had more guidance and circulars from central government than have ever before been received in such a short space of time: 242 in 1998 and already well over 100 in 1999. Furthermore, 'joined-up government' may not have been achieved yet, but it certainly means that all agencies are being changed or modernised simultaneously, and so are all in the same position. This paper examines the impact that some of these directives and changes may have on clinicians and clinical practice. The paper does not deal with the issue of setting up primary care groups (PCGs), which could form the basis of an article on its own.

Delivery of Health Care↗
PubMed2001

Six sigma. The quest for quality.

Many hospitals are looking for a way to improve their quality performance to improve outcomes, increase patient satisfaction and lower costs. Frustrated by the slow gains from traditional quality programs, some executives have turned to Six Sigma, the statistical quality method made famous by Motorola and General Electric. But Six Sigma can be a difficult concept to grasp. Our toolkit will serve as a primer for health care executives to find out what Six Sigma is, how it can be applied to health care organizations, and how some hospital executives have made it work for them.

Cost Control↗
PubMedDate not supplied

National Iodine Deficiency Disorders Control Programme in India.

Iodine Deficiency Disorders are one of the biggest worldwide public health problem of today. Their effect is hidden and profound affecting the quality of human life. An attempt has been made to describe the various aspects of the National Iodine Deficiency Disorders control Programme (NIDDCP) being implemented in the country. The paper also focuses about the problems associated in implementing this national programme.

Adolescent↗
PubMed2005

Implementation and outcomes of commercial disease management programs in the United States: the disease management outcomes consolidation survey.

Despite widespread adoption of disease management (DM) programs by US health plans, gaps remain in the evidence for their benefit. The Disease Management Outcomes Consolidation Survey was designed to gather data on DM programs for commercial health plans, to assess program success and DM effectiveness. The questionnaire was mailed to 292 appropriate health plan contacts; 26 plans covering more than 14 million commercial members completed and returned the survey. Respondents reported that DM plays a significant and increasing role in their organizations. Key reasons for adopting DM were improving clinical outcomes, reducing medical costs and utilization, and improving member satisfaction. More respondents were highly satisfied with clinical results than with utilization or cost outcomes of their programs (46%, 17%, and 13%, respectively). Detailed results were analyzed for 57 DM programs with over 230,000 enrollees. Most responding plans offered DM programs for diabetes and asthma, with return on investment (ROI) ranging from 0.16:1 to 4:1. Weighted by number of enrollees per DM program, average ROI was 2.56:1 for asthma (n = 1,136 enrollees) and 1.98:1 for diabetes (n = 25,364). Most (but not all) respondents reported reduced hospital admissions, increasing rates of preventive care, and improved clinical measures. Few respondents provided detailed information about DM programs for other medical conditions, but most that did reported positive outcomes. Lack of standardized methodology was identified as a major barrier to in-house program evaluation. Although low response rate precluded drawing many general conclusions, a clear need emerged for more rigorous evaluation methods and greater standardization of outcomes measurement.

Disease Management↗