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At least 1,261 records · Page 70Linked to original sources
PubMed1999

Medical records contaminated with dried blood: A quality issue.

A routine chart review over 23 months in a 256-bed community hospital revealed 246 medical records contaminated with apparent blood. Sixty percent of the records were nursing and anesthesiology records. Analysis of systematically selected records confirmed blood as the visible contaminant in 27% of the cases (8/30). Total quality improvement methodology reduced the incidents by 75%. Actions included policy development, in-service education, and changes in work practices. Although bloodborne pathogen transmission is statistically improbable, we should improve work practices to eliminate blood contamination of charts.

Blood↗
PubMedDate not supplied

[Public health functions, activities and structures: the role of large and middle-sized municipalities].

OBJECTIVE: The aim of this paper was to analyze how public health functions are covered in large or medium-sized cities in Catalonia (Spain) by assessing the role, activities and structure of local services. METHODS: Data were collected through a questionnaire with items on public health functions and activities and on the structure of municipal services. The study population comprised the 43 cities of Catalonia with a population above 25,000 (3% of towns and 70% of the population). Answers were obtained from 28 cities (65%), covering 60% of the population of Catalonia and all towns with a population above 50,000 inhabitants. RESULTS: The public health function in which local governments were least active was need assessment while they were more active in policy development and service delivery assurance. For public health activities, the role of local governments was relatively greater in health protection while few municipal services were active in epidemiological surveillance and substance abuse. Municipal public health expenditure per resident/year was estimated at 1,063 pesetas (approximately 6 Euros). Among the public health personnel, 72% worked full-time while the remaining (mainly members of the corps of health officers serving local administration) worked part-time. Local governments often mixed within the same structure public health services and services, mainly consumer affairs, environmental or social services. CONCLUSIONS: Local governments showed significant activity in public health. The volume of resources involved and management capacity were considerable. In some cities, some public health activities were perceived as not covered.

Delivery of Health Care↗
PubMed1992

To stay or not to stay: are fears about shorter postnatal hospital stays justified?

Common concerns raised during a Ministerial Review of Birthing Services in Victoria, Australia about the potential detrimental effects of shorter hospital stays after birth were examined in a study of women's actual experiences of and opinions about their hospital stays. Just under one in four women left hospital within five days of the birth, with the greater majority staying five days or more. Satisfaction with length of stay was high in the sample, with 82% of women feeling their stay had been about right, 11% feeling it had been too long and only 7% of women feeling their stay had been too short. A number of the concerns about the consequences of shorter lengths of stay were not borne out. Women who left hospital earlier than the traditional 5-7 day stay were not less likely to breast feed, nor were they more likely to be depressed 8-9 months after the birth. They were also much more likely to feel confident about looking after their baby when they went home than women who stayed five days or more. Implications for further research and for policy development concerning length of stay are considered.

Adult↗
PubMed2002

Defining the spatial impacts of poultry farm ammonia emissions on species composition of adjacent woodland groundflora using Ellenberg Nitrogen Index, nitrous oxide and nitric oxide emissions and foliar nitrogen as marker variables.

The marker variables, Ellenberg Nitrogen Index, nitrous oxide and nitric oxide fluxes and foliar nitrogen, were used to define the impacts of NH3 deposition from nearby livestock buildings on species composition of woodland ground flora, using a woodland site close to a major poultry complex in the UK. The study centred on 2 units in close proximity to each other, containing 350,000 birds, and estimated to emit around 140,000 kg N year(-1) as NH3. Annual mean concentrations of NH3 close to the buildings were very large (60 microg m(-3)) and declined to 3 microg m(-3) at a distance of 650 m from the buildings. Estimated total N deposition ranged from 80 kg N ha(-1) year(-1) at a distance of 30 m to 14 kg N ha(-1) year(-1) at 650 m downwind. Emissions of N2O and NO were 56 and 131 microg N m(-2) h(-1), respectively at 30 m and 13 and 80 microg N m(-2) h(-1), respectively at 250 m downwind of the livestock buildings. Species number in woodland ground flora downwind of the buildings remained fairly constant for a distance of 200 m from the units then increased considerably, doubling at a distance of 650 m. Within the first 200 m downwind, trends in plant species composition were hard to discern because of variations in tree canopy composition and cover. The mean Ellenberg N Index ranged from 6.0 immediately downwind of the livestock buildings to 4.8 at 650 m downwind. The mean abundance weighted Ellenberg N Index also declined with distance from the buildings. Tissue N concentrations in trees, herbs and mosses were all large, reflecting the substantial ammonia emissions at this site. Tissue N content of ectohydric mosses ranged from approximately 4% at 30 m downwind to 1.6% at 650 m downwind. An assessment of the relative merits of the three marker variables concludes, that while Ellenberg Index and trace gas fluxes of N2O and NO give broad indications of impacts of ammonia emissions on woodland vegetation, the application of a critical foliar N content for ectohydric mosses is the most useful method for providing spatial information which could be of value to policy developers and planners.

Agriculture↗
PubMed1997

Training, management, and credentialing for CRRT in the ICU.

Continuous renal replacement therapy (CRRT) in the intensive care unit (ICU) requires a dedicated training and educational process that includes both theoretical and practical approaches. Important goals for this process include achieving an acceptable circuit life without patient complications and providing a high percentage of staff with bedside expertise. Lectures or didactic sessions must link into bedside instruction and simulations or mock patient/circuit setup. An annual seminar may be useful for all clinicians to share and gain knowledge. Managers require a system of staff review to ensure expertise levels are maintained. Policy development, quality assurance, and complication monitoring systems provide useful information for managers and educators in this field. Credentialing may be useful to confirm the goals of CRRT, but it requires further development of practice standards before adoption.

Credentialing↗
PubMed1996

Childbearing research: a transcultural review.

This article provides an examination of the keynote and current literature concerning traditional beliefs and practices pertinent to childbearing. Toward this aim, investigations implemented in western and non-western societies spanning 35 years are discussed. Each study is summarized in a table indicating the characteristics of the population, the methodology and the results. The key issues identified for study in developing countries are: poverty, illiteracy, malnutrition, prostitution, substance abuse, family disruption, lack of child care, high rates of maternal and infant mortality and the patterns of utilization of health services. Industrialized societies are faced with different problems: isolation of the nuclear family, economic pressure for mothers to work, deficiency of child care facilities, ambiguity in the definition of parental roles, marital instability and impersonal, medicalized health care. These reported results provide the basis for culturally-sensitive suggestions to improve social welfare schemes, health prevention and treatment programs. Dominant themes and changing trends in research content and methodology have been drawn from this literature review. These trends indicate that future investigations will: (a) focus upon populations-at-risk; (b) involve large representative samples; (c) address prominant social and health problems; (d) challenge currently held assumptions; (e) and use interdisciplinary methods, ethnographic, epidemiologic and intervention approaches in concert to produce vital and culturally-informed data for research development, policy decisions and program implementation.

Anthropology, Cultural↗
PubMed1998

General practice in urban and rural Europe: the range of curative services.

The variation in the range of services provided by general practitioners (GPs) is not only related to personal characteristics and features of the country's health care system but also to the geographical circumstances of the practice location. In conurbations health services are more widely available than in the countryside, where GPs often are the only providers. With highly mobile populations and a plentiful supply of doctors, in cities the prevailing regulations for access and use of services are more difficult to maintain. It is also more difficult to control access and thus opportunities for inappropriate use are greater. Against this background an international study was conducted on variation in task profiles of GPs, especially focusing on differences between urban and rural practices. In 1993 standardised questionnaires in the national languages were sent to samples of GPs in 30 countries. Various aspects of service provision were measured as well as practice organisation, location of the practice and personal backgrounds of the GP. Completed questionnaires were received from 7,233 respondents, an overall response rate of 47%. Sources of variation have been analysed by using a two-level model. Rural practices provided more comprehensive services regardless of the health care system. Approximately half of the variation was explained by features of a country's health care system. The GP's position at the point of access to health care was strongly associated with the gatekeeper function controlling access to secondary care. In western countries where the GPs were self employed they had greater involvement in technical procedures and chronic disease management. There was a considerable gap between the task profiles of GPs in eastern and western Europe. We found evidence of a reduced gatekeeper role in inner cities in those countries where GPs held this position. GPs with an estimated overrepresentation of socially deprived people and elderly in the practice population reported a wider range of services. Differences also appeared to be related to factors which are largely controlled by the individual doctor, such as level of training and education, availability of equipment and practice staff. The results have important implications for education, policy development and health care planning both in eastern and western Europe.

Adult↗
PubMed1998

Higher earnings, bursting trains and exhausted bodies: the creation of travelling psychosis in post-reform China.

This paper examines the biomedical construction of "travelling psychosis" (TP), a contested psychiatric diagnosis pertaining to a severe mental disturbance that occurs among migrant workers who travel long distance in China's overcrowded trains. Although TP can produce substantial psychiatric morbidity, it is also a socially constructed entity that serves social uses. By subscribing to a ritualistic model of validation and by invoking the rhetoric of scientific authority, Chinese psychiatrists who created TP have been able to accomplish such goals as legitimating its forensic function, securing research funds, enhancing their academic status and raising railway authorities' consciousness about passengers' safety issues. But the "biopsychosocial" paradigm they espouse supplies only a parochial form of social analysis and a spurious sense of comprehensiveness. By privileging proximate risk factors, it fails to address the wider environment of the post-reform political economy that ultimately governs population movement and put migrant workers at risk of health problems. This paper submits that a critical examination of this sanitised biopsychosocial paradigm will enliven biomedical research as well as augment its impact on policy development in China.

Adolescent↗
PubMed1999

Obstacles on the path to a primary-care led National Health Service: complexities of outpatient care.

An interpretive qualitative study was carried out as part of a large cohort study of factors affecting outpatient re-attendance. Individuals from three groups involved in the provision of care across the primary-secondary interface were interviewed: patients, general practitioners and consultants. The aim was to explore understandings concerning referral to and re-attendance at outpatients, and to elicit detailed descriptions of the complexities of the outpatient experience for both providers and recipients of care at the primary/secondary interface, given the policy commitment to a 'primary-care led National Health Service'. Semi-structured interviews were carried out with nine individuals currently attending outpatients, ten general practitioners, and ten consultants. Transcripts were analysed individually and cross-checked between analysts for validity of interpretation, to identify key themes and subthemes. Data were compared across the three groups. Negative case analysis was employed. Seven major issues were identified, some of which could be identified with interests and experience of the three obvious groupings, and some of which were common. The three groupings are not as homogeneous as is often supposed. From the cross-group analysis common themes included: interpersonal communication, knowledge, power relations and anxiety/reassurance. Issues of trust, social status, funding and consumerism/litigation were also highlighted. The analysis has implications for altering the balance of care across the interface, for example in the finding of what could be termed a dissonance in power perceptions, in that consultants perceived general practitioners as relatively powerful and able to influence things', whereas general practitioners often expressed themselves as relatively powerless and unable to be proactive in 'reclaiming' their patients. The analysis highlights the complexity of the outpatient experience, drawing attention to detailed areas of contradiction, irony and conflict in the total context of outpatient care. These areas should be addressed in policy development designed to shift the balance of care further towards the primary sector.

Ambulatory Care↗
PubMed1999

Prioritising family health needs: a time--space analysis of women's health-related behaviours.

Much has been made over the years of the view that health-related geographical research has failed fully to explore the complex and mutually reinforcing impact of social and spatial relations on individual health-related behaviours. At the same time, there is a growing awareness elsewhere in the social sciences and in health services research of the generally inadequate exploration of the role of place particularly at the scale of the local community--in the social construction of health, illness and health care use. This paper aims to contribute to the debate by offering a clear framework within which to analyse the impact of spatially configured social relations at the micro-level. In-depth interview evidence from Liverpool shows that, looking at the problem from the perspective of the opportunity-costs of time-space constraints, is a useful means to understand the distinct ways in which health services are used, when and why, across different social groups and geographical areas. Particular attention is drawn to the different thresholds for decision-making depending upon whose health-related needs are being negotiated within the family. The paper concludes with the latest policy developments in UK primary care which offer professionals the clear opportunity to develop much more sophisticated understandings of what constitutes locally-sensitive health service provision. The argument is that such developments must be based on a firm sense of how individual time-space circumstances interact with conditions in the local area if the best possible use of increasingly scarce and valuable resources is to be achieved--particularly in communities characterised by poverty and social exclusion such as those in Liverpool.

Adult↗
PubMed1999

Informal economic activities of public health workers in Uganda: implications for quality and accessibility of care.

This paper reports the results of a study in Uganda of the 'informal' economic activities of health workers, defined as those which earn incomes but fall outside official duties and earnings. The study was carried out in 10 sub-hospital health facilities of varying size and intended role and used a variety of quantitative and qualitative methods. The paper focuses on those activities which are carried out inside public health facilities and which directly affect quality and accessibility of care. The main strategies in this category were the leakage of drug supply, the informal charging of patients and the mismanagement of revenues raised from the formal charging of patients. Few of the drugs supplied to health units were prescribed and issued in those sites. Most health workers who have the opportunity to do so, levy informal charges. Where formal charges are collected, high levels of leakage occur both at the point of collection and at higher levels of the system. The implications of this situation for the quality and accessibility of services in public health facilities were assessed. Utilisation levels are less than those expected of the smallest rural units and this workload is managed by a handful of the expected staff complement who are available for a fraction of the working week. Even given these few patients, drugs available after leakage were sufficient to cover less than half of those attending in most facilities. Evidence on staff motivation was mixed and better motivation was associated with better performance only in a minority of units. Informal charging was associated with better performance regarding hours worked by health workers and utilisation rates. Drug leakage was associated with worse performance with respect to both of these and unsurprisingly, with drug availability. Short term strategies to effect marginal performance improvements may focus on the substitution of strategies based inside health units (such as informal charging) for those based outside (facilitated by drug leakage). In the long term, only substantially higher funding of the sector can be expected to facilitate major change, but alone will be insufficient. Investment strategies supported by appropriate policy development has to be informed by understanding and monitoring of the 'informal' dimension of health sector activity.

Drug Utilization↗
PubMed2003

Local perceptions of risk to livelihood in semi-arid Tanzania.

This paper examines variation in local perceptions of risk in semi-arid Tanzania, identifying factors that influence local perceptions of problems and testing the feasibility of risk mapping as a technique. Twelve villages in six districts were visited between February and April 2001. Villagers were asked about their worries and concerns in providing for themselves and their families using a risk questionnaire. The responses were grouped into 21 categories of problem and incidence and severity indices were calculated for each category. Most problems were associated with the availability of natural resources on which livelihoods depend but others related to human and social capital assets. In addition to environmental factors, livelihood strategy and gender both influenced people's perceptions of risk. Problems of irrigation and weather, for example, were important for agricultural communities while problems relating to livestock diseases, access to land and hunger were more important in pastoral communities. The risks cited by men and women generally reflected their traditional roles in society. Very broadly, the risks associated with natural capital tended to be seen as higher by men while women mentioned more problems relating to human and social capital. However, this was not always the case. Problems linked to finance, traditionally the concern of men, were ranked similarly by men and women. In projects designed to facilitate community management and control over common pool resources, the identification of common interests is particularly important. Risk mapping can provide a cost-effective way of gaining insights to help improve research design and to inform policy development.

Adult↗
PubMed1999

Description of the role of nonphysician practitioners in radiation oncology.

PURPOSE: With changes in reimbursement and a decrease in the number of residents, there is a need to explore new ways of achieving high-quality patient care in radiation oncology. One mechanism is the implementation of nonphysician practitioner roles. The purpose of this paper is to describe the roles and responsibilities of clinical nurse specialists (CNSs), nurse practitioners (NPs), and physician assistants (PAs) currently working in the field of radiation oncology in the United States. METHODS AND MATERIALS: A nationwide mailing was sent to elicit responses to an 8-page self-report questionnaire. RESULTS: The final sample of 86 included 45 (52%) CNSs, 31 (36%) NPs, and 10 (12%) PAs. Two-thirds worked in private practice settings. Most of the nonphysician practitioners frequently obtained histories (57-90%) and ordered laboratory studies (52-68%). However, NPs and PAs were more likely than CNSs to frequently perform "medical" services such as perform physical exams (42-80% vs. 19-36%), order radiologic studies (50% vs. 17%), and prescribe medication (60-84% vs. 26%). CNSs were more likely to provide "supportive" services such as develop educational materials, participate in quality improvement initiatives, and develop policies and procedures. CONCLUSIONS: Nonphysician practitioners are not substituting for physicians, but rather are working in collaboration with them, performing designated tasks.

Health Care Surveys↗
PubMed2003

The impact of very premature birth on the psychological health of mothers.

BACKGROUND: The birth of a very premature infant is a critical event in the life of a family and studies have shown that mothers of these infants are at greater risk of psychological distress than mothers of full-term infants. STUDY DESIGN: A total population study of mothers of preterm infants born at less than 32-week gestation at a tertiary referral hospital. SUBJECTS AND METHODS: Sixty-two mothers of very preterm infants (<32 weeks) participated in the present study which examines correlates of maternal depressive symptomatology at 1 month following very premature birth. Information was obtained from structured questionnaires completed by mothers at 1 month after infant admission to neonatal intensive care. RESULTS: Forty percent of the mothers reported significant depressive symptoms on the Edinburgh Postpartum Depression Scale (EPDS). Logistic regression analysis indicated that high maternal stress resulted in an increased likelihood of depressive symptoms (OR 1.15, CI 1.04-1.26, p<0.01). Higher levels of maternal education (p<0.05), and increased perception of support from nursing staff (OR 1.06, CI 0.88-1.00, p<0.05) resulted in decreased likelihood of depressive symptoms. CONCLUSIONS: The birth and subsequent hospitalisation of a very premature infant evokes considerable psychological distress in mothers. These results have implications for policy development in order to enhance family centred care in the neonatal intensive care.

Adult↗
PubMed1999

The Missouri Disability Epidemiology and Health Project.

INTRODUCTION: Estimates of disability in this country are as high as 20%. State health departments need to provide the core activities to deal with this public health problem including assessment, policy development, and assurance. A collaboration among academic institutions and the Missouri Department of Health (MDOH) is a model for providing this core. METHODS: A disability workgroup was established among bureaus of the MDOH and three universities. This group selected the disability domain of mobility impairments for initial work. Existing data from the Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS) in Missouri and data from the 1990 Census were analyzed. Dissemination of the findings involved community and consumer participation via an advisory group and a public health-sponsored conference on disability. In addition, new data collection efforts are underway using the BRFSS. Education and training activities include both public health students and public health practitioners in learning the content and methodology associated with disability epidemiology. RESULTS: Data analyses have identified rural geographic areas of the State with high levels of disability and a trend of increasing work disability since 1993. A selected key condition, arthritis, has been confirmed as having a high prevalence (28%) in Missouri. These data also demonstrate that there is a strong risk of limitations associated with arthritis [adjusted odds ratio (OR) 3.57; 95% confidence intervals 3.0, 4.2]. These results will be applied to program planning. CONCLUSIONS: The Missouri program is succeeding in providing both academic and public health practice partners with a productive experience that meets the needs of each.

Data Interpretation, Statistical↗
PubMed2000

Cost-effectiveness analysis of case management versus a routine community care organization for patients with chronic schizophrenia.

This article reports the economic analysis of a study on the implementation of case management in the Community Psychiatric Nursing Service (CPNS) caring for chronic schizophrenic clients in Hong Kong. The purpose of the study was to compare the outcome of case management service with the conventional practice CPNS. Sixty-two subjects participated in the analysis. Cost-effectiveness analysis showed that case management costs more in Hong Kong $3,600 (US$450) per person and that over a 5-month period, case management was associated with improvements in psychological and functional outcomes and patient satisfaction. The results of this study will inform policy makers about resource allocation and policy development in the implementation of case management for the care of mentally ill clients.

Adult↗
PubMed1997

Surveillance for the emergence and dissemination of antimicrobial resistance in bacteria.

Effective surveillance of antimicrobial-resistant bacteria is important for developing rational empiric therapy guidelines and for guiding public health efforts to control and prevent the spread of infective agents. Surveillance must include a timely and thorough review of the test results generated in clinical microbiology laboratories because this data serves as the core of surveillance activities. Besides ensuring data accuracy and optimizing detection of emerging resistance, the role of clinical microbiology also includes supporting the production of informative surveillance reports, providing laboratory resources for outbreak investigations, and monitoring the performance of commonly used susceptibility testing methods. Once the accuracy of susceptibility results has been validated, the data are used by public health agencies and professional societies to monitor resistance trends on a local, state, national, and international level. This information is also used to develop policies for prudent antimicrobial use locally and nationally.

Anti-Bacterial Agents↗
PubMed2004

The personal impact of schizophrenia in Europe.

The personal impact of schizophrenia is poorly described in the scientific literature. The European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) study compared representative treated prevalence cohorts of patients with schizophrenia in five European countries, to assess unmet needs, impact on caregivers, quality of life, satisfaction with services, symptoms and disability. Of the 404 patients, 79% undertook no work of any kind, and 65% were single. Low quality of life was associated with: anxiety, depression, psychotic symptoms, more previous psychiatric admissions, alcohol abuse, having no reliable friends nor daily contact with family, being unemployed, and having few leisure activities. The most frequently occurring unmet needs among the patients were: daytime activities, company and intimate relationships, psychotic symptoms, psychological distress, and information. The most common worries of relatives were about the patient's health, and their own future, safety and financial position. Psychiatric services were therefore largely ineffective in managing the personal impact of schizophrenia, especially upon work, home and family life. Research, clinical practice and disability policy developments need to address a wider range of consequences of the disorder than symptoms alone.

Activities of Daily Living↗