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PubMedDate not supplied

Bridging refugee youth and children's services: a case study of cross-service training.

Bridging Refugee Youth and Children's Services(BRYCS), a public-private partnership between the federal Office of Refugee Resettlement, Lutheran Immigration and Refugee Service, and the United States Conference of Catholic Bishops, provides national technical assistance to public child welfare. After a series of "community conversations," BRYCS identified a lack of knowledge among child welfare staff about newcomer refugees, negative stereotypes, and a fear of child protective services among refugees. BRYCS initiated a number of technical assistance initiatives, including a pilot cross-service training project in St. Louis to strengthen collaboration between child welfare and refugee-serving agencies. This article details the lessons learned from this training and recommends changes in policy and practice.

Adolescent↗
PubMed2006

Building an interoperable regional health information network today with IHE integration profiles.

One of the key challenges of architecting electronic record sharing solutions that are scalable and can provide acceptable performance is how to create a longitudinal record for a patient when the desired data will be stored in several distributed point-of-service systems. This paper will review the design and standards selection process that has been made by Integrating the Healthcare Enterprise, a multi-national collaborative of care providers and developers that analyzed a variety of approaches. In particular, the requirements, issues, and alternative solutions for scalable, standards-based data locating services supporting regional and national health information exchange solutions will be discussed. Guidance will be offered to architects of regional health information organizations to take advantage of this experience and leverage the IHE Technical Framework, its testing processes, and tools to accelerate their projects and facilitate the interfacing of EHR systems serving different care settings from different vendors or developers. The implementation experience in 2005-2006 of the IHE Integration Profile specifications supporting an interoperable RHIO solution among various EHR systems from more than 30 vendors will be analyzed, with key lessons summarized.

Computer Communication Networks↗
PubMed1990

[Stress echocardiography in clinical cardiology].

In their generally designed presentation the authors focus on practical problems concerning indication, different stress modalities and projections, evaluation and interpretation of findings, as well as on technical novelties and their use. Only dynamic exercise echocardiography is being discussed. Currently available knowledge is assessed in the light of the authors' own experience. Problems of evaluation and interpretation are considered to be most intricate. In the authors' opinion, many technical problems which have prevented the routine use of the method in practice will be eliminated by introducing technical novelties such as digitalization of the display with image loop. Other innovations will certainly be used to advantage and render the method less demanding and far more widespread.

Echocardiography↗
PubMed1989

A new method of transcervical female sterilization: preliminary results in rabbits.

In search of an outpatient procedure for female sterilization, the authors performed the following animal study. Two groups of seven rabbits were subjected to laparotomy, hysterotomy, and hysteroscopy. The uterotubal junction (UTJ) was destroyed with bipolar electrical current, and a plug (Aqualloy, Drachten, The Netherlands) was inserted. The plug on the right side contained quinacrine (Q) in group A and platelet extract (PE) in group B. Histologic assessment by serial sections indicated occlusion of the UTJ in all but one case (96% success rate). This one failure is attributed to the technical difficulties associated with hysteroscopy in the rabbit. The authors project that this method may have the potential of becoming an acceptable outpatient procedure for female sterilization in the human.

Animals↗
PubMed1996

[Quality and homogeneity monitoring of radiologists in the Turin mammographic screening. Comparison of the pilot phase results].

The Turin mammographic screening program was designed to be carried out in several independent screening centers because of the large proportion of population involved (76,000 women aged 50 to 59 years). The first center began working in 1992 and the second center was opened in 1995. The latter center carried out an early pilot study in which 1024 women were examined to assess the homogeneity and the quality of the results. The results were then compared with European quality standards and with the results of both the pilot and the active screening periods in the first center. The results from the second center were very good as far as detection rate is concerned (7.8/1000-2.9/1000 in carcinoma < or = 1 cm). This rate is higher than the so-called "desirable" European standard. Recall rate and benign/malignant biopsy ratio were higher than the so-called "fair" European standard (recall rate: 7.1%; B/M biopsy ratio: 0.62). These results are slightly superior to those of the pilot period in the first center and slightly inferior to the results of active screening in the same center. The improvement relative to the pilot period in the first center (1991) is probably related to technical progress, such as the introduction of the double mammographic projection. The difference relative to the results from the active screening period in the first center (1992-1994) reflects different specific experience. Even though pilot periods have no statistical significance, they can be used for comparison, and in our experience they have proved, with positive results, the quality of the mammographic screening program provided to the Turin population.

Female↗
PubMed2005

The Baltic Health Network - Taking Secure, Internet-based Healthcare Networks to the Next Level.

Internet-based health care networks are a step forward compared to first generation health care networks, which has been limited to pushing text-based messages between different systems. An Internet-based network can also "pull" data - and not only text but any digital data - for instance images and video sequences. The Internet-based networks can more effectively fulfil the vision of access to relevant data regardless of time and location. Although far from identical, the health delivery systems of Denmark, Norway and Sweden are similar. They also share a shortage of specialized health personnel - not least radiologists and in some regions obstetricians. Furthermore, over the past ten years they have implemented an IT-strategy to increase efficiency in the delivery of healthcare services. Part of this strategy has been to build three national networks on top of the existing regional, secure and Internet-based healthcare networks. These national networks connect not only all hospitals in the three countries, but also a majority of the other stakeholders in the healthcare sector (GPs, private specialists, laboratories, homecare services etc.). The organizations behind the three networks are now working on creating a trans-national network, the Baltic Health Network (BHN), which will be one of the outcomes of the Baltic eHealth project and will not only connect the three national networks but also add two hospital networks from Lithuania and Estonia. The BHN is expected to be operational by June 2005. One of major advantages of the BHN is that the many rural hospitals of the Baltic Sea Area with a few mouse clicks can reach a specialist for second opinion in any of the approximately 200 hospitals connected to the network. For instance the midwives in the rural areas of Västerbottan County, Sweden, are awaiting the establishment of BHN to get access to second opinions from specialists at National Center for Foetal Medicine at the University Hospital of Trondheim, Norway. The BHN will remove a very important technical barrier for collaboration between health professionals and the Baltic eHealth project hopes that this and other project initiatives will facilitate the large-scale usage of second opinion from available health care experts regardless of institutional, regional and even national borders. This will lift the quality of service to patients in the Baltic Sea Region - especially in the rural areas where highly specialized health professionals tend to be geographically far away.

Cooperative Behavior↗
PubMed1995

Military personnel and dependents in population analysis and projection.

"Concentrations of [U.S.] armed forces and their dependents create some unusual (and little recognized) problems for applied demographers, both in analysis and projection.... Their presence complicates both the collection and interpretation of data, and has special impact on the preparation of projections." The authors discuss possible ways of resolving these problems.

Americas↗
PubMed1991

Backcalculation of flexible linear models of the human immunodeficiency virus infection curve.

The authors present a regression approach to the backcalculation of flexible linear models of the HIV infection curve. They note that "because expected AIDS incidence can be expressed as a linear function of unknown parameters, regression methods may be used to obtain parameter and covariance estimates for a variety of interesting quantities, such as the expected number of people infected in previous time intervals and the projected AIDS incidence in future time intervals. We exploit these ideas to show that estimates based on maximum likelihood are, for practical purposes, equivalent to approximate estimates based on quasi-likelihood and on Poisson regression. These algorithms are readily implemented on a personal computer." These concepts are illustrated by projecting AIDS incidence in the United States up to 1993.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Improving the use of research evidence in guideline development: 3. Group composition and consultation process.

BACKGROUND: The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the third of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. OBJECTIVE: In this review we address the composition of guideline development groups and consultation processes during guideline development. METHODS: We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. KEY QUESTIONS AND ANSWERS: What should be the composition of a WHO-panel that is set up to develop recommendations? The existing empirical evidence suggests that panel composition has an impact on the content of the recommendations that are made. There is limited research evidence to guide the exact composition of a panel. Based on logical arguments and the experience of other organisations we recommend the following: Groups that develop guidelines or recommendations should be broadly composed and include important stakeholders such as consumers, health professionals that work within the relevant area, and managers or policy makers. Groups should include or have access to individuals with the necessary technical skills, including information retrieval, systematic reviewing, health economics, group facilitation, project management, writing and editing. Groups should include or have access to content experts. To work well a group needs an effective leader, capable of guiding the group in terms of the task and process, and capable of facilitating collaboration and balanced contribution from all of the group members. Because many group members will not be familiar with the methods and processes that are used in developing recommendations, groups should be offered training and support to help ensure understanding and facilitate active participation.What groups should be consulted when a panel is being set up?We did not identify methodological research that addressed this question, but based on logical arguments and the experience of other organisations we recommend that as many relevant stakeholder groups as practical should be consulted to identify suitable candidates with an appropriate mix of perspectives, technical skills and expertise, as well as to obtain a balanced representation with respect to regions and gender. What methods should WHO use to ensure appropriate consultations? We did not find any references that addressed issues related to this question. Based on logical arguments and the experience of other organisations we believe that consultations may be desirable at several stages in the process of developing guidelines or recommendations, including: Identifying and setting priorities for guidelines and recommendations, commenting on the scope of the guidelines or recommendations, commenting on the evidence that is used to inform guidelines or recommendations, commenting on drafts of the guidelines or recommendations, commenting on plans for disseminating and supporting the adaptation and implementation of the guidelines or recommendations, key stakeholder organisations should be contacted directly whenever possible, consultation processes should be transparent and should encourage feedback from interested parties.

Journal Article↗
PubMed1990

[Accuracy of forecasts of annual numbers based on monthly numbers].

"Since 1985 monthly forecasts have been made of yearly numbers of births, deaths, immigration, emigration and marriages [in the Netherlands] on the basis of monthly figures. The forecasts are equal to the arithmetic average of an ARIMA projection and a naive forecast.... This article compares the forecasts for the years 1985-1989 with forecasts obtained from a simple alternative method." (SUMMARY IN ENG)

Developed Countries↗
PubMed1995

Hepatic artery thrombosis after liver transplantation: diagnosis with spiral CT.

OBJECTIVE: The purpose of this study was to prospectively evaluate spiral CT with maximum-intensity projection in the diagnosis of hepatic artery thrombosis in patients with liver transplants. SUBJECTS AND METHODS: Thirty liver transplant recipients (19 men, 11 women; mean age, 49 years) underwent Doppler sonography and spiral CT with maximum-intensity projection to evaluate both hepatic parenchyma and hepatic vessels. In five cases, these examinations were followed by angiography for suspected hepatic artery thrombosis. RESULTS: Among the 30 patients, results of both Doppler sonography and spiral CT were abnormal in five patients. In all five patients, Doppler sonography revealed an absence of intrahepatic arterial signal (sensitivity, 100%). Spiral CT showed the hepatic artery to be patent from its origin to the anastomosis and then occluded distally in four patients and showed occlusion of the entire hepatic artery in one patient (sensitivity, 100%). Aortography and/or selective arteriography of the celiac axis confirmed the diagnosis of hepatic artery thrombosis in all five cases. The other 25 patients had a normal clinical outcome, 24 with normal findings on Doppler sonograms (specificity, 96%), and 23 with normal findings on spiral CT. Two patients had false-positive CT studies because of technical failures (specificity, 92%). CONCLUSION: Spiral CT with maximum-intensity projection is highly accurate in identifying hepatic artery thrombosis after liver transplantation.

Adult↗
PubMedDate not supplied

Establishing learning curves for surgical residents using Cumulative Summation (CUSUM) Analysis.

BACKGROUND: The assessment of technical proficiency is of paramount importance in the training of surgical residents. The fact that technical proficiency is underrepresented in the context of the ACGME outcomes project is evidenced in that proficiency skills comprise less than 5% of all assessments that evaluate residents. In this study, we use Cumulative Summation Analysis (CUSUM) as a visual objective analytic tool to determine performance accuracy and establish learning curves for PGY-1s in surgery. METHODS: From April 2001 to May 2002, 11 surgical residents completed a 1-month anesthesia rotation. Each resident was asked to complete a preoperative airway assessment followed by endotracheal intubation with induction of anesthesia. Airway assessment was performed independently by a resident and a licensed anesthesiologist or certified anesthetist with the modified Mallampati Score. Data were sequentially collected and plotted for summated successes and failures. RESULTS: The average intern required approximately 19 intubation attempts to complete the learning curve experience. There was no learning curve for airway assessment. CONCLUSIONS: The CUSUM analysis is an effective objective tool to define learning curves for technical skills. Vital information is provided for surgical programs that place residents in positions to manage airways, and limitless potential for defining the learning curves for technical skills is provided.

Adult↗
PubMedDate not supplied

[A survey on the practice of drug prescription in hospitals. Concepts and methodology].

A clinical practice survey, if patient focused, identifies and analyses complexity of drug use. It is not a clinical audit whose aim is to compare observed practice with predetermined criteria. A clinical practice survey is useful when a problem exists in a low evidence based clinical area or to elaborate clinical guidelines. Implementation is based on epidemiological methodology and project management and needs a framework determined by a facilitator (trained in quality improvement methods and expert in the clinical area concerned), planning (the more higher the number of wards, the higher the complexity) and the project guidelines must be respected. Since lack of physician involvement is a drawback, support provided by the quality centre (if it exists) must be limited to technical aspects. It is important to appreciate the level of quality culture of the organization and the project must be approved by the hospital manager.

Data Interpretation, Statistical↗