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A review designed to assess the state of the art of social work research in mental health discovered that a number of important studies have built knowledge cumulatively on community-based care of the chronically mentally ill. This article highlights the major findings of the studies, as well as their methodological strengths and weaknesses.
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Terrorism and its aftermath have become part of the Western way of life, and social workers have a central role to play in helping affected families and their communities. Drawing on community-based experience in Israeli communities, the authors examine the planning of multidisciplinary teams and how their planning was put into effect in their communities in several terrorist attacks. The authors use reports of social workers, community volunteers, and clients to map the phases of the activity, the roles and goals of the social workers with different focal systems during the phase stages, and the tasks that the social workers carried out.
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An integrated system of health care for serving the uninsured population of one community was followed from formation through early growth. Funding was provided through the Health Resources Services Administration's Community Access Program to bring together a diverse set of health care providers to form a collaborative network managed by a central administrative entity. Legitimacy building was critical for explaining how the network evolved and the effectiveness of the network in sustaining itself and building a patient base. Based on the study's results, conclusions are drawn that contribute to theory on network legitimacy in health care. In addition, lessons learned are offered that may help other communities address the health needs of the uninsured through collaborative health care networks.
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Care paths for the maternal and infant populations are used to define immediate and long-term outcomes related to care received in the home. This article describes a care path developed by public health nurses for intervention with an at-risk maternal-child population in a city/county health department. A public health nursing care management model provided the framework for developing this care path to foster cost-effective use of limited resources. It is crucial that public health nurses articulate clearly the services provided in the home both for those who may seek service and for policy makers who determine funding structure. The project demonstrated that care paths for home visitation involving high-risk prenatal clients are useful tools that streamline documentation, foster consistency and continuity of care, facilitate quality improvement efforts, and provide outcome data.
BACKGROUND AND OBJECTIVES: The Cuban Ministry of Public Health plans to implement the syndromic approach to sexually transmitted diseases in persons with urethral or vaginal syndrome in Cuba using 500 mg ciprofloxacin as therapy. Although the emergence of clinical isolates of Neisseria gonorrhoeae with decreased susceptibility to ciprofloxacin have been sporadically detected in Cuba, there has been no report of isolates that exhibited significant resistance to this drug. This is the first report of the isolation of a N gonorrhoeae strain resistant to ciprofloxacin in Cuba. STUDY DESIGN: Case report. CONCLUSIONS: This case emphasizes the need for awareness regarding the potential emergence of a clinically significant resistance of N gonorrhoeae in Cuba. There is a need for continued antimicrobial susceptibility surveillance of Cuban isolates to ciprofloxacin and other fluoroquinolones.
Analysis of recent and projected trends in the geographic distribution of Texas physicians indicates that maldistribution may continue to be a problem into the foreseeable future. A survey of manpower officials in other southern states and a review of research on the effectiveness of various policy interventions reveals that programs involving preferential medical school admissions and Medicaid reimbursement levels may hold the most promise for Texas and other southern states seeking to alleviate physician maldistribution.
Home telehealth involves the use of video conferencing or remote monitoring equipment in patients' homes. The installation of hardware and training of patients has historically been performed by nurses, typically RNs. This article examines the experience of RNs as telehealth installers in the Informatics for Diabetes Education and Telemedicine (IDEATel) project, where RNs were responsible for the installation of the Home Telemedicine Units (HTUs) and for training patients in the use of the HTUs, blood pressure cuffs, and fingerstick glucose meters. Average installation and training time was 166 minutes (SD 51 min). Structured interviews with RN installers revealed that patient education and training accounted for roughly two thirds of the in-home time. Technology-related problems, especially those related to telecommunications, were the primary cause of installation difficulties. Thematic analysis of installer interviews identified eight major themes and confirmed the importance of both clinical and technical knowledge during the telehealth installation process.
Although trauma was identified as a "neglected disease" over three decades ago, it continues to remain the leading cause of death through the first four decades of life. Because trauma is preventable and frequently predictable, it is subject to the same epidemiology as disease. In the case of disease, the intervention of choice is prevention. By defining and addressing trauma as a disease, and approaching it within the context of behavioral nursing theory, the practitioner can develop interventions with the potential to reduce the impact and incidence of trauma across a wide spectrum of groups at identifiable risk.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
The preparation and dissemination of policy statements are necessary but insufficient to prevent the inappropriate use of infant-feeding products in emergencies. The widespread failure of humanitarian agencies operating in the Balkan crisis to act in accordance with international policies and recommendations provides a recent example of the failure to translate infant-feeding policies into practice. This article explores the underlying reasons behind the failures which include: (1) the weak institutionalisation of policies; (2) the massive quantities of unsolicited donations of infant-feeding products: (3) the absence of monitoring systems; (4) inadequate co-ordination mechanisms; (5) the high costs of correcting mistakes; and (6) the cumulative effects of poor practice. Efforts to uphold best practice during the crisis are also documented. Finally, the article identifies actions that could be undertaken in advance of and during future emergencies to enhance the application of infant feeding policies in emergencies.
Nearly every state is encouraging or requiring Medicaid beneficiaries to enroll in managed care delivery systems. In New York City, Medicaid officials began with an incremental, but not insignificant, managed care initiative. Buoyed by its success, New York policy makers tried, and failed, to accelerate the transition to managed care. The legacy of that failure still plagues them. A comparison of such initiatives in other states indicates that most state officials have remembered what New York's leaders temporarily forgot, namely, that Medicaid managed care is a complex exercise that demands consultation and consensus building.
The short-term objective of the DHSS of a 1:1 consultant: junior ratio by 1988 is compatible with current trends in consultant expansion and implies no reduction in registrars before then. The target of doubling the number of consultants in 15 years cannot be met in anaesthesia without a fairly sharp, and relatively short-lived increase in senior registrar numbers. This has implications for planning in other specialties, particularly surgery. It seems prudent to assume the target will take longer than 15 years to achieve. Between 1988 and 2004 there would need to be a reduction of between one and two registrar posts per region per annum if the DHSS target of a consultant:junior ratio of 1.8:1 is to be met. Lesser reductions would be necessary if there were to be expansion of Hospital Practitioners in anaesthesia. No change in the number of senior registrar posts need be envisaged. If entry were properly controlled, the current number of registrar posts would be compatible with a viable career structure for British graduates.