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PubMed2004

The feasibility of government partnerships with NGOs in the reproductive health field in Mexico.

In 1995 the Mexican government began to develop policies on establishing collaborative agreements with civil society organisations, and there is currently interest in Mexico in government and NGOs working together. This paper analyses whether the conditions exist in Mexico for successful partnerships between the public sector and NGOs in the reproductive health field. In-depth interviews were carried out with key informants in the public sector at national and state level and the NGO sector in six states in Mexico. Partnerships were found to be an option for the provision of reproductive health services in geographical areas where the population is under-served, and for services the government does not provide. While the contribution of NGOs to the reproductive health field is recognised, at least at federal level, there are still very few public agencies that collaborate with NGOs, and agreements are often limited to short-term financing of projects. The future of NGOs in Mexico will depend largely on their ability to obtain funding from within the country. More effective mechanisms are needed by government to generate resources for health care. Government must recognise the specific contribution of NGOs, including inputs of social capital and creation of community networks, and must share decision-making more equitably with NGO for partnerships to succeed.

Cooperative Behavior↗
PubMed1998

Perceptions of senior nursing staff about current action, barriers and solutions to working on active and passive smoking in the Liverpool Health Sector.

Nurses, particularly those working in antenatal, maternity and paediatrics, can greatly assist their patients to reduce the harms associated with tobacco use. Senior nursing staff from the Division of Women's and Child's Health, and Primary Health in the Liverpool Health Service were surveyed to identify action currently taken with patients, on active and passive smoking. The survey showed that there was an emphasis on assessment and education. Barriers that hindered staff action included the lack of resources, particularly for people of non-English speaking background (NESB), and training. This research also suggests the need for policy development as a way to achieve consistency and maintenance of action.

Adult↗
PubMedDate not supplied

AIDS, nursing, and physician-assisted suicide: Part 2.

Nurses who work in HIV/AIDS care often hold conflicting views from each other about appropriate nursing roles in relation to physician-assisted suicide. Regardless of whether the individual nurse supports or opposes physician-assisted suicide, nurses in HIV/AIDS care need to have a broad knowledge base of the legal and ethical issues related to physician-assisted suicide. This article has as its major purpose to provide nurses with the knowledge base they need to assist them in their work in clinical practice, education, policy development, and research.

Ethics, Nursing↗
PubMedDate not supplied

AIDS, nursing, and physician-assisted suicide: Part 1.

Nurses who work in HIV/AIDS care often hold conflicting views about appropriate nursing roles in relation to physician-assisted suicide. Regardless of whether the individual nurse supports or opposes physician-assisted suicide, nurses in HIV/AIDS care need to have a broad knowledge base of the legal and ethical issues related to physician-assisted suicide. This article's main purpose is to provide nurses with the knowledge base they need to assist them in their work in clinical practice, education, policy development, and research.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Training people with HIV disease for involvement in community planning process: Project LEAP. Learning Empowerment Advocacy, Participation.

Social and political pressure, as well as public health theory, mandate inclusion of PLWHIV in community planning and policy development processes. Barriers to PLWHIV participation may be cognitive, instrumental, and/or affective. The authors report on development, implementation, and initial evaluation of a pilot project testing a psychoeducational intervention to increase organizational participation by people with HIV. Organizational participation by individual increased from a mean of 0.5 organizations at entry to 2.3 at follow-up. Evaluation data indicate that increases in self-esteem, self-confidence, and specific knowledge, along with demystification of organizational operations, networking, and modeling by project staff contributed to the outcome.

Adult↗
PubMedDate not supplied

End-of-life issues: a survey of English-speaking Canadian nurses in AIDS care.

This anonymous postal survey explored attitudes and experiences concerning end-of-life decisions. Respondents were English-speaking members of the Canadian Association for Nurses in AIDS Care (CANAC) and other nurses identified as working primarily in HIV/AIDS settings. Seventy-three percent believed that the law should be changed to allow physicians to practice voluntary euthanasia (VE) and assisted suicide (AS). Fifty-three percent indicated that nurses should be allowed to practice VE and AS. Although VE and AS are illegal, fewer than one in five nurses would report a colleague whom they knew to be involved in such acts. More than one in five nurses have received requests from patients to hasten their deaths by VE. Nearly 98% believe that the nursing profession should be involved in policy development concerning VE and AS, and nearly 78% believe that nurses should be involved in the decision-making process with patients if such acts were legal. Given that ethical codes for Canadian nurses promote client self-determination and that nurses are the largest group of care providers for the terminally ill, the profession must promote discussion and research if it is to take a leadership role with respect to end-of-life issues.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Ready or not, here it comes: the legal, ethical, and clinical implications of E-mail communications.

Electronic mail (E-mail) has the potential to enhance the professional relationship both between physician and patient, and among physicians of the same and different specialties. Despite this promise, E-mail communication in the medical environment raises important questions of legal, ethical, and professional propriety. This article discusses the potential uses of E-mail in medical practice, identifies its benefits, and analyzes the hazards that may be associated with this new and powerful technology. In doing so, the authors hope to foster an approach to E-mail use that takes advantage of its strengths while developing policies and practices that mitigate its weaknesses.

Child↗
PubMedDate not supplied

Medication management in primary and secondary schools.

OBJECTIVE: To summarize present knowledge about medication management in primary and secondary schools; to place this knowledge in its drug use and organizational contexts; and to provide a foundation for studying the problem and developing policy- and practice-level interventions aimed at alleviating it. To offer recommendations for practitioners, policy makers, and health professions educators aimed at improving the situation. DATA SOURCES: MEDLINE database (1966-1998); International Pharmaceutical Abstracts database (1977-1998); complete Medscape full-text search; contents of the Journal of School Nursing and the Journal of School Health (1966-present). STUDY SELECTION: We reviewed 95% of all articles, books, and reports identified using the search terms elementary school, middle school, junior high school, high school, primary school, secondary school, school nurse, school health, and schoolchildren. DATA EXTRACTION: The literature on this topic includes background material describing the nature of the problem and its political and organizational context and implying its significance; summaries of regulations, guidelines, and recommendations regarding medication management in the schools; and empirical studies. Few articles address pharmacist involvement in medication management in schools. DATA SYNTHESIS: Although approaches to this important problem vary widely, a set of core medication management guidelines is identifiable. Formal research is sparse, but it shows that medication use is widespread in schools and carries significant therapeutic and safety consequences. CONCLUSION: Pharmacists and school nurses must cross professional borders if they wish to play a role in solving this important drug therapy problem. Pharmacists can provide therapeutic and contextual perspectives on the problem, while school nurses can implement solutions within the schools.

Child↗
PubMed2003

Public-private mix DOTS in the Philippines.

The National Tuberculosis Prevalence Survey done in 1997 (1997 NPS) revealed that the magnitude of tuberculosis in the Philippines hardly declined between 1982 and 1997. In 1996, the National TB Control Program (NTP) adopted the directly observed treatment short-course (DOTS) strategy. By the end of 2001, more than 90% of the population have access to it. Cohort analysis revealed good treatment outcomes. Despite this improvement in the public sector, there is a concern that the epidemiological impact of DOTS will be limited due to the non-participation of the private practitioners, a major stakeholder. Public-private sector collaboration in TB control was strengthened since the Philippine Coalition Against TB (PhilCAT) was organized in 1994. There are four areas of collaboration, namely, policy development, advocacy and information dissemination, training and research and service delivery. Four models of public-private mix (PPM) DOTS in service delivery were developed. The private DOTS clinics provide the space, staff and operational funds while the Department of Health (DOH) provided technical assistance, anti-TB drugs, laboratory supplies and forms. Evaluation showed that PPM in TB control is feasible with good results. The major challenge is to replicate and institutionalize the PPM DOTS.

Communicable Disease Control↗
PubMed2002

International stem cell research considerations.

Legislative bodies in the international arena and in individual countries are actively engaged in developing policies regarding the establishment, distribution and use of human embryonic stem cells. Present and anticipated policies concerning research on human adult and embryonic stem cells of possible medical importance reflect the wide spectrum of popular views that range from complete rejection to enthusiastic support. Since the public debate concerning the use of human gametes or embryos for research purposes is not likely to abate anytime soon, all the more urgent becomes the quest for alternative approaches toward generating stem cells that are not embryonic and yet are pluripotent.

Ethics, Research↗
PubMedDate not supplied

Boyer's multidimensional nature of scholarship: a new framework for schools of nursing.

This article compares Boyer's concept of four dimensions of scholarship with nursing's traditional definition of scholarship. A case is made that Boyer's concept is congruent with nursing's present and future direction of scholarship. An example is given of how one school of nursing has used Boyer's concept as a framework to develop policies and practices to promote and reward the scholarship of discovery, integration, application, and teaching.

Education, Nursing↗
PubMed2000

Mass media exposure and its impact on family planning in Bangladesh.

This paper analyses mass media exposure and its effect on family planning in Bangladesh using data from the Bangladesh Demographic and Health Survey (BDHS) 1993-94. The findings indicate that radio and television are two important mass media for disseminating family planning information in Bangladesh. However, access to them and exposure to family planning through them are still limited. Slightly more than 40% (42.1%) of respondents reported that they had heard family planning messages via radio, while 17.2% said television, 8.4% said poster and 5.4% said billboard. Respondent's place of residence, education, economic status, geographical region and number of living children appeared to be the most important variable determining mass media exposure to family planning. Multivariate analysis shows that both radio and TV exposure to family planning messages and ownership of a radio and TV have a significant effect on current use of family planning methods. These factors remain significant determinants of contraceptive use, even after controlling socioeconomic and demographic factors. The study reveals that both socioeconomic development policies and family planning programmes with a special emphasis on mass media, especially radio, may have a significant effect on contraceptive use in Bangladesh. The principal policy challenge is to design communications strategies that will reach the less privileged, rural and illiterate people who are by far the majority in Bangladesh.

Adolescent↗
PubMed1999

The survey form of SCAN: the feasibility of using experienced lay survey interviewers to administer a semi-structured systematic clinical assessment of psychotic and non-psychotic disorders.

BACKGROUND: The success of large scale surveys depends on well designed questionnaires and the skills of lay interviewers. Discrepancies in prevalence rates between epidemiological surveys and poor agreement between survey interviewer and clinician diagnostic interviews are giving rise to increasing concern among researchers, public health planners and policy developers. New approaches to information collection are called for. The feasibility of training experienced survey interviewers in semi-structured, clinical, diagnostic interviewing has never been investigated systematically across the range of neurotic and psychotic disorders. METHODS: Eight experienced survey interviewers from the Office for National Statistics (ONS) were selected and underwent extended training in a Survey Form of SCAN (SCAN-SF). Sixty-four adults, including a majority of psychiatric in-patients were assessed by ONS interviewers and reinterviewed within a week by SCAN-trained clinicians. Feedback was sought from interviewers and trainers. RESULTS: Trainers found lay interviewers coped at least as well with psychotic as with neurotic symptoms. Concordance for any disorder was 0.74 (95% CI: 0.57 to 0.91); for any specific psychotic disorder 0.63 (0.40 to 0.86); for any specific neurotic disorder 0.63 (0.43 to 0.83). Sensitivity ranged from 0.6 to 0.9 and specificity from 0.8 to 0.9. There was no evidence of rater bias. CONCLUSIONS: These preliminary findings are very promising. However, before the SCAN-SF, administered by carefully trained lay interviewers, can be recommended in large scale surveys, further evaluations of its feasibility and reliability in the general population are needed.

Adaptation, Psychological↗
PubMed1992

Clinical PET scanning. A "short-lived" orphan.

Positron emission tomography (PET) is a method of nuclear medicine imaging that uses short-lived radiopharmaceuticals to detect and quantify the metabolic abnormalities of disease processes. PET initially was developed in a research environment as a research tool; data from these research studies resulted in the gradual recognition that PET studies would be useful for various routine clinical applications. The diffusion of PET into clinical practice has been slow in comparison with other new imaging methods (e.g., magnetic resonance imaging). This slow diffusion is attributable to several factors, including the complexity and high cost of PET, the uncertain role of the U.S. Food and Drug Administration in regulating the radiopharmaceuticals that are produced and used on-site for PET studies, and the apparent slow pace at which the Health Care Financing Administration and other third-party payers are developing policies for reimbursing for PET.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2004

Clinical practice guidelines for the management of psychosocial distress at the end of life.

Algorithm-based clinical practice guidelines relating to psychiatric, psychosocial, and spiritual domains can effect a major improvement in end-of-life care by defining a gold standard for clinicians in an area not previously subjected to such a level of scrutiny. This article outlines the status of these guidelines and offers recommendations for policy development relative to doctor-patient communication and management of distress (psychological, social, existential, spiritual) and psychiatric disorders. The arching principle of these standards and guidelines is the recognition that the physical and the psychosocial are interrelated and overlapping in end-of-life care, and that patients should receive their total care as a seamless integration of physical and supportive services.

Algorithms↗
PubMed2002

Current directions in the practice of environmental risk assessment in the United Kingdom.

The manner in which regulators apply environmental risk assessment to their decisions on managing risk is changing. Expectations of risk assessment work are becoming clearer, the social issues agenda is having an impact on risk assessment practice, and there is a trend toward harmonizing approaches to the treatment of environmental risk. For risk analysts, the multiplicity of environmental problems is providing opportunities for the transfer of expertise between the different contexts of applying environmental risk assessment. With the latter as a focus, we summarize recent policy developments in the United Kingdom and illustrate how Government guidance on environmental risk assessment and management is being implemented. We emphasize the need for proportionality in risk analysis, the targeting of regulatory effort to risk, and the explicit treatment of uncertainty. These developments are contributing toward better "risk-informed" environmental decisions in which risk analysis plays an important part alongside other considerations. The forward agenda is likely to see further practical integration between technical risk issues and economic and social concerns, and the positioning of environmental risk assessment within a broader landscape of decision-making tools.

Conservation of Natural Resources↗
PubMed1998

Health care management modelling: a process perspective.

Modelling-based health care management ought to become just as popular as evidence based medicine. Making managerial decisions based on evidence by modelling efforts is certainly a step forward. Examples can be given of many successful applications in different areas of decision making: disease process modelling, screening and prevention policy development, resource allocation, waiting lists and waiting times, patient scheduling. Also examples can be given which would have benefited by prior modelling, for example adverse effects of health care system reform decisions. This contribution aims at giving an overview of health care management modelling areas, and observations from a European perspective on developing successful health care management models. The overview is created by presenting different reference frameworks for mapping health care management modelling applications. We report a development from an almost arbitrary list of applications used for bibliographic purposes (scheduling, simulation, queueing, etc.) towards frameworks that focus on the process of delivery. The advantage of mapping modelling applications in this way is that we are able to position contributions within a reference framework with a focus on processes, with the patient process at the top. The acceptance of process-orientation as a basis for modelling has consequences for the way models are developed. Close cooperation between modeller and manager and a profound insight into the dynamics of the modelling area concerned are important requirements for developing successful models. This is illustrated for waiting lists as an area of modelling.

Decision Making, Organizational↗
PubMed1998

How well do birth certificates describe the pregnancies they report? The Washington State experience with low-risk pregnancies.

OBJECTIVES: Birth certificates are a major source of population-based data on maternal and perinatal health, but their value depends on the accuracy of the data. This study assesses the validity of information recorded on the birth certificates for women in Washington State who were considered to be low risk at entry into care. METHODS: Birth certificates were matched to data abstracted from prenatal and intrapartum clinic and hospital records of a sample of 1937 Washington State obstetrical patients who were considered to be low risk at the beginning of their pregnancies. Accuracy of a variety of pregnancy characteristics (e.g., complications, procedures) on the birth certificate was analyzed using percentage agreement and sensitivity with record abstracts as the "gold standard." Next, we weighted the data from each source to produce estimates of pregnancy characteristics in the population. We compared these estimates from the two data sources to see whether they provide similar pictures of this subpopulation. RESULTS: Missing data for specific items on the birth certificates ranged from 0% to 24%. The birth certificate accurately captured gravidity and parity, but was less likely to report prenatal and intrapartum complications. The population estimates of the two data sources were significantly different. CONCLUSIONS: Because birth certificates significantly underestimated the complications of pregnancies, number of interventions, number of procedures, and prenatal visits, use of these data for health policy development or resource allocation should be tempered with caution.

Adult↗