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Over the past four years a public awareness campaign has succeeded in focusing national attention on nutritional problems in Papua New Guinea, particularly as they affect children. All development plans and new government expenditure is now reviewed by the National Planning Office to ascertain its possible impact on nutrition.
The ability to carry out rapid mobilization and full integration of well-trained reserve/guard personnel with active component personnel proved to be a decisive factor during the Gulf War. Such an approach can also be effective in fulfilling peacetime military missions, especially in an environment of increasing requirements, nontraditional missions, and pervasive force reductions. This paper describes the role played by Army Reserve Individual Mobilization Augmentation (IMA) assets in support of two important Army Medical Department missions involving new initiatives in scientific peer review and extramural grant administration: military nursing research and breast cancer. Successful planning, development, and implementation of these programs is attributed in part to the fostering of an effective partnership between reserve and active components on both individual and organizational levels. Critical factors influencing this partnership are analyzed and the relevance of such peacetime IMA taskings to wartime missions is discussed.
An established clinical development plan was expanded to form a framework for a competency assessment model. Each nursing competency has a technical, interpersonal and critical thinking component. Behaviors describe all areas from novice to expert. The framework identifies and supports a professional model of nursing practice.
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Interindividual variability of hepatic metabolism of drugs may be responsible for decrease in efficacy, increase in the incidence and severity of adverse effects or drug-interactions. This variability may be due to hepatic drug interaction, specific physio-pathologic condition or genetic polymorphism. Search for variability of hepatic metabolism and the factors determining this variability during the pre-clinical and clinical development of new drug contributes to an individual optimization of treatment during clinical research and after introduction into the market. This strategy results in an improvement of the benefit-risk ratio. The various methodological approaches to the study of hepatic metabolism during the successive phases of drug development and the integration of these studies in the clinical development plan of a new drug are discussed in this paper.
Redirecting an i.v. team is a progressive approach to interdepartmental and community i.v. needs for the future viability of i.v. therapy. Cut backs and cost justification can be redirected to increase revenue. First the i.v. team should present a proposal to hospital management that includes statistics of i.v. team duties, cost justification by phlebitis and infection, and ways that revenue can be increased. Areas of expertise and needs in the department, hospital or agency, and community must be determined. The possibilities and feasibility of implementation should be researched and prioritized. These possibilities should then be planned, developed, and implemented according to the prioritized list.
Case Management can be used in developing plans to evaluate the care given to patients undergoing operative cholecystectomies. Although many cholecystectomies are now performed by laparoscope, some patients fail to meet the criteria for laparoscopic cholecystectomy and, therefore, require the open approach. This project was undertaken to scrutinize the time and activities of care for patients undergoing cholecystectomies to provide a baseline of information for the comparison of open cholecystectomy with laparoscopic cholecystectomy.
Large, well-funded, community heart health programs (CHHPs) have successfully focused on improving the cardiovascular health status of entire communities. CHHPs attempt to reduce the prevalence of risk factors associated with high rates of coronary heart disease mortality: high blood pressure, elevated serum cholesterol, smoking, overweight, and sedentary lifestyle. Program components include community organization, needs assessment, priority and evaluation, and program maintenance. Organizing the community, assessing needs and resources, and setting priorities generally occur concurrently, followed by implementing interventions. CHHP activities include social marketing, direct behavior-change efforts (including skills training, health education, and contingency management), screening (including counseling and referral), and policy and environmental change. Because State-sponsored efforts will seldom have the resources of federally-funded demonstration projects, they must pay particular attention to the "3 As" of community interventions: affordability, acceptability, and adequacy. Attention to these principles and the critical program components outlined in this paper facilitate the planning, development, implementation and evaluation of the next generation of CHHPs.
The health care environment is expected to undergo significant change in the coming years. The continued growth of managed care, in particular will exert a profound impact on medical practice. This trend will be accelerated if a managed competition approach to health system reform is adopted at the federal level. As physicians continue to consider possible strategies by which to adapt to the changing practice environment, two options may merit special consideration: first, integration with other physicians, particularly through formation of a medical group and, second, vertical integration with a hospital, through formation of a PHO. Although PHOs are a relatively recent phenomenon, they represent a potentially powerful strategy by which physicians and hospitals can combine forces to take a leadership role in managed care contracting. Through careful planning, development of a sound legal structure and efficient governance process, and implementation of effective criteria for participation in the PHO, it is possible to further the goals of the physician and hospital participants, while meeting the needs of payers.
The principles of treatment for addictive disorders are simple: Identify the disorder. Find skilled therapists to direct a treatment plan. Pursue the plan. Develop the skills to cope with life after addiction. Seek appropriate support from family and systems in the community.
In 1994, the Hospital Library Service Program of the Central New York Library Resources Council conducted a study to evaluate the usefulness, impacts, and potential services of eleven hospital libraries in a four-county area in New York State; determine the degree to which the libraries comply with Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standard IM.9.2; and provide recommendations for improved services in the member libraries. Two research instruments were used: a survey for hospital-based health sciences professionals and a survey for hospital-based information providers. Results from the two surveys were compared to determine if users' needs were being filled, and to develop plans for improved information services and products. Fourteen recommendations are made that, if implemented, will support the creation of user-defined information products, enhance the library's profile within the hospital, and exploit resource sharing to reduce costs and enhance coordination.
A PREP profile records information that can help you to plan for the future. These sections of the profile will contain personal plans which do not have to be shown to others. The Rational Model of career planning provides a simple four-stage structure to analyse career choices.
This study aims to identify the embryo transfer constraints and production costs at a village level in the district of Kolda (Senegal). Fifteen (15) donors cows were superovulated using 2500 UI PMSG (group A n = 8), 32 mg of FSH (group B n = 3) and 36 mg of FSH (group C n = 4). The average number of yellow bodies that were palpated was 5.06 and the mean rates of collected embryos were 5.66 for group A, 2.5 for group B and 3.3 for group C. The average transferable embryos were 2.33 for group A, 0 for group B and 1.4 for group C. The identified constraints are nutritional, healthy, social and logistic nature. The average cost of a produced and transferred embryo amount respectively to 75.940 F CFA and 99310 F CFA. Embryo transfer can fit in with a dairy production development plan in Senegal.
The care of elderly patients with seizure disorders in the critical care unit is an important nursing challenge. The potential that a seizure is an isolated event or one that will require lifelong treatment must be expected. The critical care nurse is in a unique position to help the patient and his or her family as they begin to grapple with the important changes the seizure may bring. The critical care nurse also can assist in the transition from the acute setting to the less acute setting in which the patient and the family will be assisted in developing plans for long-term management of this serious situation.
BACKGROUND: This article focuses on planning, developing, implementing, and evaluating the data collection method used for evaluating a community health education program in a rural setting, the North Carolina Native American Cervical Cancer Prevention Program. METHODS: Evaluation of program effectiveness used face-to-face interviews with a randomly selected sample of women from the target population. Selection of a data collection method was based on thorough community and program analysis. Each element of the community's analysis revealed key cultural, environmental, and procedural factors that affected the selection of an appropriate data collection method. RESULTS: Costs per completed interview varied over time, ranging from a low of $48 during the height of survey activity to $243. The average cost per completed interview overall was $113. CONCLUSIONS: Several factors contributed to the overall costs of interviews, including the economy of the community, the number of call-backs made to contact women, and local environmental conditions.
The aim of the work has been to develop a planning guide for local infrared heating systems and to compare the results to the heaters in the work place. The planning process for radiators is started by defining the goal ambient temperature and then the electric power needed for the radiators. The planning result should always be compared to the recommendations for infrared radiation. The usefulness of the planning instructions were tested by building a local heater for a cooled storage where a computer was used. The increase in operative temperature and the physiological responses of workers were measured as well as the change in the thermal sensations after using heaters. With these heaters the operative temperature increases 7 degrees C. The skin temperature of the fingers increased about 7 degrees C, which is meaningful, when finger dexterity is needed in using computers. Also the thermal sensations increased all over the body. Both the planning instructions developed and the local heating system turned out to be very useful. Also the low costs of local heaters are a good reason for using them. However the exact direction and the narrow bean cone of the heaters are important in obtain the maximum benefit from them.
Ritanserin is a potent long-acting 5-HT2 antagonist that acts centrally. In humans, ritanserin increases deep slow wave sleep, improved liveliness in a variety of psychiatric disorders and facilitated participation in behaviour therapy. During clinical trials unexpected observations indicated that ritanserin may be of value in treating drug addicts. Furthermore, initial clinical observations confirmed the efficacy of ritanserin in the chronic withdrawal phase after detoxification from ethanol. In the present paper, four experiments which support the potential of ritanserin as a pharmacological treatment for alcohol abuse and dependence are described. Firstly, ritanserin has been demonstrated to lack abuse potential and any direct interaction with ethanol. Secondly, in various models ritanserin has been shown to reduce alcohol intake and preference. The level of activity varies to some degree depending on the test and treatment procedure, as well as on the animal strain used. Long term ritanserin-related efficacy was illustrated by the gradual increase in alcohol drinking after cessation of the ritanserin treatment. Thirdly, the dopaminergic pathway and the nucleus accumbens have been shown to play a role in the effects of ritanserin. Finally, ritanserin reduces some alcohol withdrawal signs. Based on these findings, a clinical development plan started. After safety-interactions studies, ritanserin was demonstrated to influence the desire to drink in normal volunteers who display heavy social drinking. Currently, three major trials in 900 alcohol-dependent patients with different levels of dependence are running.
Since the condition of subspecialty medicine in Chile has not been thoroughly studied, little can be said on an objective basis. From a standpoint of national health policies, the Ministry of Health wishes to establish a mixed system in which participating subsystem can define its own goals as means to meet the populations' health demands. The National System of Health Services (SNSS), in accordance with its social objectives, has decided to implement the delivery of integral health care, emphasizing health promotion and disease prevention. The epidemiological priorities of the populations will guide the action of the SNSS. The more complex and expensive medical actions will be delivered at pre-established points of the patient care network. The desirable profile of physicians working in this setting includes philosophical as well as technical characteristics. The type of patient care to be delivered must emphasize preventive and promotional actions. Problem-solving abilities will not ascribed to a particular type of institution but to where they may be more efficacious, in a context of quality and efficiency. Most activities will be carried on on an outpatient basis, and primary care clinics will be strengthened by becoming Health Centers. The model of patient care devised by the SNSS will require 6 different types of physicians: an undifferentiated generalists, a family-oriented physician, a specialist in one of the four major disciplines of Medicine, a specialist in other primary specialties, a subspecialist and a specialist in specific techniques. To determine the number of physicians required to make the SNSS work, a methodology is needed that will consider its character of executer of Ministry-defined policies, along with the peculiarities of each health service. Health care givers must define periodically their needs in view of their own development plans and their beneficiaries requirements. Nevertheless, it is impossible to predict with certainly for the long or medium term how many physicians will be required at any level of patient care. The role that the SNSS may ascribe to specialist will condition the number of them that Chile will require.