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PubMedDate not supplied

Innovative intersectoral approach reduces blood leads levels of children and workers in Romania.

With the support of the U.S. Agency for International Development (USAID), an intersectoral approach involving the community, governmental and nongovernmental agencies, and the management of the local copper smelting plant succeeded in reducing the blood lead levels of plant workers and of young children living in the vicinity of a copper smelter, Zlatna, Romania. Specifics of the collaborative effort, which attracted enthusiastic responses from all participants, are provided.

Air Pollutants↗
PubMed2006

Failure mode and effect analysis: a technique to prevent chemotherapy errors.

Complex, multidrug chemotherapy protocols commonly are administered to patients with cancer. At every step of the chemotherapy administration process, from the point that chemotherapy is ordered to the point that it is infused and beyond, potential for error exists. FMEA, a proactive process that promotes systematic thinking about the safety of patient care, is a risk analysis technique that can be used to evaluate the process of chemotherapy administration. Error prevention is an ongoing quality improvement process that requires institutional commitment and support, and nurses play a vital role in the process.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Successfully developing a telemedicine system.

Successfully developing telemedicine systems is primarily about effective change management. The literature suggests that certain principles are likely to increase the chances of success in developing a telemedicine system. These are: (1) telemedicine applications and sites should be selected pragmatically, rather than philosophically; (2) clinician drivers and telemedicine users must own the systems; (3) telemedicine management and support should follow best-practice business principles; (4) the technology should be as user-friendly as possible; (5) telemedicine users must be well trained and supported, both technically and professionally; (6) telemedicine applications should be evaluated and sustained in a clinically appropriate and user-friendly manner; (7) information about the development of telemedicine must be shared. If telemedicine is to realize its full potential, it must be properly evaluated and the results of any evaluations published, whether the results are positive or negative. Since telemedicine is about communication with colleagues and patients across large distances, it should be possible for those involved in it to do the same with their experiences.

Delivery of Health Care↗
PubMed2000

A pilot scheme for the development of evidence-based practice.

This article presents an evaluative account of a pilot scheme that aimed to introduce evidence-based practice in one NHS trust. The scheme was based on collaboration between staff in the quality assurance department and a nurse researcher based in a university. This collaboration enabled three designated staff to develop skills required for evidence-based practice and guide the production of information that could be disseminated to nurses throughout the trust. Evaluation demonstrated that participants had examined eight practice-based topics and devised protocols that could be applied to practice in a range of hospital and community settings throughout the trust. Evaluation also highlighted the importance of ensuring that members of other disciplines are aware of, and feel involved in, new developments even if they are not directly concerned with them.

Community Health Nursing↗
PubMed2002

The expert patient: issues and implications for community nurses.

First highlighted in "Saving Lives: Our Healthier Nation" (Department of Health, 1999), the Expert Patient programme is now being piloted throughout England and Wales. The programme is focused on helping individuals to self-manage their long-term condition more effectively. While acknowledging the expertise an individual brings to the management of their condition, the programme seeks to further develop these skills with the aim of reducing incapacitation and increasing symptom control and self-esteem. As this is a lay-led programme it is unlikely that community nurses will have an explicit role within the initiative. However, all community nurses have significant input with individuals with long-term conditions and will know clients whom they would term as expert. Following an outline of the initiative, this article presents a number of case scenarios and seeks to explore some of the issues that patients, families and practitioners face when dealing with the concept of "expert patient".

Adult↗
PubMed2006

Development and validation of the self-administration of medication tool.

BACKGROUND: Consumer participation in planning and implementing health care is actively encouraged as a means of improving patient outcomes. In assessing the ability of patients to self-medicate, health professionals can identify areas in which patients need assistance, education, and intervention to optimize their health outcomes after discharge. OBJECTIVE: To develop and validate a tool to quantify the ability of patients to administer their regularly scheduled medications while they are hospitalized. METHODS: Past research enabled us to develop the Self-Administration of Medication (SAM) tool. Using a Delphi technique of 3 rounds, a panel of expert health professionals established the content validity of the tool. For determining level of agreement in using the SAM tool, 56 patients were selected; for each patient, 2 randomly selected nurses completed an assessment. Construct validity and internal consistency were examined by testing the tool in 50 patients and comparing with other validated scales. RESULTS: The 29-item SAM tool had high content validity scores for clarity, representation, and comprehensiveness, with content validity index values ranging from 0.95-1.0. In testing the level of agreement between 2 nurses, out of 43 valid cases, 95.3% of nurses overwhelmingly agreed about the patients' competence to self-administer their drugs. The intraclass correlation coefficient was 0.819 (95% CI 0.666 to 0.902). Internal consistency for the SAM tool was high, with a Cronbach's alpha of 0.899. A moderate to strong correlation was obtained when comparing the SAM tool with other validated measures. CONCLUSIONS: The SAM tool is valid and reliable for quantifying patients' ability to manage their regularly scheduled medications in the hospital setting.

Adult↗
PubMedDate not supplied

Radical simplification: Disaster Relief Medicaid in New York City.

In the four months following the 11 September 2001 attacks on the World Trade Center, nearly 350,000 people signed up for Disaster Relief Medicaid. The process was quick and simple; applicants completed a one-page form and got a decision on the spot or the next day. While the program's success stemmed in part from the unique circumstances facing New Yorkers in the fall of 2001, Disaster Relief Medicaid was an experiment in radical simplification that demonstrated a new way of thinking about how to design a simple, effective public health insurance program stripped of the vestiges of welfare.

Aircraft↗
PubMed2001

Syringe prescription to prevent HIV infection in Rhode Island: a case study.

Injection drug users (IDUs) are a population at high risk for many diseases, including AIDS, and are clearly in need of medical and substance abuse treatment. Access to sterile syringes is critical for lowering the risk of transmission of HIV and other blood-borne pathogens among IDUs. Previously tried strategies include needle exchange programs and changing laws to allow the legal purchase and possession of syringes. An alternative strategy is to have physicians prescribe syringes to IDUs. To the best of our knowledge, this has previously been tried by only a few physicians in rare situations and never on a programmatic basis. This report describes the genesis of physician's syringe prescription in Rhode Island and some of the lessons learned to date. Because of the illicit nature of drug use, a tremendous amount of mistrust and fear on the part of IDUs often leads to poor interaction with the medical establishment. Prescription of syringes by a physician can serve as a tool for reaching out to a high-risk and often out-of-treatment population of drug users. It is a way for the health care community to tap into drug-using networks and bring those populations into a medical care system.

Adult↗
PubMed2006

Shift in the epidemiology of pertussis infection: an indication for pertussis vaccine boosters for adults?

Pertussis vaccination of young children has been effective in reducing the overall disease burden due to Bordetella pertussis in many countries. However, the disease has not been eliminated, although humans are the only known host of this pathogen. In fact, in some countries, the number of reported cases has increased dramatically from their nadir and epidemics routinely occur. In areas where >80% of children <2 years of age have been vaccinated, the burden of disease has shifted from elementary school-aged children (who are presumably protected by vaccination) to young infants (<6 months of age) and individuals >11 years of age. With the recent availability of acellular pertussis vaccines for older children to adults, consideration of a change in current vaccination policy is necessary in order to provide better disease control.

Adolescent↗
PubMed2003

Medication administration by unlicensed caregivers. A model program.

The assisted living housing option for older adults with limitations in activities of daily living presents a problem with medication administration. The purpose of this project was to expand the functions of the unlicensed caregivers in Group Senior Assisted Housing (GSAH) in Maryland. The caregivers and the GSAH providers or managers completed a 16-hour medication administration training program. Additionally, an oversight program using a delegating registered nurse (DRN) was established. The DRN verified the learning of the unlicensed caregivers, delegated medication administration (not including injections), and monitored this new care practice. Completion rate of the training program was 89% (N = 176). A high school education was significant in being successful. The oversight by the DRN was positively received by the caregivers, and it was clear that this was an essential part of the program. The project led to the first statewide regulations related to medication administration in assisted living.

Aged↗