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PubMed1998

Design and methodology in a community, practice-based research network: a study of nurse-midwifery home-birth practice.

OBJECTIVE: To assess the feasibility, probable success, and inherent problems of conducting a multi-site, multi-year cohort study of planned home birth in the USA. DESIGN: A prospective cohort study. SETTING: 14 states across the USA, representing a variety of regions and settings. PARTICIPANTS: 29 home-birth midwifery practices, representing 44 individual midwives in both large and small, solo and group practices. DATA COLLECTION: Birth outcomes for all women initially enrolled in these home-birth practices. KEY CONCLUSION: Multi-site studies of evaluating outcomes in small community-based practices are possible if several requirements are met. IMPLICATIONS FOR PRACTICE: Understudied birth alternatives can be formally researched within a co-operative network of participating practitioners.

Data Collection↗

PubMed2005

[Structure of the Surveillance and management of infectious diseases in the European Union. The EU surveillance networks and the European Centre for Disease Prevention und Control (ECDC)].

In 1998, the European Parliament and Council published the Decision on setting up a network for the epidemiological surveillance of communicable diseases in the Community. As a first step, the Network Committee (representatives of the Member States) and the Commission determined the diseases for European surveillance. Subsequently, case definitions were developed for these diseases. For rapid information exchange among Member States on serious diseases, outbreaks and the control measures taken, a web-based, password protected early warning system was established. In parallel disease-specific networks were developed for enhanced surveillance of important diseases. A training programme (EPIET) and a European bulletin (Eurosurveillance) complete the network. The directive on the monitoring of zoonoses constitutes the basis for the joint analysis and evaluation of data on human illnesses, animals and foods. Starting in May 2005, the coordination and further development of the Community Network will be carried out by the European Centre for Disease Prevention and Control (ECDC).

Communicable Disease Control↗

PubMed1995

Developing AJN Network: phase two. An information resource for nurses.

Computer Communication Networks↗

PubMed2003

Imaging diagnosis of schistosomiasis japonica--the use in Japan and application for field study in the present endemic area.

For detecting lesions-related schistosomiasis japonica, X-rays, scintillation scanning, ultrasonography (US), computed tomography (CT), magnetic resonance (MR) and endoscopic examinations with biopsies have been used in Japan. Liver fibrosis and calcified changes are detected by US and CT. Most of the lesions that are detected by endoscopic examinations are due to deposited ova of Schistosoma japonicum. Portal hypertension is detected by US, CT and gastroscopic examination. Because schistosome infection decreased rapidly in Japan, most of the studies on imaging diagnosis were performed on chronic lesions or sequelae of schistosomiasis. Most of the techniques were used on admitted patients in well-equipped hospitals. US was introduced in the 1970s as a safe, rapid, non-invasive and inexpensive technique and has been used for diagnosis in hospitals and screening in the fields. As a typical US image of the liver, septal formation by high echogenic bands like mosaic was described, and this network pattern was reported in the other endemic countries; China and Philippines. As an appropriate technique, US has been broadly used in developing countries. Not only for diagnosis in a hospital, but also for monitoring changes of morbidity, US is used in the community level. Network pattern related to the severity of S. japonicum infection, has not been described in S. mansoni or S. haematobium infection. Appearance of network pattern depends on pathological changes such as periportal fibrosis, postnecrotic fibrosis and calcified ova. For advanced studies on morbidity of schistosomiasis japonica, further research on pathological basis of network pattern and standardization of US diagnosis are necessary.

Calcinosis↗

PubMed1998

[Service expectations facing Saxony's newly established social psychiatric services. Attitudes of established neurologists, physicians in psychiatric clinics and social psychiatry service staff].

In the wake of the disintegration of the policlinical system which had prevailed in the former German Democratic Republic, far-reaching restructuring has become necessary in the "new" German laender in the field of complementary psychiatric care. Establishment throughout the state of Saxony of a uniform outreach-based ambulatory service ranks as a first component towards building regionalized community psychiatric networks. In light of some twenty years of experience in the old laender, this function is considered a task of the Social Psychiatric Services ("Sozialpsychiatrische Dienste", SPDIs). The present study had been directed at a state-wide investigation of the expectations community-practice psychiatrists (n = 165), physicians in psychiatric clinics (n = 95) and staff working in SPDIs (n = 138) in Saxony hold regarding service programmes and operating methods of these newly established service delivery structures. Given the high return rates in this anonymous postal questionnaire study, the findings presented are considered near-representative. A concurrent finding for all of the groups interviewed, expectations concerning the client population to be serviced by the SPDIs focus on the group of persons with chronic mental illness. Also, the expectations expressed concerning major care/therapeutic services to be rendered by the SPDIs concur in their emphasis on a core area of immediately client-oriented SPDI activities. Between the two medical groups, a major difference found is that community-practice psychiatrists more frequently expect high SPDI commitment regarding sociotherapeutic programmes at an institutional level, whereas clinical physicians expect them to focus on taking over medical therapies in the narrower sense. The expectations SPDI staff hold relative to the therapeutic services to be rendered by themselves go beyond the scope of what has so far been implemented in their current activity, and qualitative content analyses are presented in the article for each of the areas concerned. Along with better staffing levels, removal of in-service organizational and further education deficits are identified by SPDI staff as the two main requirements for stabilizing their operations. In order to counter undue burdening of the SPDI with service expectations and to enable a more clear-cut positioning of its programme structures within a complex psychosocial service delivery system, it is necessary--at least in the state of Saxony--that further needs-oriented establishment and/or extension of community-based psychiatric services and agencies take place.

Attitude of Health Personnel↗

PubMed1994

Developing AJN Network: transforming information to meet the needs of the future.

In September of 1993 the American Journal of Nursing Company was awarded a three-year Special Projects Grant from the Division of Nursing, Department of Health and Human Services to develop a national information service to provide a variety of formal and informal continuing education services to nurses in medically underserved communities. AJN Network went "live" in March 1994. Using a train the trainer approach, over 150 trainers were oriented in rural areas of our pilot states: North Carolina, Nevada and Wisconsin. This core group is now going out to rural hospitals to train other nurses on the system. During the first year of operation, AJN Network has been be available through a dial in service. Beginning in September 1994 it will be offered over the Internet, an international network linking hundreds of smaller computer networks throughout the world. This project will make use of the High Performance Computing and Communications (HPCC) initiative which provides a backbone extending across the country, capable of transmitting data at tremendous speeds. Services that are currently available on AJN Network are described along with plans for future development.

Computer Communication Networks↗

PubMed1998

Burden on the families of patients with schizophrenia: results of the BIOMED I study.

The burden, the coping strategies and the social network of a sample of 236 relatives of patients with schizophrenia, living in five European countries, were explored by well-validated assessment instruments. In all centres, relatives experienced higher levels of burden when they had poor coping resources and reduced social support. Relatives in Mediterranean centres, who reported lower levels of social support, were more resigned, and more often used spiritual help as a coping strategy. These data indicate that family burden and coping strategies can be influenced by cultural factors and suggest that family interventions should have also a social focus, aiming to increase the family social network and to reduce stigma.

Adaptation, Psychological↗

PubMed1998

Complementary therapists and cancer patient care: developing a regional network to promote co-operation, collaboration, education and patient choice.

Complementary therapies, particularly aromatherapy, reflexology and relaxation techniques are increasingly valued by cancer patients. However, many health professionals doubt their value, and often question whether therapists claim inappropriate benefits, lack understanding of cancer-related issues and pose a potential danger to patients. The Lynda Jackson Macmillan Centre for Cancer Support and Information, which has provided therapies since 1993, explored some of these issues and attempted to identify common areas of interest, possible collaboration, and an additional source of meeting patient needs. Two hundred and fifty questionnaires were sent to aromatherapists and reflexologists within the region served by the hospital to: (1) identify and profile interested therapists; (2) assess the need for cancer-related educational programmes; and (3) address some of the professionals' concerns. One hundred and four responses described work patterns, qualifications, cancer-related experience, the contribution of therapies to cancer care and interest in cancer-related training. A lack of information on cancer was identified. Therapists appeared to be working sensitively, even over-cautiously, and misgivings concerning this group appeared to be unfounded. Subsequent workshops resulted in a therapists' network, whose members collaborate with the centre in various ways. Patients and carers appreciate access to therapists informed about cancer, treatments and related issues.

Community Networks↗

PubMed2004

[Networking as an opportunity to profile a clinic? Strategy options after the evaluation of resource allocation].

BACKGROUND AND OBJECTIVES: Diagnosis-related groups of medical services has recently been introduced for reimbursing hospital services. The aim has been to optimize bed capacity, decrease the duration of inpatient stay and provide good follow-up medical care. This confronts hospitals with the need for closely cooperating with the referring general practitioners or specialists. METHOD: A specially structured questionnaire was sent to all those general practitioners and specialists (n=890) who had referred patients to a university department of dermatology. The response rate was 23%. The completed questionnaires were analysed with respect to criteria judged to be important in determining referral for inpatient care and the quality of medical and related service provisions. RESULTS: Especially important to the referring doctors were optimal competence of patient care, the degree of cooperation and prompt, detailed information after the patients have been discharged. CONCLUSION: This type of analysis can serve to optimize the course of diagnosis/treatment and to utilize fully the available hospital resources. Also considered are various ways in which a hospital department can, by networking with general practitioners and specialists, become a centre for providing optimal services.

Clinical Competence↗

PubMed2003

[Care network in addictive pathologies: where is it?].

Network practise is important in the care of addictive pathologies. It aims to fulfill patient needs on a social and health level, as part of a concertive approach from the different health workers. Co-ordinated practise seems to provide an adapted and proven response for more than twenty years now, but has only recently been recognised as such by the health authorities. It was originally initiated by militant care workers in response to a daily reality too complex to be managed alone. The bringing together of experience and competencies, an adapted response to the demands in a context of dependency, patient care facilitated by exchanges, complementarily and the sharing of competencies are the objectives of a rich and beneficial network. However, it seems necessary to supplement with financial, human and legal help in order maintain the continuity and improve this novel approach.

Community Networks↗

PubMed1999

[Reconstruction of mental health services in the Federation of Bosnia-Herzegovina].

The war in Bosnia and Herzegovina has caused severe suffering of the population, and left behind destruction and misery. Hundreds of thousands were killed, ten thousands were severely injured, and almost the whole population has endured severe psychological traumas. The consequences today are numerous stress related psychical disorders, and especially PTSD. The war has almost destroyed the system of psychiatric services, and lead to lack of professional staff. Because of this, after the war, Federal Ministry of Health of Bosnia and Herzegovina has decided to carry out a complete reconstruction of psychiatric services based on new principles. Comprehensive care for improvement of mental health; prevention of mental illness, treatment and rehabilitation of mentally ill, should be transferred from institutions into the community. Consequently Ministry of Health have designed 38 Community Mental Health Centers in the Federation of Bosnia and Herzegovina in connection with already existing Primary Health Care centers (Dom zdravljas). Each of these centers is responsible for mental health in general within a catchment area of 50,000-80,000 inhabitants. A network of Community Mental Health Centers has started to operate. An efficient and useful training of the staff going to work in these centers have been carried out. Nevertheless, there is still significant resistance towards this new approach to mental health services and treatment of people with mental illness in the community. However, many problems related to this new program of community psychiatry have been identified and are under consideration.

Bosnia and Herzegovina↗

PubMed2006

Knowledge transfer & exchange through social networks: building foundations for a community of practice within tobacco control.

BACKGROUND: Health services and population health innovations advance when knowledge transfer and exchange (KTE) occurs among researchers, practitioners, policy-makers and consumers using high-quality evidence. However, few KTE models have been evaluated in practice. Communities of practice (CoP) - voluntary, self-organizing, and focused groups of individuals and organizations - may provide one option. This paper outlines an approach to lay the foundation for a CoP within the area of Web-assisted tobacco interventions (WATI). The objectives of the study were to provide a data-driven foundation to inform decisions about organizing a CoP within the geographically diverse, multi-disciplinary WATI group using evaluation and social network methodologies. METHODS: A single-group design was employed using a survey of expectations, knowledge, and interpersonal WATI-related relationships administered prior to a meeting of the WATI group followed by a 3-week post-meeting Web survey to assess short-term impact on learning and networking outcomes. RESULTS: Twenty-three of 27 WATI attendees (85%) from diverse disciplinary and practice backgrounds completed the baseline survey, with 21 (91%) of those participants completing the three-week follow-up. Participants had modest expectations of the meeting at baseline. A social network map produced from the data illustrated a centralized, yet sparse network comprising of interdisciplinary teams with little trans-sectoral collaboration. Three-week follow-up survey results showed that participants had made new network connections and had actively engaged in KTE activities with WATI members outside their original network. CONCLUSION: Data illustrating both the shape and size of the WATI network as well as member's interests and commitment to KTE, when shared and used to frame action steps, can positively influence the motivation to collaborate and create communities of practice. Guiding KTE planning through blending data and theory can create more informed transdisciplinary and trans-sectoral collaboration environments.

Journal Article↗

PubMed1994

IS: the neural nexus. Why you should consider information systems as the central nervous system of an integrated healthcare network.

Until now, utilization of information systems in America's healthcare industry has been anything but scientific. And individual healthcare providers have managed to deliver the world's best healthcare services despite lousy information systems, lack of clinical outcomes data, lack of adequate service costing data and lack of customer satisfaction data. The key to the scientific improvement of the health status of a community health network is the acquisition and application of knowledge, which we believe to be wholly dependent upon scientifically designed clinical information systems. We've got some work to do.

Comprehensive Health Care↗

PubMedDate not supplied

Improving marketability for joint ventures.

Many believe that by being in line with the revised Statements on Antitrust Enforcement Policy in Health Care, released by the Federal Trade Commission (FTC) and Department of Justice (DOJ) on August 28, 1996, they can regain control of their markets by being able to negotiate with employers, restore clinical autonomy to physicians, minimize the intrusion of health plans in the doctor-patient relationship and compete more effectively with managed care plans. To really succeed, however, physician network joint ventures should exceed the antitrust guidelines. By doing so, the physician network joint venture will have the ability to define its worth and quality in terms and measurements to which purchasers and consumers understand and relate.

Antitrust Laws↗

PubMed1998

Increasing the marketability and recognition of provider network joint ventures.

Physicians have been developing provider network joint ventures to market their services jointly to managed care plans, employers, and other purchasers. Over the past few years, external market factors have produced a growing impact on these joint ventures. These external market factors include the Federal government's revised antitrust guidelines, National Committee for Quality Assurance activities, and state and Federal consumer protection laws. Simply responding to these forces may not increase a provider network's marketability unless the network can demonstrate its value in the terms and measurements accepted by the consumer, managed care plans, and provider networks. By doing so, a provider network can not only increase its marketability, but also increase its recognition in the market, improve its competitive advantage, and enhance its return on investment.

Antitrust Laws↗

PubMed1996

HealthSouth's integrated service model: a case study.

The HealthSouth Corporation's St. Louis, Missouri, provider network is a forward-looking example of an alternative approach to integrated delivery. Patients are served through a continuum of care weighted toward outpatient services.

Ambulatory Care↗

PubMedDate not supplied

The role of informal and formal social support networks for patients with cancer.

PURPOSE: In this study, the authors examined the role of informal and formal social support networks in mitigating barriers to cancer treatment among whites, blacks, and Hispanics, based on a representative sample of cancer patients in Texas. DESCRIPTION OF STUDY: The sample frame for this study was obtained from the University of Texas M. D. Anderson Cancer Center's Texas Community Oncology Network, a consortium of cancer treatment facilities in Texas. Of the 910 patients who were contacted, 593 (65%) responded to the survey. RESULTS: The results show the value of social support networks in assisting cancer patients with continuing treatment. An important finding indicated that health professionals do not provide information regarding social support groups to patients with cancer at the time of diagnosis. Fewer than half of the respondents were asked whether they would be interested in joining a formal social support group. Individuals of all racial/ethnic groups reported that the formal support groups provided emotional assistance. Minorities were more apt to report that the formal support groups helped with continuing treatment. In addition, informal social support networks, such as extended families and civic clubs, were seen as more helpful for blacks and Hispanics as compared with whites. CLINICAL IMPLICATIONS: The need for formal and informal networks is indicated by the results of this study, which show that networks, such as relationships with family, friends, and relatives, play an important role in assisting patients in coping with their cancer. These networks are part of the patient's total treatment experience and must be acknowledged by healthcare professionals. A large number of patients are not asked to join social support groups, suggesting a need for training healthcare professionals to provide information regarding the potential benefits of support groups for cancer patients.

Adolescent↗

PubMed1996

A tripartite regulation of health networks.

With the Republicans in power, market-driven forces of managed care plans, capitated payment, and the regional networks (alliances) are likely to serve as centerpieces for improving the organization, financing, and delivery of our nation's health services. These "voluntary" alliances of health providers and health insurance underwriters foreshadow the powerful, geographically linked regional health networks that are now becoming oligopolies. As a result of these providers developing monopolistic practices, state health services commissions will be formed to regulate market share, the scope of health services, reimbursement rates, and profits. State departments of public health will continue to focus on broader community health initiatives such as access and quality. Complexities of relationships among those regulated by these responsible agencies, and the interfacing of these state health services commissions and state departments of public health and insurance, with their potentially conflicting goals and political forces, are expected.

Antitrust Laws↗