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PubMed2004

Continuing medical education. The point of view of asthmatic patients at the beginning of a mandatory CME system.

BACKGROUND: CME is well established in the USA and many European countries, but in Italy it became mandatory by law starting from 2002. The patient's opinion is a critical feedback signal for the outcomes of CME. We attempted, through a structured questionnaire, to evaluate the patient's opinion on CME a few months after its introduction. METHODS: A structured questionnaire involving 8 items concerning several aspects of CME was administered to asthmatic outpatients all over Italy. The questionnaire was anonymous and collected only demographic data. RESULTS: 298 questionnaires were eligible for analysis. One third of the patients were informed about the Health Ministery Law. 42% of patients indicated the update knowledge as the priority in CME, followed by communication with patients (14.09%) and attention to Quality of Life (13.09%). DISCUSSION: Independently of the Health Ministery Law knowledge, patients consider that the updating of knowledge has the priority in the professional development plan; the improvement of skills as communication with the patient and his family and the attention for Quality of Life, are recognized as more important than economical aspects of disease management.

Adolescent↗
PubMed2004

Animal habitats for space experiments.

There has been little opportunity for flight experiments using small animals, due to delay of construction of the International Space Station. Therefore, proposals using small animals have been unfortunately excepted from International Space Life Sciences Experiment application opportunity since 2001. Moreover, NASA has changed their development plan of animal habitats for space experiments according to changes of the U.S. space policy and the outlook is not so bright. However, international researchers have been strongly requesting the opportunity for space experiments using small animals. It will be also important for Japanese researchers to make a request for the opportunity. At the same time, researchers have to make an advance in ground based studies toward space experiments and to respond future application opportunities immediately. In this symposium, we explain the AEM (Animal Enclosure Module), the RAHF (Research Animal Holding Facility), and the AAH (Advanced Animal Habitat). It will be helpful for investigators to have wide knowledge of what space experiment is technically possible. In addition, the sample share program will be introduced into our communities. The program will provide many researchers with the organs and tissues from space-flown animals. We will explain the technical aspect of sample share program.

Animals↗
PubMed2005

[Factors related to the demand of caregivers for institutionalization of disabled persons living at home].

PURPOSE: Recently, there has been an increase in the number of caregivers who are demanding institutionalization of the disabled, despite having taken care of them at home since their birth. It is important to clarify the background of this demand in order to help develop plans aimed at socially supporting the caregivers. This study was aimed at elucidating the factors related to demands of caregivers to have disabled persons living at home institutionalized. METHODS: To caregivers of 410 home-living disabled persons, we handed out and collected questionnaires asking for the following information: age of the disabled persons and their caregivers, severity of the disability, status and level of manageability of the caregivers, and the place where the caregivers wanted the disabled to live in the future. The demand for institutionalization of the disabled and the attributes of the responders were analyzed by multiple logistic regression. RESULTS: From the responses of 297 people who replied to the questions, univariate analysis revealed that the demand for institutionalization significantly correlated with the labels of "severe" in the mental disability certificate, "incapable of conversation" according to the Office of Population Censuses and Surveys (OPCS) scale, "severe disability" in Oshima's classification and "unfit" and "unable to give daily care." The results analyzed by multiple logistic regression revealed that older caregivers had a significantly higher odds ratio (18.3 for those in their 40s and 37.2 for those in their 50s), indicating a strong correlation between the demand for institutionalization and the age of the caregivers. According to the mental disability certificate, the odds ratio of those with "A" was 5.0 relative to "other than A," while the odds ratio was 3.8 for those "unable to give care" against "able to give care," in both cases statistically significant. As for suffering in daily life, a majority of the caregivers aged 50 years or older claimed "a limit to home caring" and "aging". Regarding the shortage of public welfare services, a large percentage pointed out the inconveniences of emergency short stay, short stay, day care, and bathing services. CONCLUSION: The factors related to demand for institutionalization of disabled care receivers at home were aging of the caregivers, incapability of giving daily care, and severe mental impairment. The age of the caregivers was identified as an explicit factor.

Adolescent↗
PubMedDate not supplied

Six areas lead national early immunization drive.

On June 13, 1991, President George Bush announced in a White House ceremony a local planning effort to break down barriers and provide better access to immunization in six representative localities "to solve the problem of late immunization." (children need to be immunized appropriately by their second birthday, not just in time for school.). The community "Immunization Action Plans" (IAP) are one of several Federal, State, and local responses to an outbreak of measles that produced 27,600 cases and 89 deaths in 1990. The community effort and subsequent early childhood immunization plans around the country are also part of a much broader effort initiated by Secretary Sullivan as a Healthy People Year 2000 goal to increase immunization levels to at least 90 percent for the nation's children by their second birthday. These efforts also respond to 13 recommendations for improving immunization availability made by the National Vaccine Advisory Committee in January 1991. The recommendations focused on improvements in the management of immunization delivery and in methods for measuring immunization status, increasing appropriate consumer demand, and other prevention needs. Although measles prompted the action, the immunization initiative is aimed also at eight other communicable childhood diseases--diphtheria, tetanus, pertussis or whooping cough, poliomyelitis, mumps, rubella, and Haemophilus influenza type b that causes bacterial meningitis, and hepatitis B. Details are described of the immunization action plans developed by Dallas, TX; Maricopa County (Phoenix), AZ; South Dakota; Detroit, MI; San Diego, CA; and Philadelphia, PA, to ensure that children are fully immunized not just by the time they enter school but by age 2 years. The six were chosen by the Centers for Disease Control as representative of many without adequate childhood immunization coverage.

Arizona↗
PubMedDate not supplied

A nursing update course. Service and education collaborate.

This article describes the planning, development, implementation and evaluation of a nursing update course. It identifies collaboration between a hospital and college as the key element in the program's success. Evaluation showed the program was effective in recruiting and educating students; it helped alleviate a local nursing shortage and brought nursing practice and education together, and 87% of the course participants either returned to practice or entered formal education programs to continue their professional development.

Budgets↗
PubMed2004

Implementation of an event reporting system in a transfusion medicine unit: a local experience.

Event reporting can provide data to study the failure points of an organization's work process. As part of the ongoing efforts to improve transfusion safety, a Medical Event Reporting System Transfusion Medicine, (MERS - TM) as designed by Kaplan et al was implemented in the Transfusion Medicine Unit of the University Malaya Medical Centre to provide a standardized means of organized data collection and analysis of transfusion errors, adverse events and near misses. An event reporting form was designed to detect, identify, classify and study the frequency and pattern of events occurring in the unit. Events detected were classified according to Eihdhoven Classification model (ECM) adopted for MERS - TM. Since our system reported all events, we called it Event Reporting System - Transfusion Medicine (ERS-TM). Data was collected and analyzed from the reporting forms for a period of five months from January 15th to June 15th 2002. The initial half of the period was a process of evaluation during which 118 events were reported, coded, analyzed and corrective measures adopted to prevent the recurrence of the same event. The latter half saw the reporting of 122 events following the adoption of corrective measures. There was a reduction in the occurrence of some events and an increase in others, which were mainly beyond the organization's control. A longer period of evaluation is necessary to identify the underlying contributory causes that can be useful to develop plans for corrective and preventive action and thereby reduce the rate of recurrence of errors through proper training and adoption of just culture.

Academic Medical Centers↗
PubMed2005

[The fight against tuberculosis and developments in public health from 1890 to 1930 in Italy].

The author presents the developments in society and public health that paved the way, thanks to the birth of social and scientific associations and later to state intervention, for the establishment of hospitals for tuberculosis in Italy at the beginning of the 20th century. From 1890 onwards many fruitful meetings, conferences and debates ultimately led to the passing of a specific law on public health care; in 1927 this law covered about half the population. The First World War was undoubtedly the prime cause that stopped the downward trend in mortality and morbidity from the tuberculosis epidemic in the early 20th century. Early on, Bologna, together with other cities in Tuscany and Lombardy, developed plans for therapy (i.e. hospitals for tuberculosis) and prevention (i.e. holiday camps). However, in Italy in the 1930s tuberculosis continued to be a major problem despite such improvements in public health. In Europe, Germany was the nation that pioneered the fight against tuberculosis by social, scientific and legislative means. Since 1883 there had been a specific law for insurance against illnesses and a network of sanatoria had been established.

Antitubercular Agents↗
PubMed2005

Continuing professional development--supporting the delivery of quality healthcare.

Patients and the general public have a right to expect that doctors remain up to date and are professionally competent. The ultimate aim of continuing professional development (CPD) is to contribute to high-quality patient care. The General Medical Council in the UK has published guidance in relation to standards for CPD, appraisal and revalidation. Doctors in the UK participate in an annual appraisal, the outcome of which is the development of the Personal Development Plan. This paper describes a framework for effective CPD and includes methods of self-assessment of clinical practice. Contributions to effective CPD come from 3 sources--doctors, CPD providers and accrediting bodies. The CPD system of recording credits currently in use by the Royal Colleges of Physicians in the UK is also described.

Education, Medical, Continuing↗
PubMed2006

Surveying the RHIO landscape. A description of current RHIO models, with a focus on patient identification.

Across the country, new RHIOs are being formed every day. The 21 RHIOs studied by the work group illustrate the variety of purposes, funding, and record linking methods RHIOs may adopt. As this trend continues to evolve and improve, RHIOs may prove to be a valuable stepping stone on the road to a national system in which a patient's medical data will be available anywhere, anytime. Accurate patient identification and linking are the foundation of health technology that is implemented in a RHIO or any similar network that shares patient information. Without accurate patient identification, patient safety and quality of care are compromised. When high percentages of duplication or overlaying of records occurs in electronic health record databases, physician trust in the system is lost. As HIM professionals, we must be involved in addressing the security and confidentiality of RHIO databases and in defining the record linking method appropriate to the RHIO. As professionals skilled in patient identification methods and possessing significant organizational skills and personnel management experience, HIM professionals should become involved in this process at the earliest opportunity in the RHIO formation. HIM professionals can participate in long-term planning, business plan development, and organizational structure definition. Future articles will address how HIM professionals can become involved, what particular attributes and skills they can bring to the table, and job descriptions appropriate to HIM professionals in the healthcare information sharing industry. The work group urges all HIM professionals to become involved personally in this exciting new field.

Humans↗
PubMedDate not supplied

Community-based organizations and CDC as partners in HIV education and prevention.

By 1982, community responses to the acquired immunodeficiency syndrome (AIDS) epidemic were evident in some cities in the United States. Community responses were planned, developed, and coordinated largely by service-oriented, community-based organizations. Indirect evidence suggests that such organizations' activities mainly were in the form of attempting to discourage behaviors associated with the transmission of human immunodeficiency virus. During 1984, Centers for Disease Control (CDC) assessed the educational activities of community-based organizations and public health agencies in several cities nationwide. Investigators found that in those cities where health education had become a secondary activity within a health department, prevention activities tended to be ineffective. They noted that the challenge of the epidemic lay in finding effective strategies for disseminating relevant information. They concluded that prevention efforts directed to groups at risk needed to be appropriate to the lifestyle, language, and environment of a particular risk group. CDC recognized these findings by adopting a policy of support of community-based organizations in its overall AIDS prevention strategy.

Centers for Disease Control and Prevention, U.S.↗
PubMed2005

[Monitoring and official control of pesticide residues in foodstuffs in Poland in 2004].

Poland, as a Member State of the European Union, is obliged to establish efficient system of food control allowing assessment of health quality of food products for general population as well as for high risk groups, like infants and toddlers. In case of pesticide residues this task is realized by carrying out programs of monitoring and official control of foodstuffs in order to check compliance with Maximum Residue Levels set up by Polish Regulation of Minister of Health on maximum residue levels of pesticides in or on food. The Chief Sanitary Inspectorate is an authority responsible for above mentioned activities with essential participation of Department of Environmental Toxicology of National Institute of Hygiene. The analysis of food samples indicated in yearly developed plans of sampling, is carried out in 16 integrated local laboratories of National Sanitary Inspection. In 2004, 868 samples have been analyzed in system of monitoring and official control of foodstuffs in Poland. The samples were taken in retail and wholesale. Among analyzed samples 67% were fresh or frozen fruit and vegetables, and 14% were baby food. The samples have been analyzed or presence of over 50 pesticides. In the year 2004 maximum residue levels have been exceeded in 14 samples (2%) of fruit, vegetables and cereals. All samples were of Polish origin, except two samples from Spain. In samples with violated MRLs the following pesticides have been found: Benomyl group, Maneb group, Endosulfan, Mecarbam, Hexachlorobenzene, and Methyl bromide. Additionally, 49 follow-up enforcement samples has been analyzed. In none of them MRLs violation have been found.

Crops, Agricultural↗
PubMed2006

[Importance of nanobiology and nanomedicine].

Focused on nanobiology and nanomedicine, this article elucidates its main research targets and contents, discusses the important of researches in this field, introduces the tasks and objectives of the corresponding researches in the national long- and mid-term science and technology development planning, and also describes the present research status in China.

Biology↗
PubMed1991

Problem of fascioliasis in animal husbandry in Thailand.

One of the most important parasitic diseases in adult cattle and buffalo in Thailand is fascioliasis, caused mainly by Fasciola gigantica. The economic loss from fascioliasis in cattle and buffalo throughout Thailand has been assessed at not less than 100 million Baht. Recent investigations have been shown that the average prevalence of F. gigantica in cattle and buffalo in Thailand was 11.8%. However, the prevalence varies considerably between villages, ranging from 0 to 85%. The prevalence is high in areas surrounding dams or large ponds in which Lymnaea auricularia rubiginosa, the intermediate host of F. gigantica is found. An epidemiological study revealed that the disease has a seasonal pattern from which the following conclusion for control of the disease can be drawn. Strategic liver fluke treatment of all cattle and buffalo which are older than 8 months should be carried out once a year in September. In addition, animals in poor condition should be treated in April to prevent severe losses, especially in high prevalence areas or where strategic treatment was missed. Problems of liver fluke control include the lack of knowledge about the parasite on the part of the farmers and the lack of availability of drug supplies at the village level, both of which are important to allow strategic treatment of animals. To approach these problems, the government had developed "Farmer Self-Help Worm Control Program" in seven provinces in Northeast Thailand which is operated by village farmers trained as program "keymen". This program is very effective and will be extended throughout Thailand in the next Seventh Social and Economic Development Plan.

Animals↗
PubMed1976

Nursing consultation: a clinical specialty.

In summary, the Mental Health Nurse Consultant is committed to the belief that nursing staff are competent to implement appropriate mental health care. Because of this the consultant utilizes both resource and process consultation to assist staff in determining care plans and to support a realistic method for delivery. The Mental Health Nurse Consultant interviews clients in order to assess dynamics of behavior and uses this information for care plan development. The direct interview also enables the consultant to investigate client perceptions of Psychiatric Mental Health Intervention and support the utilization of direct involvement by a member of the Consultation and Liaison Team. The Mental Health Nurse Consultant acts as a facilitator for ongoing utilization of existing resources through resource and process consultation to members of the Department of Nursing. Thus, consultation as a clinical specialty offers an additional opportunity for nurses to utilize individual skills and refocus the tasks of nursing within the general hospital.

Hospitals, General↗
PubMed1991

Technology acquisition: trends in imaging.

A great deal has happened in the imaging area this year. Our imaging special report examines changes in the field: from hospitals' new negotiating tactics to the impact of the new Medicare capital payment regulation. In an in-depth report, we examine new trends developing in hospitals' and hospital groups' contracting for imaging equipment purchasing. Then we take a look at how hospitals' technology acquisition strategies--and vendors' research and development plans--are being remolded by the new capital regulation. Finally, we revisit the capital fold-in regulation itself.

Capital Expenditures↗
PubMed1991

New trends in asthma management.

The trend in asthma management is to promote the regular use of preventive medications to reduce airway inflammation and to maintain good control of asthma. Bronchodilators are to be used on an 'as required' basis when symptoms or peak flow rates indicate and in uncontrolled asthma. New delivery devices are becoming available. It is hoped that all asthmatics will have an asthma management plan developed by their doctors, so that patients understand how to control their asthma, how to assess their asthma control, and what to do in the situation of uncontrolled asthma.

Administration, Inhalation↗
PubMed1991

Human exposure assessment and public health.

The scientific basis for public and private actions to ameliorate environmental health risks is the suspected or verified link between environmental exposures and human health effects. Exposure information is a key parameter, along with data on dose-response relationships, in determining which environmental health risks are unacceptable. Moreover, human exposures are the standard by which we judge the success of measures to prevent or reduce those risks that are deemed unacceptable. The concept of "total human exposure" has gained credence as a useful and viable framework by which to assess environmental exposures. It places exposures in the context of the continuum beginning with pollutant emissions to the environment and ending with human health consequences. The advent of biologic exposure markers, as well as effects and susceptibility markers, promises the opportunity to more accurately characterize total human exposures for environmental contaminants; thereby enhancing the quality of health risk assessments. The U.S. Environmental Protection Agency plays a significant role in the validation, application, and interpretation of biologic markers, with a lesser but important role in their development. Because the Agency is involved in virtually all phases of the biologic markers issue, EPA scientists have identified important research questions and developed plans to address those questions over the next several years. The EPA is positioned to promote the science necessary to bring biologic markers to bear on environmental issues and to interpret the results for risk assessment, risk management, and risk communication.

Biomarkers↗
PubMed1991

Leprosy in the WHO African region.

The African Region has the second largest prevalence of leprosy among the WHO regions with about 1 per 1,000 population affected. With a very uneven distribution among countries, the region currently has a total of about 480,000 registered cases. The number of new cases detected per year is reported to be about 37,000. A high proportion (25-40%) of the registered cases are estimated to have significant physical disabilities. In spite of the introduction of multidrug therapy (MDT) in the early 1980s, currently only about 20% of the patients are benefiting from this improved treatment. The major problem in the low MDT coverage appears to be operational, against the background of a difficult socioeconomic situation. However, there have been favourable trends towards increased political commitment in several countries in recent years. The operational and technical constraints were discussed at an interregional conference in Brazzaville in 1989 which emphasized the need to make use of the opportunities to reduce disease prevalence through MDT; to coordinate various internal and external resources available for leprosy control; to increase political commitment and develop plans of action to build national capabilities for leprosy control; to integrate leprosy control within general health services; and to promote health education.

Africa↗