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PubMed2004

Collaborative nursing education programs: challenges and issues.

Collaborative nursing education programs have been offered to facilitate access to baccalaureate-level nursing education. Our Collaborative Nursing Program involved 10 institutional partners and has been one of the largest of such programs. The collaborative approach to nursing education has been identified as an important model; the benefits include optimal use of resources and opportunities to develop and share knowledge across institutions. However, there has been little public discussion of the issues and challenges that emerge, including differing cultures, priorities, vulnerabilities, goals and aspirations between colleges and universities; desire to preserve autonomy and uniqueness; and complexity of approval and accreditation processes. Some of our college partners have chosen to offer an independent applied degree in nursing rather than continuing in a collaborative academic degree program. This paper describes the challenges inherent in maintaining quality of the degrees and strategies to increase the likelihood of continuing collaboration. Clarity and transparency are vital, and supportive programs involving mentorship of educators can foster increasing autonomy of colleges. Collaborative nursing programs pose many challenges, and their future will hinge on understanding mutual goals and expectations.

Accreditation↗
PubMed2006

Assessing the institutional approach to implementing smoking cessation practice guidelines in veterans health administration facilities.

National smoking cessation guidelines include recommended strategies for providers and health care organizations, but they offer little guidance on how to structure care. We conducted a cross-sectional survey at 40 Veterans Health Administration facilities, to describe the structure of smoking cessation care, to assess adherence to national guidelines, and to assess facilities' preferred approach to providing smoking cessation treatment. We categorized sites as those using a primary care approach (most smokers treated by the primary care provider) versus a specialty approach (medication restricted to smoking cessation clinics, to which most patients were referred). Nearly all sites reported systematic screening for smoking and counseling of smokers, usually by both nursing staff members and the primary care provider. Most sites used a specialty approach, restricting medication access to smokers attending a cessation program. Future research should evaluate whether this approach provides adequate access and responsiveness to patient preferences for the full population of smokers in primary care.

Cross-Sectional Studies↗
PubMedDate not supplied

A decentralized trauma system design for a rural area.

Most trauma-care systems are based on an urban model in which patients are found in sufficient proximity to the trauma center to allow preferential triage. The roles of other hospitals in the community are limited. In rural areas, patients may be remote from the trauma center and may require initial stabilization at a closer, nontrauma "center" designated hospital. An inclusive trauma system design is more appropriate in such situations. The Emergency Department Approved for Trauma (EDAT) is a program implemented in a rural area of northeastern California that establishes minimum standards for nontrauma center designated hospitals in remote areas. It integrates these hospitals into the trauma system through transfer guidelines and agreements and participation in systemwide quality assurance/improvement programs. The EDAT program promotes both improved initial treatment of rural trauma patients and appropriate transfer of patients to designated trauma centers.

California↗
PubMedDate not supplied

Health department collaboration with emergency departments as a model for public health programs among at-risk populations.

OBJECTIVES: Accessing at-risk and underserved populations for intervention remains a major obstacle for public health programs. Emergency departments (EDs) care for patients not otherwise interacting with the health care system, and represent a venue for such programs. A variety of perceived and actual barriers inhibit widespread implementation of ED-based public health programs. Collaboration between local health departments and EDs may overcome such barriers. The goal of this study was to assess the effectiveness of a health department-funded, ED-based public health program in comparison with other similar community-based programs through analysis of data reported by health department-funded HIV counseling and testing centers in one Ohio county. METHOD: Data for HIV counseling and testing at publicly funded sites in southwestern Ohio from January 1999 through December 2002 were obtained from the Ohio Department of Health. Demographic and risk-factor profiles were compared between the counseling and testing program located in the ED of a large, urban teaching hospital and the other publicly funded centers in the same county. RESULTS: A total of 26,382 patients were counseled and tested; 5,232 were ED patients, and 21,150 were from community sites. HIV positivity was 0.86% (95% confidence interval [CI] 0.64%, 1.15%) in the ED and 0.65% (95% CI 0.55%, 0.77%) elsewhere. The ED program accounted for 19.8% of all tests and 24.7% of all positive results. The ED notified 77.3% of individuals testing positive and 84.4% of individuals testing negative. At community program centers, 88.3% of patients testing positive and 63.8% of patients testing negative were notified of results. All ED patients notified of positive status were successfully referred to infectious disease specialists. CONCLUSIONS: Public health programs can operate effectively in the ED. EDs should have a rapidly expanding role in the national public health system.

AIDS Serodiagnosis↗
PubMedDate not supplied

An infusion program resource nurse consult service: our experience in a major Canadian teaching hospital.

Infusion resource teams are comprised of nurses specially trained and experienced in infusion therapy. Our multidisciplinary team provides clinical, educational, and research support to a 1000-bed Canadian tertiary hospital. To characterize the infusion resource nurse service, 789 recorded consults for 250 patients during a 12-month period study were reviewed. Noncritical medicine and surgical wards accounted for a similar number of consults, with the highest volume (31% of total consults) being generated by the general and vascular surgery wards. Vein status was visible and either "fair" or "good" in approximately half of all consults, but 39% of consults were visible and "poor." Most consults (81% of total) resulted in the initiation of peripheral intravenous catheters into an area of nonflexion in an upper extremity and successful peripheral catheter initiations were accomplished in 96% of all cases. Our multidisciplinary infusion program approach to vascular access support appears to be a well-utilized and an effective resource for this hospital.

Data Collection↗
PubMed1996

Computer use, computer training, and employment. Outcomes among people with spinal cord injuries.

Computer use and training may be of special benefit to people with spinal cord injuries (SCIs) because computer technology may help lessen the impact of mobility limitations that are inherent with this disability. This article summarizes several findings from a 1994 survey conducted of New Jersey residents who suffered SCIs within the previous 10 years. The results indicate that, among people with SCIs, 46% currently use a computer in some capacity and 22% received computer training since the date of their injury. Perhaps surprisingly, both corresponding percentages are higher in the general population. People with SCIs appear to have less access to computers because most people learn how to use computers at work, and only a minority of people with SCIs work. The lower rate of use of computers among people with SCIs is unfortunate because the steep employment and earnings declines often experienced after an SCI are partially mitigated for those who have computer skills. The results suggest the importance of policies and programs aimed at increasing access to computers and computer training for people with severe disabilities.

Adult↗
PubMedDate not supplied

Foot education improves knowledge and satisfaction among patients at high risk for diabetic foot ulcer.

PURPOSE: The purpose of this study was to evaluate an intensive diabetes foot education program for veterans at high risk for foot ulcer. METHODS: We invited 100 consecutive patients with diabetes from a Department of Veterans Affairs Medical Center clinic who were insensate to the Semmes-Weinstein 5.07 monofilament to participate in a foot care education program. Two sessions were conducted by a nurse diabetes educator 3 months apart. Multiple educational approaches were used to teach patients foot self-examination, foot washing, proper footwear, and encouragement in enlisting proper physician foot care. Knowledge and satisfaction with care was measured before and after each visit. RESULTS: The 34 patients who attended both education sessions improved their foot care knowledge over the course of the program. After the second session, the mean improvement over baseline was 14%. These patients also reported improved satisfaction with foot care; mean improvement was 33%. CONCLUSIONS: An intensive education program improved the foot care knowledge and behavior of high-risk patients. Those who adhered to a foot care education program were more satisfied with their foot care than prior to the program. Ways to improve accessibility of education sessions must be explored.

Adult↗
PubMed1990

A residency-based information system.

The medical literature has grown to an unmanageable size, and we need to develop information systems that provide better accessibility. An internal medicine residency program is an ideal setting for developing a system in which articles are screened for usefulness in clinical decision making and organized to be rapidly accessible and relatively inexpensive to use. In our residency training program, we use clinical problem-solving, journal club article review, and teaching conference preparation to generate appropriate articles from PAPERCHASE (MEDLINE) database searches. With the chief resident supervising the process, articles are then selected and organized in a computerized article file. The software program, Reference Manager (Research Information Systems, Inc., Encinitas, California), stores article citations and supports searches using standard, medical subject heading vocabulary key words. In an 18-month period, residents have collected more than 1800 references appropriate to clinical decision making and have established an article file that is now used daily as a medical information source.

Abstracting and Indexing↗
PubMed2002

Accreditation as an alternative to specialty recognition.

The Commission on Dental Accreditation does not currently accredit postdoctoral training in general anesthesia. This is related to the traditional linkage of accreditation of postdoctoral training programs to ADA specialty recognition. The aforementioned ADA Guidelines are important because they provide the foundation for the continued use of sedation and general anesthesia within dentistry. The one mechanism that would "ensure safety and effective use," maintain "a strong educational foundation," provide "access to adequate training ... develop programs at the postgraduate level" and support expansion of both basic and clinical research is CDA accreditation of postdoctoral programs. Prior to 1991, hen general anesthesia training was acquired by dentists primarily through accredited medical programs, there was little need for anything more than guidelines to protect the public. With the development of non-accredited dental anesthesiology programs in accredited dental schools (primarily in the late 1980's) and the loss of access to general anesthesia training in accredited medical anesthesiology residency programs in the summer of 1991, primary responsibility for all general anesthesia training of dentists shifted to organized dentistry. However, the ADA House declined to recognize dental anesthesiology as a dental specialty on three separate occasions even though the ADA Council on Dental Education felt all requirements were met and favorably recommended specialty recognition in all three instances. Specialty recognition would have provided the needed accreditation mechanism to validate dentistry's continued use of deep sedation and general anesthesia by those practitioners not classified as oral and maxillofacial surgeons. As an alternative to the specialty recognition process and in view of the need to accredit postdoctoral general anesthesia training for dentists, the American Society of Dentist Anesthesiologists has recently requested the CDA offer accreditation for these dental programs. To address this issue and those of other non-ADA-recognized disciplines, the CDA is currently in the initial stages of developing requirements for accrediting non-ADA recognized postdoctoral training programs. This material will be circulated to communities of interest for their input. Details of the process will be forthcoming from ADA sources in the near future.

Accreditation↗
PubMed1998

Health Initiatives for Youth: a model of youth/adult partnership approach to HIV/AIDS services.

Health Initiatives for Youth (HIFY) in San Francisco, California, is an innovative organization providing health-related services for and by young people funded in part by the Special Projects of National Significance (SPNS) Program. The HIFY Youth Health Initiative (YHI) is composed of eight youth staff and aims to bring about individual and systemic change, enhance the quality of life for human immunodeficiency virus (HIV)-positive and at-risk young people, and increase the responsiveness and youth sensitivity of organizational and community systems. Comprehensive services have been delivered to 136 young men under 25 years, 33.1% of whom are HIV positive, and 164 young women, of whom 12.2% are HIV positive. In addition, thousands of youth and young adults have received lower-intensity services through dozens of educational workshops and presentations. YHI services are implemented through a comprehensive collection of education, training, and support activities that benefit the youth staff who produce them, along with the participants who benefit from the services provided. These activities include a speaker's bureau, health and advocacy trainings, internships, return-to-work and life skills training, publications, and conferences. Regional and national findings suggest that many youth do not yet comprehend their risk for HIV infection or understand the impact of HIV on their community. In direct response to these needs, HIFY programs inform and encourage access to counseling and testing, and provide meaningful access to adolescent care, treatment, and services.

Acquired Immunodeficiency Syndrome↗
PubMed2006

The big bang? An eventful year in workers' compensation.

Workers' compensation in the past two years has been dominated by events in California, which have been so fundamental as to merit the term big bang. Passage of Senate Bill 899 has led to a comprehensive program of reform in access to medical care, access to rehabilitation services, temporary and permanent disability, evidence-based management, dispute resolution, and system innovation. Two noteworthy developments thus arose: a new requirement for apportionment by cause in causation analysis, and the adoption of evidence-based criteria for impairment assessment, treatment guidelines, and, soon, utilization review. Elsewhere in the United States, changes were modest, but extensive legislative activity in Texas suggests that Texas will be next to make major changes. In Canada, the Workers' Compensation Board of British Columbia has adopted an ambitious strategic initiative, and there is a Canadawide movement to establish presumption for certain diseases in firefighters. Suggestions for future directions include an increased emphasis on prevention, integration of programs, worker participation, enhancing the expertise of health care professionals, evidence-based management, process evaluation, and opportunities for innovation.

British Columbia↗
PubMedDate not supplied

General surgery residency program websites: usefulness and usability for resident applicants.

OBJECTIVE: To assess the content of general surgery residency program websites, the websites' potential as tools in resident recruitment, and their "usability." DESIGN: The homepages of general surgery residency programs were evaluated for accessibility, ease-of-use, adherence to established principles of website design, and content. Investigators completed a questionnaire on aspects of their online search, including number of mouse-clicks used, number of errors encountered, and number of returns to the residency homepage. SETTING: The World Wide Web listings on the Fellowship and Residency Electronic Interactive Database (FREIDA) of the American Medical Association (AMA). PARTICIPANTS: A total of 251 ACGME-accredited general surgery residency programs. RESULTS: One hundred sixty-seven programs (67%) provided a viable link to the program's website. Evaluators found an average of 5.9 of 16 content items; 2 (1.2%) websites provided as many as 12 content items. Five of the 16 content items (program description, conference schedules, listing of faculty, caseload, and salary) were found on more than half of the sites. An average of 24 mouse-clicks was required to complete the questionnaire for each site. Forty-six sites (28%) generated at least 1 error during our search. The residency homepage was revisited an average of 5 times during each search. On average, programs adhered to 6 of the 10 design principles; only 6 (3.6%) sites adhered to all 10 design principles. Two of the 10 design principles (use of familiar fonts, absence of frames) were adhered to in more than half of the sites. Our overall success rate when searching residency websites was 38%. CONCLUSIONS: General surgery residency programs do not use the World Wide Web optimally, particularly for users who are potential residency candidates. The usability of these websites could be increased by providing relevant content, making that content easier to find, and adhering to established web design principles.

Attitude of Health Personnel↗
PubMedDate not supplied

Sentinel markers for industrial disasters.

Workers, managers, and occupational health and safety inspectors can be trained to detect or recognize and promote action to correct sentinel markers for industrial disasters. A sentinel marker is defined as a pre-disaster warning sign of impending failure in prevention. Administrative sentinel markers are: a weak occupational health and safety program; lack of spontaneous access to top management; failure to accept responsibility for subcontractors; the absence of written disaster plans and drills for emergency response in the factory and the adjacent community; noninvestigation of prodromal leaks, exposures, spills or injuries; punishment of "troublesome" individuals reporting such prodromal events; nonuse or misuse of data on illness, injury and absenteeism; and suboptimal work conditions and supervision of shift workers. Information sentinel markers include absence of worker and community right-to-know programs, nonuse of data on earlier mishaps from similar technologies, and failure to provide toxicologic data to hospitals in the pre-disaster phase. Technological sentinel markers are: absence of fail-safe controls, interlocks and automated alarm systems driven by real-time monitoring. Transportation sentinel markers include suboptimal vehicle standards, and drink, drugs and fatigue in drivers. Preventive programs based on identification of all sentinel markers by workers are suggested to be more effective than selective action based on risk assessment analysis.

Accidents, Occupational↗
PubMed2002

Blindness, visual impairment and the problem of uncorrected refractive error in a Mexican-American population: Proyecto VER.

PURPOSE: To report the prevalence of blindness and visual impairment and the contribution of uncorrected refractive error to visual loss, in a population-based sample of Mexican Americans aged 40 and older. METHODS: Proyecto VER is a population-based study of blindness and visual impairment in Mexican Americans in Arizona. Block groups in Tucson and Nogales were randomly selected with probability proportional to the size of the Mexican-American population aged 40 and older. Participants had a complete ophthalmic evaluation, including assessment of presenting and best corrected visual acuity using standardized procedures. Those with presenting visual acuity worse than 20/30 had refraction to determine best corrected vision. A home questionnaire and a clinic examination provided data on education, perception of visual impairment, income, and acculturation. RESULTS: The prevalence of presenting visual acuity worse than 20/40 was 8.2%, with uncorrected refractive error accounting for 73% of the impaired acuity. In multivariate models comparing those who improved two or more lines on the acuity chart with proper refraction with those who had adequate optical correction, uncorrected refractive error showed a strong association with age, less than 13 years of education (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.5-2.0), low acculturation index (OR 1.3, CI 1.1-1.3), lack of insurance coverage (OR 1.4, CI 1.1-1.7), and not having seen an eye-care provider in the past 2 years (OR 2.5, CI 2.1-3.0). Prevalence of best corrected acuity worse than 20/40 increased from 0.3% in those aged 40 to 49 years to 18% in those aged 80 years or more. CONCLUSIONS: Visual loss in this Mexican-American population is higher than has been reported in whites and is comparable to that in African Americans. Almost three quarters of those with visual acuity impairment would improve with optical correction. Socioeconomic factors that are probable markers of limited access to health care services were associated with uncorrected refractive error. These data suggest that education programs and interventions to improve access to eye care could significantly decrease the burden of visual loss among Mexican Americans.

Adult↗
PubMed2001

Eligibility policies for the state AIDS drug assistance programs.

Drug treatments for HIV infection and related opportunistic infections have had dramatic impacts on the morbidity and mortality associated with HIV disease. HIV drug therapies are essential to the survival and to improved quality of life for individuals with HIV. However, not all people with HIV disease are receiving these medications. The state AIDS drug assistance programs (ADAPs) can provide access to drug therapies for many people with HIV disease who lack adequate drug coverage. This research presents the results of a national survey that identified eligibility-related policies implemented by .48 state ADAPs during 1998 and 1999. The survey assessed the number of people receiving ADAP coverage, the percentage of ADAP beneficiaries who are women, financial and medical eligibility requirements, characteristics of the application process, any implementation of waiting lists, and any coordination of the ADAPs with other public programs.

AIDS-Related Opportunistic Infections↗
PubMed1996

Organizing Asian Pacific Islanders in an urban community to reduce HIV risk: a case study.

We present a case study of community organization efforts within the Asian Pacific Islander communities of San Diego County to reduce the risk of HIV transmission. We utilized a five-phase process to implement the strategies of locality development, social planning, and social action: community analysis, program design and initiation, program implementation, program maintenance and consolidation, and program reassessment. An evaluation of the process indicates that there were increases over time in the project's activities as well as in the levels of interagency connectedness. This is one of the few reported efforts to organize Asian Pacific Islander groups to address HIV transmission. Key elements that led to the successful organization of the original project into a tax-exempt nonprofit entity (the Asian Pacific Islander Community AIDS Project) were emphasis on community ownership, reliance on group consensus, use of "gatekeepers" to access communities, simultaneous multilevel programming, and service to the community as a "coordinating" entity.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Effect of managed care on access to mental health services among Medicaid enrollees receiving substance treatment.

OBJECTIVE: Mental health services are important to treatment retention and positive outcomes for many clients of substance abuse treatment programs. For these clients the implementation of managed care should provide for continued or increased access to mental health treatment, rather than decreased access because of short-term, cost-reduction objectives. This study assessed whether converting Medicaid from a fee-for-service program to a capitated, prepaid managed care program affected access to mental health services among clients who were treated for substance abuse. METHODS: Medicaid enrollees who were being treated for substance abuse in Oregon were interviewed before beginning treatment and after six months of service. One cohort (N=53) was interviewed one to six months before the implementation of managed care, a second (N=66) was interviewed two years after the implementation, and a third (N=49) was interviewed three to four years after the implementation. Logistic regression analyses were used to identify whether the implementation of managed care, the psychiatric need of the client, and other client characteristics affected the receipt of mental health services during the first six months of substance abuse treatment. RESULTS: Clients in all three cohorts had similar characteristics. The implementation of managed care did not affect whether clients received mental health services. A baseline interview score that was derived from items in the Addiction Severity Index psychiatric section was the only client characteristic that predicted receipt of mental health services. CONCLUSIONS: Although this study was a naturalistic experiment with many methodologic flaws, it provided a unique opportunity to observe whether the introduction of managed care changed access to mental health services among Medicaid enrollees who were being treated for substance abuse.

Adult↗