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At least 1,279 records · Page 71Linked to original sources
PubMed1997

Providing asthma education in primary care practice.

An educational dialog founded on open communication between clinician and patient is necessary for a successful partnership in asthma care. Educating patients in self-management of asthma has become a major challenge in primary care practice. The process should begin at the time of diagnosis and should be integrated into every step of medical care during office visits and any other clinician-patient interaction. Identifying patients' expectations and concerns about their disease at each office visit helps the clinician focus care. The educational effort should include a discussion of basic asthma facts, and the types and uses of medications, and a demonstration of the skills involved in the proper use of metered-dose inhalers, spacers and peak flow meters. A written asthma self-management plan developed jointly by the clinician and the patient includes recommended daily medications and the specific steps the patient should take to control asthma and achieve the goals of asthma care.

Asthma↗
PubMedDate not supplied

[Barriers in implementing innovative nursing research concepts. Results of a study].

The question of knowledge transfer into the practice of nursing is gaining more and more importance due to the urgently required innovations for the practice-last but not least also the question of the barriers of transforming them: Beginning with the problem of what shall be definitely determined as theory and what as practice, or possible transport damages, which knowledge suffers from in the process of transforming scientific findings into action recommendations that are usable in nursing practice with inclusion of the barriers with which those pragmatists have to struggle who wish to transform theoretical knowledge into institutions-disturbing factors wait everywhere: simple linear ideas of transformability of theoretical knowledge are not appropriate. Looking at the example of participants of a training course for "specialized nurses for geriatric medicine and rehabilitation" the authors investigated transformation barriers in the knowledge transfer on innovative nursing concepts and developed plans regarding transfer optimization.

Aged↗
PubMedDate not supplied

Business management and the environment of care standards.

In summary, the entire JCAHO manual is built around the concept of "know thyself." This expectation creates the need to engage in a substantial rework of existing practices to remove communication barriers and to eliminate turf warfare. The focus of the standards is on the patient. All aspects of the patient-care delivery cycle are examined during survey, as are key elements of the business-management activities. The EC standards are a case study of business management. They expect leadership and planning, development of human resources, management of information, and improvement of performance. They expect that all four of these management tools will be exercised by all managers and staff members who have an impact on or are impacted by the seven elements of the EC function. The primary focus is on teamwork among providers and maximizing benefits to patients.

Health Facility Environment↗
PubMed1998

Results of an oral rabies vaccination program for coyotes.

OBJECTIVE: To determine effectiveness of large-scale distribution of an oral rabies vaccine contained in a palatable bait for halting expansion of a canine rabies epizootic in coyotes (Canis latrans). DESIGN: Prospective study. ANIMALS: 98 coyotes during prevaccination surveillance and 449 coyotes and 60 other wild animals during postvaccination surveillance. PROCEDURE: A vaccinia recombinant oral rabies vaccine was inserted into an edible bait for coyotes that also contained tetracycline as a biomarker. Vaccine units were then distributed via aircraft, using automated distribution equipment and flight plans developed by incorporating global positioning system equipment. The target area was along the northern edge of an area that had an epizootic of canine rabies. This area was identified through previously conducted epidemiologic surveillance of rabies cases. During postvaccination surveillance, dental specimens were examined for biomarker evidence of bait acceptance, and serum samples were analyzed for rabies neutralizing antibodies. RESULTS: Samples from 449 coyotes were obtained during postvaccination surveillance. Seroconversion was detected in 39 of 96 (40.6%) coyotes that had evidence of tetracycline biomarker. Additionally, the number of rabies cases in the target area decreased, and expansion of the epizootic area ceased. CLINICAL IMPLICATIONS: Mass distribution of an oral rabies vaccine in a palatable bait is an effective means to halt expansion of a rabies epizootic involving coyotes.

Administration, Oral↗
PubMed1997

[Undergraduate curriculum reform at the Pontifical Catholic University Medical School: aims, methodology and advance status].

The Medical School of the Pontifical Catholic University is devoted to a reform process aiming to adequate undergraduate training to scientific, technological, cultural and social changes in medical practice in Chile and to incorporate novel teaching methodology. One of the main modifications is the change of the resulting professional from "a general physician capable of resolving most medical problems of rural or urban populations" to "a physician with a solid general training but qualified for a subsequent specialization". This requires curricular flexibility to obtain different professional profiles. Other important changes are a reduction in curricular contents and their vertical and horizontal integration, modernization of teaching methodologies with the incorporation of computing techniques and problem oriented teaching and the incorporation of new subjects such as molecular biology, clinical genetics, health economics. To achieve these objectives, a semi-flexible curriculum was devised, the curricular mesh has been modified extensively, an outpatient and a nine months elective internship were added. Most modifications have been implemented, remaining changes in 4th and 5th years. These changes required a reorganisation of academic structure, the use of new selection, training and perfecting criteria for teachers, better salaries for outstanding professors and improvement of teaching infrastructure. This reform must be seen as a medium term integral change in the context of an integral academic development plan.

Chile↗
PubMed1998

Linking postdoctoral general dentistry programs with managed care programs and settings.

This report presents the results of a small workgroup convened by the American Association of Dental Schools to examine experiences related to postdoctoral general dentistry programs linked with managed care systems and clinical settings. The workgroup was a component of an Association effort to identify and promote innovative and nontraditional methods by which the number of postdoctoral general dentistry (PGD) positions can be increased to meet current demand for PGD education. The participants identified factors and conditions that they believed to be critical to the planning, development, and conduct of PGD programs with substantial linkages with managed care systems and settings. The information should be helpful to others as they consider opportunities to establish PGD programs or increase their number of PGD training positions.

Academic Medical Centers↗
PubMed1998

Linking resources to process in disability management. Successful program.

1. Occupational health services need to link resources to business process to product to support the business goals of the corporate organization. 2. Use of business process steps in business plan development provides an organized, comprehensive approach to effective product development. 3. It is essential to demonstrate a cost reduction which is reflected in the business organization's ROI, resulting in the shareholder's increased per share earnings.

Case Management↗
PubMedDate not supplied

Adherence to management of high blood pressure: recommendations of the Canadian Coalition for High Blood Pressure Prevention and Control.

Adherence or compliance, in the context of medical treatment, refers to how well a patient follows and sticks to the management plan developed with her/his health care provider, which may include pharmacologic agents as well as changes in lifestyle. Adherence is of great concern in asymptomatic conditions such as hypertension, where lack of control may have serious ramifications including end organ damage and premature mortality. To address this issue, the Canadian Coalition for High Blood Pressure Prevention and Control established a national Advisory Committee on Adherence to the Management of High Blood Pressure. The Advisory Committee consisted of 11 members from different disciplines of health care providers. The Committee reviewed all evidences to date and drew up four practical recommendations with respect to patient, provider and environment. Based on Canadian Task Force on Periodic Health Examination's guidelines, all four recommendations can be classified as 'level C' with a quality of evidence of II.

Canada↗
PubMed1998

Clinical safety evaluation of combination vaccines.

The development plan for new combination vaccines should include clinical studies designed to provide an adequate safety database (as well as efficacy data) to support licensure. Ideally, randomized studies to compare the safety of the combination vaccine with the separately administered components (or already licensed combinations of components) should be performed. For new combination vaccines having components with proven efficacy, comparative immunogenicity data may provide a sufficient basis to support efficacy, precluding the need for a large efficacy study. In the absence of the safety database that would have been derived from such an efficacy study, it is important to conduct a comparative safety study with a sample size suitable for the evaluation of less common adverse events. For large safety trials, a simplified design where only a subset of subjects is assessed in detail for the more common adverse events may be appropriate.

Biometry↗
PubMed1998

Epidemiology of opisthorchiasis and national control program in Thailand.

Opisthorchiasis is a disease caused by opisthorchis trematode commonly known as liver fluke. In Thailand Opisthorchis viverrini is the only parasite of opisthorchiasis, the first case of opisthorchiasis was reported in 1911 by Leiper from the autopsy of corpse in Chiang Mai. Later on Sadun in 1953, Harinasuta and Vajjarasthira in 1961, and Wykoff in 1965 had demonstrated a complete life cycle of O. viverrini. History of opisthorchiasis control has dated back to 1950 as a small scale helminthiosis control program in some high risk areas. Following a number of studies and trial projects of the Faculty of Tropical Medicine of Mahidol University, the national liver fluke control program has been developed and operated under different National Public Health Development Plans. Presently, the program is being operated in some central provinces, and all northeastern and northern provinces of Thailand. The main strategies for liver fluke control are comprised of 3 interrelated approaches, namely stool examination and treatment of positive cases with praziquantel for eliminating human host reservoir; health education for a promotion of cooked fish consumption for preventing infection; and the improvement of hygienic defecation for transmission interruption. Data obtained from liver fluke control operation in 1996 show the countrywide prevalence of opisthorchiasis at 21.5% with a variation in all age groups. Differences of infection are also found among geographical regions. A large percentage of infection is mild infection. Comparing figures of 1981 and 1991, there is a considerable increase in the central and northern regions, while the northeastern region has significant decrease.

Adolescent↗
PubMed1993

Study and introduction of family planning methods in developing countries.

Research in developing countries is essential for the evaluation of the safety, efficacy and acceptability of both new and already available contraceptives. Research conducted by scientists in developing countries has also played an essential role in the development of new contraceptives. The continuous delivery of progestin at a low dose, copper IUDs, contraceptive implants, monthly injectables and vaginal rings are examples of new methods developed with the input of research conducted largely in developing countries. When research in developing countries is funded or coordinated by international agencies, local scientists have to be involved not only in its implementation, but in the planning, analysis and dissemination of such research. The World Health Organization, the Population Council and Family Health International have played an important role in supporting collaborative studies for the development, introduction and evaluation of family planning methods in developing countries.

Developing Countries↗
PubMedDate not supplied

Principles of health infrastructure planning in less developed countries.

This article proposes a number of key principles for health infrastructure planning, based on a literature review on the one hand, and on a process of internal deduction on the other. The principles discussed are the following: an integrated health system; a thrifty planning of tiers within that health system; a specificity of tiers; a homogeneity of the tiers' structures; a minimum package of activities; a territorial responsibility and/or an explicit and discrete responsibility for a well-defined population; a necessary and sufficient population basis; a partial separation of administrative and public health planning bases; and, finally, rules for a geographical division and integration of non-governmental organizations. The definition of two strategies, primary health care and district health systems, is also revisited.

Continuity of Patient Care↗
PubMedDate not supplied

The role of data-driven planning and coalition development in preventing cardiovascular disease.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States. Effective programs for the prevention and control of CVD need to include data-based planning and evaluation at the State and local levels. The authors describe the development of data-driven planning and intervention strategies in Missouri. Statewide planning activities have resulted in the formation of an advisory committee and development of a State plan, a resource directory, and training courses. Analysis of mortality data revealed an unusual concentration of CVD deaths in the southeast portion of the State. Local coalitions are being developed in each of six counties in this region to reduce the prevalence of CVD risk factors. A regional behavioral risk factor survey of 1,006 adults identified key risk factors that will be addressed by the coalitions. These data suggested that physical inactivity, obesity, and hypertension are especially acute problems in the area. Key components of the local coalition development included providing localized data and obtaining the strong commitment of the local health departments. Expanded use of chronic disease surveillance data for planning and evaluation will increase the probability that localities, States, and the nation will achieve Year 2000 Health Objectives. The data-based planning process is described as a possible model for use by other States and localities.

Cardiovascular Diseases↗
PubMedDate not supplied

Perceptions of population policy, development, and family planning programs in northern Nigeria.

In this article, local perceptions of family planning programs and federal population policy are examined, based on responses to a childbirth survey and on interviews with a range of individuals in one northern Nigerian town. The respondents' differing perceptions of the relationship between population and national development reflect distinctive ideas about political authority, population policy, and family planning programs, about development, and about domestic and international political affairs. Local suspicions about the Nigerian population policy and family planning programs suggest that they cannot be implemented in isolation from broader political and economic concerns. This distrust has ramifications for current family planning programs and reproductive health initiatives undertaken by Western-sponsored aid projects.

Adolescent↗
PubMed2001

Development of a treatment planning protocol for prostate treatments using intensity modulated radiotherapy.

We have developed a treatment planning protocol for intensity-modulated radiation therapy of the prostate using commercially available inverse planning software. Treatment plans were developed for ten patients using the Corvus version 3.8 planning system, testing various prescription options, including tissue types, dose volume histogram values for the target and normal structures, beam arrangements, and number of intensity levels. All plans were scaled so that 95% of the clinical target volume received 75.6 Gy; mean doses to the prostate were typically 79 Gy. The reproducibility of the inverse planning algorithm was tested by repeating a set of the plans five times. Plans were deemed acceptable if they satisfied predefined dose constraints for the targets and critical organs. Figures of merit for target coverage, target dose uniformity, and organ sparing were used to rank acceptable plans. Certain systematic behaviors of the optimizer were noted: the high dose regions for both targets and critical organs were 5-10 Gy more than prescribed; reducing bladder and rectum tolerance increased the range of doses within the target; increasing the number of fields incrementally improved plan quality. A set of planning parameters was found that usually satisfied the minimum requirements. Repeating the optimization with different beam order produced similar but slightly different dose distributions, which was sometimes useful for finding acceptable solutions for difficult cases. The standard set of parameters serves as a useful starting point for individualized planning.

Humans↗