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PubMed1987

Guidelines for evaluating potential joint ventures.

Holy Cross Health System (HCHS), South Bend, IN, participates in 25 joint ventures; 9 of these involve partnerships with for-profit structures and 18 relate to activities with medical staffs. To ensure that such arrangements respect the sponsoring religious institute's requirements, HCHS follows a 16-point policy to guide the development of joint ventures. The policy requires joint ventures to: Have a specific purpose relevant to community health care needs; Strive to respond to need regardless of a person's race, creed, color, or ability to pay; Include in legal documents a statement of the intent to uphold Church teachings; Base their activities on an "arm's length" relationship; Undertake reasonable efforts to establish the entity as a not-for-profit, tax-exempt corporation; Confine operations to the subsidiary's service area unless collaboration with other Catholic-sponsored organizations is involved; Include a "dispute resolution" clause in organizational documents; Establish as the partner on adequately capitalized, wholly owned not-for-profit corporation to minimize liability exposure, if the HCHS is to be a general partner in the joint venture; Retain professional consultants approved by the corporate office; Maintain reserved powers for majority-owned or majority-controlled joint ventures that are ecclesiastical entities.

Catholicism↗
PubMed2004

Empowerment, skills, and values: a comparative study of nurses and social workers.

This article focuses on social workers and nurses who complement each other's work in providing health care services to their patients. The professional literature suggests that understanding the professional differences between social workers and nurses may lead to more collaboration between these groups. This study empirically compares empowerment, skills, and values of social workers (n = 213) and nurses (n = 152). Nurses reported higher scores in all empowerment and value variables. Nurses also claimed to use more therapeutic and communication skills, and social workers reported the use of more social action skills. The differences in empowerment, skills and values between social workers and nurses are discussed in light of their different professional roles and work environments.

Adult↗
PubMed1994

International sera exchange analyses in relation to DNA sequences: summary report from 1990 to 1994.

One hundred ninety-five sera were tested against over 7,000 cells originating from approximately 100 laboratories in the world during the past 5 years. This collaboration was useful to compare local data with data from other laboratories, although the local panel of cells varied from 30 to 200. In analyzing the reactions of the sera, it was noted that antibodies that react cleanly to well-defined antigens can usually be defined by a single unique amino acid residue. Antisera which appear to be definable by several amino acids (a motif) have reactivities which are more variable.

Amino Acid Sequence↗
PubMed2006

Variation in caregiver perceptions of teamwork climate in labor and delivery units.

OBJECTIVE: To test the psychometric soundness of a teamwork climate survey in labor and delivery, examine differences in perceptions of teamwork, and provide benchmarking data. DESIGN: Cross-sectional survey of labor and delivery caregivers in 44 hospitals in diverse regions of the US, using the Safety Attitudes Questionnaire teamwork climate scale. RESULTS: The response rate was 72% (3382 of 4700). The teamwork climate scale had good internal reliability (overall alpha = 0.78). Teamwork climate scale factor structure was confirmed using multilevel confirmatory factor analyses (CFI = 0.95, TLI = 0.92, RMSEA = 0.12, SRMR(within) = 0.04, SRMR(between) = 0.09). Aggregation of individual-level responses to the L&D unit-level was supported by ICC (1) = 0.06 (P < 0.001), ICC (2) = 0.83 and mean r (wg(j)) = 0.83. ANOVA demonstrated differences between caregivers F (7, 3013) = 10.30, P < 0.001 and labor and delivery units, F (43, 1022) = 3.49, P < 0.001. Convergent validity of the scale scores was measured by correlations with external teamwork-related items: collaborative decision making (r = 0.780, P < 0.001), use of briefings (r = 0.496, P < 0.001) and perceived adequacy of staffing levels (r = 0.593, P < 0.001). CONCLUSION: We demonstrate a psychometrically sound teamwork climate scale, correlate it to external teamwork-related items, and provide labor and delivery teamwork benchmarks. Further teamwork climate research should explore the links to clinical and operational outcomes.

Adult↗
PubMed2000

Obstetric management of a protracted labor in a captive western lowland gorilla.

This article discusses the cooperative efforts of a team of physicians and veterinarians resulting in the successful assisted vaginal delivery of a Western lowland gorilla at the Woodland Park Zoo in Seattle, Washington. A 10-year-old, captive-born female gorilla, gravida 3, para 0, aborta 2, was observed to be in labor at term after spontaneous rupture of membranes. After 36 hours of observation, she had not yet delivered her infant. A team of physicians and veterinarians intervened. After induction of general anesthesia, an assessment of fetal and maternal status was made. With ultrasonographic monitoring of fetal cardiac activity, labor was augmented with administration of intravenous oxytocin. A vaginal delivery was performed with a vacuum extractor, resulting in the birth of a viable, 2.4-kg female infant. The infant survived the neonatal period and was hand reared until she was successfully introduced to the gorilla troop at the age of 1 year. Although there are several cases of cesarean delivery in captive gorillas, this is the first reported use of labor augmentation and assisted vaginal delivery in this captive species. Captive breeding is the key to survival of the Western lowland gorilla. The collaborative work of physicians and veterinarians is an integral part of this successful program. It is reported that in the captive population approximately 30% of newborns die in the first year, with more than half of the deaths occurring just before birth or within the first day of life. This does not include early spontaneous pregnancy losses. With aggressive management of pregnancy and labor complications, it may be possible to reduce perinatal morbidity and mortality in the captive gorilla population. Because gorillas are closely related to humans, with the only closer relative being the chimpanzee, it is probable that the basic principles of obstetric management in humans can be safely and appropriately applied to the captive gorilla population. With the exception of this report and the cited cesarean delivery reports, there are no other references to cross-species studies of active intervention in gorillas with human obstetric techniques. It is hoped that an increased awareness on the part of obstetricians of the importance of their knowledge and skill to zoos will lead to more successful outcomes in the captive gorilla population.

Animals↗
PubMed1997

Consequences of prolonged inhalation of ozone on F344/N rats: collaborative studies. Part XII: Atrophy of bone in nasal turbinates.

As part of the National Toxicology Program/Health Effects Institute collaborative study of the health effects of prolonged ozone exposure, it was observed that rats chronically exposed to ozone had marked histopathologic changes in the upper respiratory tract, including atrophy of the nasal turbinates. The principal objective of the present study was to morphometrically assess the severity of the ozone-induced changes in the bony tissue of the maxilloturbinates in these chronically exposed rats. Male and female F344/N rats were exposed to 0, 0.12, 0.5, or 1.0 part per million (ppm) ozone, 6 hours/day, 5 days/week for 20 or 24 months. Rats were killed one week after the end of the exposure, and nasal tissues were processed for light and electron microscopy. Using image analysis and standard morphometric techniques, the amounts of bone, surface epithelium, and lamina propria comprising the maxilloturbinates were estimated by measuring the cross-sectional area of each tissue compartment at a defined location in the proximal nasal passage. Both male and female rats had significant morphologic and morphometric changes in the maxilloturbinates after prolonged exposures to 0.5 or 1.0 ppm ozone, but not to 0.12 ppm ozone. Ozone-exposed rats had significant reductions in the cross-sectional area of turbinate bone, reflecting the loss of bone in the maxilloturbinate after prolonged exposure. This ozone-induced bony atrophy was more severe in male than in female rats. Using electron microscopy, numerous bone-resorption sites were identified on the outer, periosteal, surface of the turbinate bone in ozone-exposed animals. Rats with bony atrophy also had a conspicuous influx and mixed inflammatory cells into the lamina propria surrounding the turbinate bone. In addition, ozone exposures caused reductions in the area of lamina propria, due to blood vessel constriction, and increases the in the area of the surface epithelium, due to hyperplasia and metaplasia. The results of the present tudy demonstrated that prolonged exposure of rats to ozone can cause marked loss of turbinate bone. The severity of this ozone-induced bony atrophy in rats is dependent on both concentration and gender.

Administration, Inhalation↗
PubMed2000

Preventive attitudes towards the threat of AIDS: process and determinants in rural Senegal.

This report is intended to identify the determinants of preventive attitudes and thereby enable the further elaboration of effective prevention programs in a country where the HIV epidemic has remained controlled. Across-sectional survey using a standardized questionnaire was conducted among a sample of 866 adults of the general population of the rural area of Niakhar, Senegal. The analysis identified psychosocial determinants related to preventive attitudes and the influence of sociodemographic characteristics and of sources of AIDS information on these determinants. Psychosocial determinants of preventive attitudes differed according to gender: Among men, personal risk perception was associated with preventive attitudes. Among women, level of AIDS-related knowledge, communication about AIDS, and optimism about the future were associated with preventive attitudes. Sociodemographic factors and sources of information were similar for men and women: Preventive attitudes were adopted primarily by young, educated subjects who had been exposed to urban life. Religion appeared to be a major obstacle to preventive attitudes. Preventive messages broadcast on radio or television may be determinative. Our results call for a strengthened collaboration with religious leaders and a focus on risk perception to rationalize preventive actions. We also encourage the targeting of vulnerable populations, such as women in rural areas, by developing preventive messages to be delivered through national media (radio, television) and by staff from health centers, which most women visit, at least for prenatal care.

Adolescent↗
PubMed2003

Evaluability assessment. A catalyst for program change and improvement.

Using a local cross-cultural health service program as a framework, the authors describe the process of an evaluability assessment (EA) and illustrate how it can be a catalyst for program change. An EA is a process that improves evaluation. The key product was a logic model, which traces the links between objectives, activities, and outcomes. Four key insights emerged. First, the distinction of who was included and excluded in the target population, originally ambiguous, was clearly defined. Second, through the development of the logic model, staff members were able to analyze their goals and assumptions and critically explore possible gaps between expected outcomes and activities. Third, the EA enabled reflection on and clarification of both process and outcome measures. Finally, global goals were pared down to better match the project capacity. Developing an evaluability assessment was a cost-effective way to collaborate with staff to develop a clearer, more evaluable project.

Alberta↗
PubMedDate not supplied

Detection of botulinal neurotoxins A, B, E, and F by amplified enzyme-linked immunosorbent assay: collaborative study.

An amplified enzyme-linked immunosorbent assay (amp-ELISA) was compared with the AOAC Official Method 977.26 for detection of Clostridium botulinum and its toxins in foods. Eleven laboratories participated and the results of 10 laboratories were used in the study. Two anaerobic culture media, tryptone peptone glucose yeast extract (TPGY) and cooked meat medium (CMM) were used to generate toxic samples with types A, B, E, and F botulinal strains. Nonbotulinal clostridia were also tested. The toxicity of each botulinal culture was determined by the AOAC method, and the cultures were then diluted, if necessary, to high (about 10,000 minimal lethal dose [MLD]/mL) and low (about 100 MLD/mL) test samples. The overall sensitivity of detection in TPGY and CMM cultures with the amp-ELISA was 94.7% at about 100 MLD/mL and 99.6% for samples with > or = 10,000 MLD/mL toxicity. The amp-ELISA detection sensitivity for low toxin samples was 92.3% in TPGY and 99.4% in CMM. The false-positive rate ranged from 1.5% for type A to 28.6% for type F in TPGY, and from 2.4% for type A to 11.4% for type F in CMM. Most of the cross-reactivity was due to detection of other botulinal types, especially in high toxin samples. The amp-ELISA could be used to screen suspect cultures for botulinal toxins. Positive amp-ELISA samples would be confirmed by the AOAC reference method.

Animals↗
PubMed1983

The burden of mental illness on the family. Results of observations in four developing countries. A report from the WHO Collaborative Study on Strategies for Extending Mental Health Care.

As part of the WHO Collaborative Study on Strategies for Extending Mental Health Care 259 families in four developing countries (Colombia, India, Sudan and the Philippines) were screened with regard to the social burden caused by mental illness of one of its members. Levels of subsistence, previous illness, financial burden, personal relations and social acceptance were studied. The social burden was greatest in the urban areas.

Adult↗
PubMedDate not supplied

Surveying public health nurses' continuing education needs: collaboration of practice and academia.

In the last twenty years, entry level requirements for public health nursing have shifted to less and less educational preparation. Many agencies hire registered nurses with associate degree or diploma preparation who have no experience. The shift in entry level requirements has challenged public health nursing administrators and educators to examine continuing education needs to meet knowledge deficits among public health nurses. The study reported here presents findings from a national survey of 56 state and territorial health departments. The results clarify the continuing education needs and issues related to the educational gaps of public health nurses of the 1990s.

Clinical Competence↗
PubMed2004

Achievement of insulin independence via pancreatic islet transplantation using a remote isolation center: a first-year review.

BACKGROUND: Owing to advances in both immunosuppressive protocols and pancreatic islet isolation techniques, insulin independence has recently been achieved in type 1 insulin-dependent diabetics (IDDM) via pancreatic islet transplantation (PIT). Although the dissemination of immunosuppressive protocols is relatively easy, transferring the knowledge and expertise required to isolate a large number of quality human islets for transplantation is a far greater challenge. Therefore, in an attempt to centralize the critical islet processing needed for islet transplantation and to avoid the development of another islet processing center, we have established a collaborative islet transplant program between two geographically distant transplant centers. PATIENTS AND METHODS: Eleven consecutive type 1 IDDM patients with a history of severe hypoglycemia and metabolic instability underwent PIT at the Methodist Hospital (TMH) in Houston, Texas, utilizing pancreatic islets isolated at the Diabetes Research Institute (DRI) at the University of Miami in Miami, Florida between January 1, 2002 and June 31, 2003. Forty-one pancreata have been procured in the Houston area and have subsequently been transported for isolation at the DRI following enzymatic ductal perfusion by the automated method (Ricordi chamber). Following purification the islets were immediately transported back to TMH in Houston and transplanted via percutaneous transhepatic portal infusion. Immunosuppression regimen consisted of sirolimus, tacrolimus, and daclizumab. RESULTS: Following harvesting, donor pancreata arrived at the DRI for initiation of the isolation process within 6.5 hours of cross-clamping (median time 5.4 hours; range 4.8 to 6.5 hours). The islets were immediately transported back to TMH for final sterility and viability tests and transplanted via percutaneous transhepatic portal vein infusion. The harvesting of 41 pancreata has yielded a number of pancreatic islets sufficient for transplantation (>5000 IEQ/kg recipient body weight) 26 times (63% of harvested pancreata). Thus far, three patients have received three PITs and eight patients have received two PITs. Six remain insulin independent. All have experienced a decrease in serum hemoglobin A(1c) levels, and both basal and stimulated C-peptide levels have increased. There have been no major complications related to the procedure or the immunosuppressive regimen used. CONCLUSIONS: Our series demonstrates that pancreatic islets isolated at a remote isolation center can successfully and safely be used for PIT and the achievement of insulin independence.

Adult↗
PubMed1990

Risk for cancer of the urinary bladder among hairdressers in the Nordic countries.

Several studies have indicated an increased risk for cancer of the urinary bladder among hairdressers. In a Danish linkage between census data and cancer register data both male and female hairdressers have an elevated risk for bladder cancer. The risk for lung cancer is close to unity, indicating that occupational factors rather than smoking, may be responsible for the increased risk for bladder cancer among hairdressers. To evaluate this hypothesis we conducted a collaborative analysis of data from similar linkages in Finland, Norway, and Sweden. The combination of high risk for bladder cancer and low or no risk for lung cancer was not found in the other Nordic countries; however, statistically significant increased risks for both bladder and lung cancer were found among male hairdressers in both Norway and Sweden. The relative risks for bladder cancer were of the same magnitude as the relative risks for lung cancer.

Adolescent↗
PubMed1992

A population survey of ischaemic heart disease and minor psychiatric disorder in men.

Associations between ischaemic heart disease and psychiatric morbidity in hospital recruited samples may be confounded by differential referral of patients with co-morbidity. Associations of angina, past history of myocardial infarction, blood pressure, and electrocardiographic evidence of ischaemia with psychiatric disorder can best be examined in community samples as reported here in 2204 middle-aged men from the Caerphilly Collaborative Study. There was a strong association between past history of myocardial infarction, non-specific chest pain, Angina Grade II and psychiatric disorder measured by the 30-item General Health Questionnaire. Electrocardiographic evidence of ischaemia alone was not significantly associated with psychiatric disorder. It is suggested that non-specific chest pain is a symptom of psychiatric disorder; conversely in severe angina psychiatric disorder is secondary to the pain, restricted activity and threat to life which angina implies.

Chest Pain↗
PubMed2001

The development of advanced practice roles: implications in the international nursing community.

This article examined the critical elements that have been identified in the development of advanced practice roles of nurses in four countries: Brazil, Thailand, the United Kingdom and the United States of America. Several sociopolitical and professional forces were examined for possible insights and ways in which they may have shaped the development and evolution of the roles of advanced practice nurses (APNs). These forces were: the socio-political environment; the health needs of society; the health workforce supply and demand; governmental policy and support; intra- and interprofessional collaboration; the development of nursing education; and documentation of effectiveness of the advanced role. The development of APN roles in the four social systems was reviewed to illustrate how socio-political and professional forces may have shaped nursing roles in each health care delivery system. Commonalities and distinguishing features across the four health and social systems were analysed to assess the predictive forces that may be identified as advanced roles in nursing have evolved in the global community.

Community Health Nursing↗
PubMed1991

The measurement of referrals for practice audit.

The Royal College of General Practitioners and the Office of Population Censuses and Surveys have collaborated in three national studies of morbidity in general practice at approximately ten-year intervals. This paper presents data derived from the second survey conducted in 1970/71. A comparison of practice referral rates based on different measures is reported, and consideration given to the consequences of the choice of measure on how practices may be perceived. The findings of this study emphasise the need for caution in the interpretation of practice referral data while providing encouragement for general practitioners to engage in open peer review of their practice activities.

Abstracting and Indexing↗
PubMed1998

Brain abnormalities in the elderly: frequency and predictors in the United States (the Cardiovascular Health Study). Cardiovascular Health Study Collaborative Research Group.

PURPOSE: Characterize brain abnormalities in elderly people using cranial magnetic resonance imaging (MRI). METHODS: Comprehensive lists of people 65 years and older living in the United States of America were used to obtain a representative sample of 5,888 community-dwelling participants who underwent extensive standardized evaluations. A subset of 3,660 underwent MRI. Without clinical information, neuroradiologists evaluated each scan. RESULTS: Enlarged ventricles and sulci and prominent white matter changes were relatively common, even in a subset of the healthiest participants. Infarcts 3 mm or greater were present in 31% of all participants and 28% of those without a history of stroke. Most infarcts were clinically silent, small, and in the basal ganglia. Among those without a history of stroke, white matter changes were common but mostly of a mild degree. These changes were independently related to greater age, silent stroke, higher systolic blood pressure, lower forced expiratory volume in one second and income less than $50,000 per year. Changes were also associated with dysfunction, especially of cognition and the lower extremities. CONCLUSION: MRI abnormalities are common in elderly people. Cautious interpretation is appropriate because participants are healthier than the general population and the study's design is cross-sectional.

Aged↗
PubMed1990

Sex differences in the lifetime prevalence of depression: does varying the diagnostic criteria reduce the female/male ratio?

Most studies report the lifetime prevalence of major depressive disorder to be higher among women than men. One possible explanation is that this finding is the result of the diagnostic criteria used, in particular the inclusion of criterion symptoms associated with depressed mood. The number of criterion symptoms required for a diagnosis were varied and applied to 2163 first-degree relatives of affectively disordered probands of the NIMH Collaborative Study of the Psychobiology of Depression. Results indicated that differences between men and women in number of symptoms reported could not account for the difference in rates of depression. Women had a greater number of associated symptoms only at higher symptom levels, suggesting an excess of women only above a diagnostic threshold. Thus, findings supported a true difference in rates of major depressive disorder rather than a general trend for women to remember or report more criterion symptoms.

Adult↗