Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Development Policy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,405 records · Page 78Linked to original sources
PubMed2006

Recombinant factor VIIa: unregulated continuous use in patients with bleeding and coagulopathy does not alter mortality and outcome.

Recombinant factor VIIa (rFVIIa) is used in patients with hemophilia who had developed inhibitors. A hemostatic effect has been demonstrated following the administration of rFVIIa in patients after trauma and bleeding. Currently, there is no widely accepted guideline for off-label rFVIIa usage in bleeding patients. We planned to review the rFVIIa utilization practice in our institution and develop policies and guidelines for future rFVIIa use. We acquired the medical records of 55 patients who received rFVIIa at our institution during 2003-2004. Patient charts were reviewed regarding their rFVIIa administration and indications, dose and frequency, cost, pre-rFVIIa blood component usage, utilization of hematology services and outcome were analyzed. Underlying liver disease with coagulopathy was the commonest (47%) indication for rFVIIa use. Recombinant FVIIa was successful (69%) in correcting laboratory parameters of coagulopathy, but did not alter outcome. Twenty-six of the 55 patients (47%) died during the same admission from their underlying diseases. Apart from two trauma patients, no one died from bleeding. We conclude that unregulated continuous administration of rFVIIa in bleeding/coagulopathic patients did not alter outcome. Closer monitoring of rFVIIa usage, including hematology consultation and enforcement of pre-rFVIIa blood component usage would optimize cost-effectiveness.

Adolescent↗
PubMed1994

Becoming strangers: the changing family caregiving relationship in Alzheimer's disease.

Alzheimer-type dementia (AD) is an insidious pervasive debilitating disorder that destroys the affected person's capacity for self-care. In this grounded theory study, we explored the reciprocal process of becoming strangers in which eastern Canadian family caregivers and care recipients with AD interact on a continuum from intimacy to alienation through dimensions of dawning, holding on and letting go. The findings illuminate the experiences of family members who struggle on a daily basis with their commitment to the person they knew and their increasing detachment from the stranger that person has become. With the increasing emphasis on home care, these findings offer insights for individual care and health policy development.

Aged↗
PubMed2005

HIV/AIDS and the workplace: perceptions of nurses in a public hospital in South Africa.

AIM: The purpose of this article is to report a study of the perceptions and experiences of nurses caring for people living with HIV/AIDS in the public health sector in South Africa. BACKGROUND: The number of people living with HIV/AIDS in South Africa has escalated at an alarming rate. Many people being hospitalized are HIV positive, and hence nurses are in more regular and prolonged contact with people suffering from HIV/AIDS than is the case in other working environments. Although studies focusing on nurses' experiences of caring for patients with HIV/AIDS have been done in numerous countries, little is known about nurses' views in Africa, and South Africa in particular. To ensure quality care for patients with HIV/AIDS, it is important to understand nurses' experiences of nursing HIV-positive patients and how they may influence their attitudes towards these patients. METHOD: A qualitative approach was used, the primary method of data collection being in-depth interviews. These interviews were conducted with 35 nurses at a public hospital in the Gauteng province of South Africa in 2002-2003. FINDINGS: Seven themes were identified: helplessness, emotional stress and fatigue, fear, anger and frustration, occupational-related concerns, empathy, and self-fulfilment. CONCLUSIONS: Increased understanding of the stresses and rewards experienced by these nurses can contribute to policy development in this area. It is also important to provide appropriate preregistration and continuing education and support for nurses working in this field, and to ensure that the working environment is adequate in terms of resources.

Acquired Immunodeficiency Syndrome↗
PubMed1982

The defined daily dose per 100 bed-days as a unit of comparison and a parameter for studying antimicrobial drug use in a university hospital. A retrospective study of the effects of guidelines and audit on antimicrobial drug use.

Growing awareness of problems arising from over-use of antimicrobial agents has led to attempts to develop policies or guidelines for rational treatment. To follow the effects of guidelines, the percentage of patients receiving anti-microbial drug therapy, acquired from patient records, has been a frequently used parameter. In this paper the Defined Daily Dose (DDD) per 100 bed-days has been used instead. This parameter can be calculated by converting the number of units of antimicrobials, delivered to individual wards, to defined daily doses per bed-day. This parameter determines the probability of treating a patient with a particular drug, based on pooled data. The DDD per 100 bed-days has been used to follow changes in prescribing habits arising from the acceptance of and adherence to guidelines over a period of 5 years in a University Hospital.

Anti-Infective Agents↗
PubMed1992

The effect of the number of withdrawals on the sterility of multidose medication vials.

Policy development with regard to the shelf life of multidose medication vials is difficult because of a lack of sufficient data. The purpose of this study was to evaluate one factor that may play a role in the contamination of multidose vials. We evaluated the effect that the number of withdrawals had on the potential contamination of multidose medication vials. Thirty multidose vials of heparin and 30 multidose vials of lidocaine (lignocaine) were used in the study. Ten vials from each group (heparin and lidocaine) were used as controls and were deliberately contaminated with Staphylococcus aereus at various concentrations (10 colony forming units per millilitre (CFU/ml) to 10(8) CFU/ml). The 20 test vials remaining from each group were then subjected to varying rates of 1-ml fluid withdrawal. Five test vials were sampled every 2 h, five were sampled twice per day, five were sampled once per day, and five were sampled every other day. Each sample was incubated in trypticase soy broth (24 h at 37 degrees C) and Columbia agar with 5% sheep blood (48 h at 37 degrees C). No multidose vials became contaminated regardless of the rate of withdrawals. Some of the deliberately contaminated multidose vials became sterile with time. Lightly contaminated vials (10(1)-10(2) CFU/ml) generally cleared within 10-15 h after initial contamination. The implications of these findings are discussed.

Drug Contamination↗
PubMed2006

Constraints and blocks to change and improvement on acute psychiatric wards--lessons from the City Nurses project.

Recent years have seen sustained criticism and inspection of acute inpatient psychiatric wards, with the publication of reports and research leading to policy developments and a variety of efforts to improve perceived deficits. The City Nurses project seeks to reduce levels of conflict and containment on acute wards through the placement of expert nurses on wards to assist with the implementation of changes according to a working model of conflict and containment generation, based on previous research. Evaluation has shown significant decreases in aggression, absconding and self-harm by patients. However, in the course of working with the wards, various constraints and blocks to change have been identified and we describe these in detail in this paper. Analysis of the fieldwork diaries of the two City Nurses identified that change was hindered by limited staffing resources, problems with the physical environment and other resources, insufficient beds and the process of bed management, hierarchical ambiguity and multidisciplinary issues, the overdemanding role of the ward manager, and pervasive anxiety about the potential for serious untoward incidents and their implications for staff. We argue that sustained positive change in acute inpatient psychiatry requires these underlying structural issues to be both acknowledged and, if possible, resolved.

Acute Disease↗
PubMed1997

Relationship of childhood protein-energy malnutrition and parasite infections in an urban African setting.

A clear understanding of protein-energy malnutrition (PEM), parasite infection and their interactions is essential in formulating health and development policies. We studied the prevalence of PEM indicators and the prevalence and/or intensity of infection in 558 Zairian children aged 4 months to 10 years. Multivariate analyses were used to estimate relationships between PEM indicators and parasitic infection. Stunting was found in 40.3% of children, wasting in 4.9% and kwashiorkor in 5.1%. The risk of stunting was significantly higher in children with Ascaris lumbricoides. The risk of wasting was higher in children with A. lumbricoides or Trichuris trichiura, whereas the risk of kwashiorkor was high with T. trichiura but very reduced in those with A. lumbricoides. Plasmodium infection was not related to nutritional indicators. These relationships highlight important interactions, both synergistic and antagonistic, between nutrition and parasites in central Africa.

Ascariasis↗
PubMedDate not supplied

Fetal alcohol syndrome: diagnosis, epidemiology, and developmental outcomes.

In Australia the issue of fetal alcohol syndrome (FAS) has not been the subject of policy development or of extensive research. There is a lack of knowledge, both in the general community and by health professionals, of the nature of the risks associated with heavy alcohol consumption during pregnancy and the factors that increase this risk. This paper reviews the literature surrounding FAS with the aim of providing the reader an understanding of the diagnostic features and epidemiology of FAS and of the developmental sequelae associated with this syndrome.

Alcoholism↗
PubMed2001

Avoidable mortality in New Zealand, 1981-97.

OBJECTIVE: To describe avoidable mortality in New Zealand, including trends and variations between groups by age, gender, ethnicity and degree of deprivation. METHOD: New Zealand Health Information Service mortality unit records, 1981 to 1997, were classified as 'avoidable' or 'unavoidable' based on a reassessment of ICD9 codes and an upper age limit of 75 years. 'Avoidable' causes of death were further subcategorised according to the level of intervention involved (primary, secondary or tertiary). Deaths were assigned a deprivation score using a Census-based small area deprivation index, the NZDep96. Mortality rates were age standardised by the direct method, with Segi's world population as the reference. RESULTS: Avoidable mortality declined 38% from 1981 to 1997; unavoidable mortality declined only 9%. In 1996-97 almost 70% of deaths in the 0-74 age range were still considered to be potentially avoidable. Almost 80% of avoidable deaths occur in the 45-74 age group. These deaths are dominated by the emergence of chronic diseases such as ischaemic heart disease, diabetes and smoking-related cancers. In younger age groups, injury (including suicide) dominates avoidable mortality. Males experience a greater burden of avoidable mortality than females--a relative excess of 54% (approximately 2,000) in 1996-97. The gender difference is largely attributable to diseases and injuries amenable to primary prevention, with the largest single contribution coming from ischaemic heart disease. The ethnic gap in avoidable mortality remains wide: rates for Mäori and Pacific people were 2-2 1/2 times higher than European rates in 1996-97. Similar gradients are seen with deprivation. CONCLUSION AND IMPLICATIONS: Avoidable mortality analysis provides a useful tool for evidence-based health needs assessment and health policy development.

Acute Disease↗
PubMed2001

Potentially avoidable hospitalisations in New Zealand, 1989-98.

OBJECTIVE: To describe potentially avoidable hospitalisation in New Zealand, including recent trends and variations between groups differentiated by age, gender, ethnicity and degree of deprivation. METHOD: Hospital discharges among people aged 0-74 years for the years 1989-98 were classified as 'potentially avoidable' or 'unavoidable' based on the ICD9-CMA code of the principal diagnosis. Potentially avoidable hospitalisations (PAH) were further subcategorised according to the intervention involved--primary prevention, ambulatory care or injury prevention. RESULTS: By 1998, one in three of these hospitalisations was theoretically avoidable--two-thirds of these through more effective primary health care services. Although in practice only a proportion of these could realistically have been avoided, these estimates reveal considerable scope for further reduction in the incidence of serious disease and injury. Maori and Pacific people had age-standardised PAH rates approximately 60% higher than European and other New Zealanders. Similar discrepancies exist by socio-economic deprivation. Had all New Zealanders enjoyed the PAH rates of the most advantaged 40% of the population, 28% fewer potentially avoidable hospitalisations would have occurred in 1998, some 26,000 hospital admissions. CONCLUSION: This analysis has revealed significant scope for the health sector to contribute to population health gain and, in particular, to improvement in equity of outcomes across ethnic and socio-economic groups. Potentially avoidable hospitalisations provide a useful tool for evidence-based population health needs analysis and health policy development.

Adolescent↗
PubMed2004

The impact of incontinence on health-related quality of life in a South Australian population sample.

OBJECTIVE: To assess prevalence of incontinence in a South Australian representative population sample and compare the health-related quality-of-life impact of incontinence with other chronic conditions. METHOD: The 1998 South Australian Health Omnibus Survey interviewed 3,010 male and female respondents aged 15 to 97 years (response rate 70.2%). This representative population survey included questions to determine the prevalence of urinary (stress and urge), and anal (faecal and flatus) incontinence, and other chronic conditions. Respondents also completed the MOS SF-36 questionnaire. RESULTS: Self-reported prevalence of all types of incontinence was 26.0%. The prevalence of anal and urinary incontinence were 10.5% and 20.3% respectively, with 4.8% of respondents experiencing both. Univariate analysis found the prevalence of incontinence was statistically significantly higher among females, and those who were older, widowed, had no post-school education, and lower incomes. After adjusting for differences in age and sex, it was found that people with incontinence were significantly impaired across all dimensions of the SF-36, scoring in the lowest 42% of the population, compared with those people without incontinence. People with incontinence exhibited different SF-36 profiles to those with other chronic conditions. CONCLUSIONS: Incontinence is common in South Australia, affecting more than one-quarter of the population, particularly older women (56.2% for 60 years and over). The impact of incontinence on health-related quality of life is characteristically different to that demonstrated by other chronic conditions. IMPLICATIONS: In an ageing population, identification of the impact of incontinence is necessary to direct policy development and resource allocation to this area.

Female↗
PubMed1997

A public health nursing model.

Public health nurses are in a strategic position to maintain, promote, and protect the health of populations both now and in the future. In the changing health care environment of the 1990s, defining the expanding and evolving role of public health nursing assists in the effective utilization of public health nurses. During a time when the health care environment is emphasizing the protection and promotion of health, access to health services, and prevention of illness, it is necessary for public health nurses to be in the forefront in the changing focus to primary prevention. Therefore, a model for public health nursing is proposed to provide a framework for defining public health nursing roles and practice. A flowering tree is one symbol of public health nursing. The tree consists of seven parts symbolizing nine public health nursing concepts. This model is proposed to articulate clearly the capacity of public health nursing within today's ever-changing environment and to provide a framework for public health nursing theory, public health nursing practice, policy development, and public health research.

Community Health Nursing↗
PubMed1998

Comox Valley Nursing Centre: from collaboration to empowerment.

The Comox Valley Nursing Centre was initiated as a two year demonstration project by the Registered Nurses Association of British Columbia (RNABC) and funded by the Ministry of Health. The purpose of the project was to demonstrate innovative nursing practice in a primary health care context. Findings from the project were expected to inform provincial health care planning, nursing scope of practice, and health and nursing policy development. A free standing nursing center was planned and implemented through a collaborative effort by RNABC, nurses and community residents. An external team of researchers evaluated the project using a variety of methods, including participatory action research. During the project an innovative nursing practice, based on principles of collaboration, developed and has continued during the extended provincial and regional funding of the Centre. Drawing from the evaluation findings, case studies and using Henneman, Lee and Cohen's (1995) concept analysis of collaboration, this paper describes how the principles of collaboration were actualized or suppressed. The paper examines how collaboration impacted empowerment for nurses, clients and the community. Lessons learned about the reciprocal relationships between collaboration and empowerment, implications for nursing practice, and how the approach can contribute to a better understanding of the impact of collaborative practice approaches on health care delivery are discussed.

British Columbia↗
PubMedDate not supplied

Knowledge and attitudes of nurses working in sexual health clinics in the United Kingdom toward post-sexual exposure prophylaxis for HIV infection.

The use of anti-human immunodeficiency virus (HIV) drugs after occupational exposure to HIV is a proven method of preventing some HIV infections. There is anecdotal evidence that this treatment is being used to treat recently exposed sexual contacts of HIV infection, known as non-occupational post-exposure prophylaxis (NONOPEP). This raises the issues of the impact of such treatment on sexual behavior and public health. Six hundred questionnaires were distributed to nurses working in sexual health clinics. Four hundred and six (67%) were returned. Questionnaires contained items related to awareness of HIV NONOPEP and items included attitudes related to its use. Seventy two percent of respondents were aware of HIV NONOPEP, and 17% had experience of its use in their clinic. Twenty one percent of respondents indicated that their clinic had a specific HIV NONOPEP policy. In relation to attitudes, practitioners were more positive of NONOPEP in relation to an HIV exposure within a long-term relationship than exposure within a casual relationship, indicating that the mode of HIV exposure was a factor in the justification of NONOPEP. Practitioners seemed to support the notion that HIV NONOPEP use in a casual exposure may increase the likelihood of unsafe sexual practice; however, practitioners with experience were less likely to express this view. It is suggested that an informed debate and NONOPEP policy development within all sexual health clinics will militate against judgmental views affecting access and care.

Attitude of Health Personnel↗
PubMed1987

The prevalence and design of ethics committees in nursing homes.

A dramatic increase in the number of ethics committees in long-term care facilities (LTCFs) has occurred since 1970 in the 487 nursing homes in Minnesota. Ten percent of the LTCFs had ethics committees which were mostly formed by administrators and nurses. The committees are most often found in large urban facilities with a high percentage of skilled-level beds and a religious name. The committees are multidisciplinary with a median of nine members including two to three nurses, a physician, a social worker, a minister, an administrator, and three other members. Nearly all committees were involved in policy development and staff education. Additional functions included resident care consultation and retrospective case review. More than half of the committees are accountable to administration. Nearly all committees kept minutes. Though all committees incurred costs, only one had a formal budget. Informal evaluation is done in only six committees. No committee had referred cases to the courts.

Bioethical Issues↗
PubMed1990

Needlestick injuries and needle disposal in Minnesota nursing homes.

We examined needle use and disposal, needlestick injuries and their management, and employee education regarding the acquired immunodeficiency syndrome and needle use by means of a questionnaire sent to all long-term care facilities certified for skilled care in Minnesota. Responses were received from 297 of 349 (85.1%) homes. Nearly all homes (271 of 293; 92.5%) provided education for new nursing employees about use and disposal of needles. Disposal of needles and sharps was generally consistent with current recommendations for short-term care hospitals. Needlestick injuries were usually related to recapping and were most common in registered and licensed practical nurses but were infrequent (i.e., less than 1 injury per home per employee-year) probably because parenteral therapy is infrequently used in long-term care settings. Only slightly over half (166 of 286; 58%) of the homes had protocols for management of needlestick injuries. Although Minnesota nursing homes properly dispose of needles and sharps, many of these institutions need to develop policies for management of needlestick injuries that are consistent with current recommendations.

Accidents, Occupational↗
PubMed1996

The relationship between ethnicity and advance directives in a frail older population.

OBJECTIVE: To assess the relationship between ethnicity and Health Care wishes, including Advance Directives, in a group of frail older persons in PACE (Program For All Inclusive Care Of The Elderly). DESIGN: Retrospective chart review of 1193 participants in the PACE program. SETTING: Program of All Inclusive Care Of The Elderly (PACE), a comprehensive managed care demonstration program serving frail older participants at 10 sites across the nation. PARTICIPANTS: A total of 1193 older adults, all of whom met state criteria for nursing home level of care. There were 385 non-Hispanic whites, 364 blacks, 156 Hispanics, and 288 Asians. MEASUREMENTS: Presence or absence of advance directives, type of health care wishes selected including living will, durable power of attorney, and health care proxy. RESULTS: Frail older white, black, Hispanic and Asian Americans differ significantly in their health care wishes and how they choose to express them. Blacks were significantly more likely to select aggressive interventions and less likely than non-Hispanic whites and Hispanics to utilize a written instrument for expressing health care wishes. Whites were significantly more likely to utilize written documents for advance directives, whereas Asians were more likely to select less aggressive interventions but were unlikely to use written advance directives. CONCLUSIONS: In this population, we found significant ethnic variations in choice of health care wishes. Although health care wishes are an individual decision, an awareness of cross cultural patterns can assist practitioners in addressing the concerns of their patients, as well as assisting Health Care Policy Development.

Advance Directives↗
PubMed1996

The effects of exposure to "synthetic" chemicals on human health: a review.

This article examines how scientists use human, animal, and bacterial evidence to develop policy recommendations about the health consequences of human exposure to modern chemicals. Human evidence is limited because many epidemiological studies are contaminated with selection effects or unobserved heterogeneity. Changes in the aggregate incidence of morbidity (such as cancer) in the population over time are not a substitute for the lack of good individual-level data because incidence data are contaminated by the medicalization of cancer. Animal tests are also problematic because the expense of conducting experiments leads researchers to use only enough animals to allow detection of large differences in cancer incidence between controls and experimental animals that can only arise if the exposure doses are large. Predictions about the cancer incidence that would result in humans at much lower exposure levels, thus, require statistical inferences that implicitly make choices between false positive and false negative inference errors. Policy recommendations about carcinogens, therefore, are as much the product of value choices as "scientific" knowledge.

Animal Testing Alternatives↗