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At least 1,603 records · Page 89Linked to original sources
PubMed2005

Economic analysis of the implementation of autologous transfusion technologies throughout England.

OBJECTIVES: This study aims to provide the first estimates of the costs and effects of the large scale introduction of autologous transfusion technologies into the United Kingdom National Health Service. METHODS: A model was constructed to allow disparate data sources to be combined to produce estimates of the scale, costs, and effects of introducing four interventions. The interventions considered were preparing patients for surgery (PPS) clinics, preoperative autologous donation (PAD), intraoperative cell salvage (ICS), and postoperative cell salvage (PoCS). RESULTS: The key determinants of cost per operation are the anticipated level of reductions in blood use, the mean level of blood use, mean length of stay, and the cost of the technology. The results show the potential for considerable reductions in blood use. The greatest reductions are anticipated to be through the use of PPS and ICS. Vascular surgery, transplant surgery, and cardiothoracic surgery appear to be the specialties that will benefit most from the technologies. CONCLUSIONS: Several simplifications were used in the production of these estimates; consequently, caution should be used in their interpretation and use. Despite the drawbacks in the methods used in the study, the model shows the scale of the issue, the importance of gathering better data, and the form that data must take. Such preliminary modeling exercises are essential for rational policy development and to direct future research and discussion among stakeholders.

Blood Loss, Surgical↗
PubMed2001

The European biotechnology funding map.

Biotechnology is an industry with very strong links to basic science. Therefore, the commercialisation of biotechnology draws heavily on public funded research. All European countries have developed policies to support biotechnology. This contribution gives an overview of public funding activities in all European member states during the 90s and identifies the biotechnology areas which received funding in the different countries. About 50% of all funds were channelled to biomedical research. Plant biotechnology, industrial biotechnology, and the cell factory were other important targets of public funding. Other fields such as animal biotechnology, environmental biotechnology, and non-technical areas of biotechnology were largely ignored by public funding in most European countries. Future funding trends indicate that this pattern will be mainly preserved.

Biotechnology↗
PubMed2005

Exploring the associations between long-term care and mortality rates among stroke patients.

Information on types of long-term care received by stroke patients after hospital discharge is essential for the formulation of long-term care resource development policy. Comparisons of outcomes resulting from different types of long-term care can provide important considerations in the selection of long- term care services. The purpose of this study is to describe the patterns of long-term care received, and to explore if associations exist between long-term care services and mortality status among stroke patients after hospital discharge. Using a longitudinal quasi-experimental study design, this study collected information on the type of long-term care received at 1, 3, and 6 months after discharge for 714 patients. At one month after discharge, 4.5 % had died, and 22.1 % had regained all functions in activities of daily living and instrumental activities of daily living. The percentage of patients receiving institutional care, home or community-based care, and family care only were 10.4 % , 22.4 % , and 40.7 % respectively. The respective percentages at 3 months after discharge were 11.2 % , 18.7 % , and 38.0 % , and, at 6 months after discharge, 10.3 % , 19.4 % , and 30.9 % . After adjusting for age, sex, previous incidence of stroke, and physical functions, the odds of dying within 6 months after discharge for stroke patients receiving home or community-based care was significantly lower than those in institutions ( OR = 0.39; 95 % CI = 0.15 to 0.97 ). It is not clear why a lower mortality rate was observed among patients receiving home or community-based services. Differences in quality of care and quality of life among users of different types of long-term care services should be investigated. More research is needed to assess the causes of the disparity in mortality rates among users of different types of long-term care services.

Activities of Daily Living↗
PubMed2005

The impact of point of care testing on diabetes services along Victoria's Mallee Track: results of a community-based diabetes risk assessment and management program.

INTRODUCTION: In the State of Victoria in Australia, diabetes is considered one of the top 10 health problems for people living in the rural Mallee Track region (which is centred on the town of Ouyen and extends west to the border with South Australia). A project entitled 'Diabetes Management Along the Mallee Track' was conducted through a Rural Chronic Disease Initiative (RCDI) program grant from the Australian Government's Department of Health and Ageing, Canberra, with the aim of improving the delivery of diabetes services in this region. The project's aims were achieved through the implementation of a community risk assessment program and the establishment of an integrated, multidisciplinary 'one-stop' service for the management of people with diabetes. The use of on-site point-of-care (POC) pathology testing equipment was the key component of both arms of the project. METHODS: Community risk assessment sessions were held in seven towns across the Mallee Track region using a local settings approach. Risk assessment included POC pathology testing for glucose and lipids, as well as blood pressure, age, personal and family history of diabetes, smoking status, and self-assessed weight and level of exercise. The multidisciplinary 'one-stop' service for the management of people with diabetes involved having a single appointment with their local GP, during which time they met the local diabetes educator and podiatrist as well as the GP, and on-site POC testing (POCT) performed for haemoglobin A1c (HbA1c), urine albumin : creatinine ratio (ACR), lipids and glucose. A written survey was conducted among patients with diabetes, local GPs and local health professionals to assess the level of satisfaction with the project and the use of POCT, and to assist policy development for the future planning and development of diabetes services along the Mallee Track region. RESULTS: Risk assessment: 320 adults were assessed for their risk of diabetes during community sessions (representing approximately 20% of the adult population of the region). Two-thirds of people tested had equivocal random blood glucose levels (5.1-11.0 mmol/L), while hypertension and high cholesterol were found in more than one-third. Management of established diabetes: 49 people with known, established diabetes were initially entered into a Central Diabetes Register (with 5 more joining the register since). These diabetes patients (n = 54) have now been monitored by POCT for a mean of 10 months (range 3-18 months). Since the introduction of the 'one-stop shop', the percentage of persons achieving optimal glycaemic control (HbA1c <7%) has increased by 30% (from 33% to 63%), the percentage achieving controlled glycaemia (HbA1c < 8%) has increased by 32% (59% to 91%), while the number exhibiting poor control has reduced by 7% (13% to 6%). The mean HbA1c has fallen from 7.6% at the commencement of the program to 7.1% (p = 0.03, paired t-test). Falls in cholesterol and blood pressure were also observed. Satisfaction with new management services for diabetes: 36 patients with diabetes (73% of all known diabetes patients in the region at the time) completed satisfaction questionnaires. There was overwhelming support within this group for the use of POCT as part of their management, because it was convenient, encouraged self-management and enhanced doctor-patient relationships. The proportion of patients with diabetes who were satisfied/very satisfied with the available diabetes services was significantly greater following the introduction of the project (before: n = 18 (64%), after: n = 29 (91%), chi2 = 6.10, p = 0.01). Doctors agreed that the immediate availability of POCT results at the time of consultation was convenient for them, contributed positively to patient compliance and improved their relationship with the patient. Health professionals felt confident in using the POC analysers and believed the program had raised community awareness about diabetes and enhanced community ownership. CONCLUSION: Point-of-care pathology testing has enabled the introduction of a community-friendly risk assessment program for diabetes and provided a convenient and rapid service for monitoring the control of diabetes in people with established disease in the Victorian Mallee Track region. The number of diabetes patients accessing diabetes services has more than doubled since the introduction of the program. All community and health professional groups surveyed agreed that the POC model delivered as part of this project should be available to all people throughout the Mallee Track region. The model, although conducted in a small rural community, has the potential to form a suitable template for the broader introduction of POCT services for diabetes in rural and remote communities across Australia. As an independent measure of the success of the program, the Australian Government's Department of Health and Ageing selected the Diabetes Management Along the Mallee Track project as one of three demonstration projects from the RCDI grants for showcasing to all rural health services in Australia through the production of an education resource called 'Building Healthy Communities'.

Adolescent↗
PubMed2005

Men's and women's use of intimate partner violence in clinical samples: toward a gender-sensitive analysis.

Early research with nationally representative samples suggested that women reported initiating violence as often as men. Such research has been criticized as focusing only on participation rates, and not assessing gender differences in impact, context, and motivation for using partner violence. Furthermore, research with nationally representative samples has been largely a-theoretical and may lack relevance to those working with clinical samples. Research with clinical populations has begun to address gender similarity and differences in the commission and experience of partner violence. The present article reviews research on men's and women's partner violence using a model for examining such gender differences that incorporates key elements of partner violence, including initiation of the overall pattern of partner violence, proportional initiation rates of violent episodes, physical and mental health impacts of partner violence, behavioral and emotional responses to partner-initiated violence, motivations for using partner violence, and fearfulness of partner-initiated violence. The review concludes that, within and across clinical samples, women are disproportionately victimized by partner violence compared to men. Implications for research, clinical programs, and policy development are discussed.

Fear↗
PubMed2005

Domestic violence among male and female patients seeking emergency medical services.

Gender differences among a cohort of injured patients seeking emergency medical services were examined with respect to their experiences as perpetrators and/or victims of domestic violence. Contextual issues, including violence initiation, emotional and behavioral responses to partner-initiated violence, and injury frequency and severity were analyzed. Women reported male partner-initiated violence more frequently than men reported female partner-initiated violence. Behavioral responses to partner initiated violence varied. Women were more likely to report using force back and to involve law enforcement. Women were more likely to be injured in a domestic assault over their lifetime, within the last year, and at the time of recruitment. Comparison of injury severity revealed that women reported higher rates of injuries than men in all possible severity categories. Women also reported experiencing more fear than men during partner-initiated violence, as well as being subjected to larger numbers of dominating and controlling behaviors, and greater intimidation secondary to their partner's size. Understanding contextual differences in partner violence for women and men has significant implications for policy development, identification, treatment, and referral of patients identified as living in violent relationships.

Adolescent↗
PubMedDate not supplied

The possibilities and the realities of home care.

BACKGROUND: An analysis of a provincial home care dataset, comparing home care client, service, and providers in 1991/92 through 2000/01, was undertaken to describe changes over the decade, and permit a more informed discussion of home care in relation to Canadian health policy developments and health system reforms. METHODS: After data were obtained upon request from Alberta's Ministry of Health and Wellness, descriptive and comparative statistical analyses were undertaken using the SPSS computer program. Logistic regression was used to compare multiple client characteristics in the first and last years. RESULTS: Home care clients doubled and the mean hours of care per client increased substantially, although the duration of care provision declined. The mean age of clients also declined. Home care continued to be primarily provided by Home Support Aides, with self-managed care increasing dramatically. Sustained geographical differences in home care were noted. CONCLUSION: Although home care has much potential for enabling early discharge from hospital, and for maintaining or improving health, few population-level studies of home care trends exist. In Alberta, although formal home care hours increased, home care expansion was not uniform across the province. Home Support Aides continued to be the primary care provider. In the face of substantial hospital downsizing, these observations could imply that the provision of home care has been off loaded to families. Moreover, home care increases do not appear to be related to an aging population.

Aged↗
PubMedDate not supplied

Partnership model for practice and education.

The faculty practice partnership model provides a framework for collaboration between a practice setting and a university school of nursing. The model created between the Bergen County Department of Heath Services (BCDHS), the Office of Public Health Nursing (PHN) and Pace University's Lienhard School of Nursing (LSN) is one that supports faculty practice and student involvement in population-based activities. The partnership provides BCDHS with the assistance it needs to provide the three core functions of public health: assessment, assurance, and policy development. It provides LSN with a practice site where faculty members are able to maintain their clinical expertise, as well as a site for student clinical experiences and research. This article describes the partnership model and its accomplishments from both practice and educational perspectives.

Education, Nursing↗
PubMed1998

Sexual harassment: a concern for the athletic trainer.

OBJECTIVE: Sexual harassment is a vital social issue that affects the business community, educational institutions, and personnel in the U.S. military. Addressing sexual harassment in the athletic training clinical setting is an important issue for the athletic training professional. Athletic trainers need to understand the complex definitions of sexual harassment and how to identify and handle claims of sexual harassment in order to prevent sexual harassment from occurring and to prevent civil lawsuits of alleged sexual harassment. BACKGROUND: Professional journals, legal textbooks, policy handbooks, unpublished findings from the NATA Women in Athletic Training Committee report, and current news media sources were used to gain a greater understanding of this social problem. DESCRIPTION: To make the athletic trainer aware of this important social issue and to offer suggestions for the athletic training staff to aid in preventing problems of sexual harassment. CLINICAL ADVANTAGES: This article provides definitions and examples of sexual harassment, discussion of policy development, and suggestions for ways to eliminate sexual harassment in the athletic training environment.

Journal Article↗
PubMedDate not supplied

Infectious disease outbreaks related to drinking water in Canada, 1974-2001.

BACKGROUND: Recent public attention on drinking water supplies in the aftermath of waterborne infection outbreaks in Walkerton and North Battleford raises questions about safety. We analyzed information on waterborne outbreaks occurring between 1974 and 2001 in order to identify apparent trends, review the current status of monitoring and reporting, and gain a better understanding of the impact of drinking water quality on public health and disease burden. METHODS: Data from outbreak investigations, published and unpublished, were categorized by the type of drinking water provider and were assessed to be definitely, probably or possibly waterborne in nature. RESULTS: The final data set consisted of 288 outbreaks of disease linked to a drinking water source. There were 99 outbreaks in public water systems, 138 outbreaks in semi-public systems and 51 outbreaks in private systems. The main known causative agents of waterborne disease outbreaks were (in descending frequency of occurrence) Giardia, Campylobacter, Cryptosporidium, Norwalk-like viruses, Salmonella and hepatitis A virus. SUMMARY: We found that severe weather, close proximity to animal populations, treatment system malfunctions, poor maintenance and treatment practices were associated with the reported disease outbreaks resulting from drinking water supplies. However, issues related to the accuracy, co-ordination, compatibility and detail of data exist. A systematic and coordinated national surveillance system for comparison purposes, trend identification and policy development is needed so that future waterborne disease outbreaks can be avoided.

Agriculture↗
PubMed2006

Rasch analysis of a new construct: functional caregiving for adult children with intellectual disabilities.

This research examined empirical evidence for a new construct, Functional Caregiving, which is a theory about mothers' caregiving of their adult children with intellectual disabilities. A sample of 108 biological mothers and primary caregivers rated survey items about their confidence to perform caregiving tasks. Rasch rating scale analysis found 61 items defined an empirical construct with three caregiving levels: Advocacy, Personal Caregiving, and Community. Results show item separation was 3.11 with high reliability, .91, and mother separation was 2.93 and reliability, .90. Both items and mothers showed adequate INFIT and OUTFIT values. Item invariance was confirmed between older and younger mothers, and principle components analysis of item residuals did not reveal any major dimensionality threats. Item decomposition analysis showed FC content theory to account for 58 percent of item calibration variance (R2 = .58, F = 42.3, p < .001). These results have important practical implications for health and social services, as well as family caregiving, interdisciplinary practices, and health policy development.

Adult↗
PubMed2006

Relationship among employment status, stressful life events, and depression in single mothers.

This purpose of this study was to extend our understanding of employment status as a social determinant of psychological distress among single mothers. A cross-sectional survey assessing stressful life events and depression was completed with 96 single mothers (48 employed and 48 social assistance [SA] recipients) between November 2003 and March 2004. The prevalence of depressive symptoms was significantly higher for the SA recipients. Mild, moderate, and severe depressive symptoms were reported by 2%, 23%, and 67%, respectively, of SA recipients. Total stressful events were markedly greater for SA recipients. In addition, SA recipients reported larger numbers of housing, health, social, and financial stressors. Regression analysis indicated that 40.6% of the variation in depressive symptoms among single mothers was explained by their employment status and stressful events. The findings suggest that women's employment status significantly impacts on their psychological well-being. Implications for nursing practice, policy development, and future research are identified and discussed.

Adult↗
PubMed2006

[Optimising antibiotic policies in the Netherlands. IX. SWAB guidelines for antimicrobial therapy in adults with acute infectious diarrhoea].

The 'Stichting Werkgroep Antibioticabeleid' (SWAB; Dutch Working Party on Antibiotic Policy) develops evidence-based guidelines for the use of antibiotics in hospitalised adults. This guideline on acute infectious diarrhoea (AID) concerns the antibiotic treatment of acute infectious inflammation of the gastrointestinal tract, manifesting primarily as diarrhoea. AID can be subdivided into community-acquired diarrhoea, traveller's diarrhoea and hospital-acquired (nosocomial) diarrhoea. In the first 2 categories, the need for antibiotic treatment is generally restricted to individuals with severe illness, dysentery or a predisposition to complications. High rates of primary fluoroquinolone resistance can be found in human Campylobacter isolates from the Netherlands and from other parts of the world. Therefore, if antibiotic treatment is necessary for community-acquired AID or AID in travellers returning to the Netherlands, it is advised to use oral azithromycin for 3 days as empirical treatment. If intravenous treatment is necessary, the combination of ciprofloxacin and erythromycin for 5-7 days may be considered. As soon as the identity of the causative organism is known, antimicrobial treatment should be tailored accordingly.

Acute Disease↗
PubMed2006

Violence at work: the experience of general practice receptionists.

Receptionists act as intermediaries between the General Practitioner and the public, and are often involved in conflicts between the GP and a demanding patient. However there is a paucity of research in this area. The aim of this study was to quantify the extent of violence directed towards GP receptionists and to categorise the type, frequency and impact of such aggression in two health board areas. A postal questionnaire was designed, piloted and sent to 400 randomly selected receptionists in the former Northern Area Health Board and the Western Health Board. We found that 62% (n= 168) of receptionists experienced violence in the past. 99% (n=166) had experienced verbal abuse while 31% (n=52) had experienced threats of physical abuse. 6% (n= 10) experienced physical abuse. In most cases the perpetrator was the patient 98% (n= 160). 28% (n=75) of practices had a practice policy for dealing with violence while only 13% (n=34) of receptionists received education on dealing with violence. This study shows that violence is a major problem among GP receptionists in Ireland. Aggression during the day is a regular feature for a GP receptionist. There is a higher reporting of violence in the Northern Area Health Board compared to the Western Health Board. We suggest that further education, research and practice policy development is needed to help target this problem and improve the overall quality of healthcare.

Adult↗
PubMed2005

After-hours care in Canada: analysis of the 2001 National Family Physician Workforce Survey.

OBJECTIVE: To determine family physicians' availability to their general practice patients after hours and to explore the characteristics and determinants of after-hours services. DESIGN: Secondary analysis of the 2001 National Family Physician Workforce Survey. SETTING: Canada. PARTICIPANTS: Canadian family physicians and general practitioners currently in practice (n = 10,553). MAIN OUTCOME MEASURES: Provision of after-hours care, defined as providing care to all practice patients outside of normal office hours. RESULTS: Sixty-two percent of Canadian family physicians reported providing after-hours service. The lowest rates were found in Quebec (34%) and the highest in Alberta and Saskatchewan (88%). Respondents practising in academic and community clinics, offering selective medical services (emergency care, palliative care, housecalls, after-hours care), or living outside of Ontario or Quebec were more likely to provide after-hours care. Women physicians, those practising in walk-in clinics, or physicians primarily paid by fee-for-service were less likely to do so. Urban versus rural location, organization of practice (solo or group), age of physician, country of graduation, and physician satisfaction were not found to significantly affect the likelihood of providing after-hours services. CONCLUSION: Knowledge of these factors can be used to inform policy development for after-hours service arrangements, which is particularly relevant today, given provincial governments' interests in exploring alternative payment plans and primary care reform options.

Adult↗
PubMed2006

Preimplantation genetic diagnosis: development and regulation.

Pre-implantation genetic diagnosis (PGD) is used to biopsy and analyse embryos created through in vitro fertilisation (IVF) to avoid implanting an embryo affected by a mutation or chromosomal abnormality associated with serious illness. It reduces the chance that the parents will be faced with a difficult decision of whether to terminate the pregnancy, if the disorder is detected during the course of gestation. PGD is widely accepted for this purpose although there have been suggestions that such procedures have the effect of de-valuing persons in the community with disabilities. PGD potentially has other more controversial purposes, including the selection of the sex of the baby for personal preferences such as balancing the family, rather than to avoid a sex-linked disorder. Recently PGD has become available to create a donor child who is Human Leukocyte Antigen (HLA) matched with a sibling in need of stem cell transplant. In most cases the intention is to utilise the cord blood. However, an HLA-matched child could potentially be required to be a donor of tissues and organs throughout life. This may arise should the initial cord blood donation fail for any one of several reasons, such as inadequate cord blood cell dose, graft failure after cord blood transplant, or the recipient child experiencing a recurrence of the original illness after transplant. However, such on-going demands could also arise if a HLA-matched child was fortuitously conceived by natural means. As such, the issue is not PGD, but rather whether to harvest bone marrow or a solid organ from a child. This raises the question of whether there should be limits and procedures to protect such children from exploitation until they achieve sufficient competence to be able to make mature and autonomous decisions about whether to donate, even if the consequence may in some cases be that it is too late to save the sibling. Additionally, the parents may not be able to make a dispassionate decision, when they have a conflict of interests between their children. As such, parents may not be the best proxy decision-makers in this area and the decision might be better made by an independent authority or court. This paper considers ethical and legal issues arising from PGD. It will compare the willingness of the HFEA in the United Kingdom to allow this process to be used even in cases where the condition suffered by the sibling is non-heritable, with the more restrictive guidelines in New Zealand and questions the constitutional basis on which ethics committees develop policy in the absence of a legislative framework.

Ethics Committees↗
PubMed2006

Self-care from the perspective of people living with diabetes.

This review presents findings from a critical integrative review of research into barriers to and facilitators of self-care from the perspective of people with diabetes. The review was motivated by a perceived need to understand self-care from the perspective of those living with this chronic disease and to explore the implications of this understanding for health-care policy in Canada. Journal manuscripts and dissertations exploring self-care from the perspective of adults with type I or type II diabetes and published in English between 1993 and 2003 were reviewed. Both quantitative and qualitative studies were included. Studies were informed by varying definitions of self-care and facilitators and barriers emerged accordingly. An overarching thematic tension was evident, based on a view of self-care as revolving around the disease or evolving in the lives of people with diabetes. This tension has implications for health professionals and for those involved in policy development related to self-care.

Adaptation, Psychological↗
PubMed2006

More coverage, better care: improving children's access to health services.

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a group of grantmakers and health services researchers on November 4, 2005 for an informative discussion about improving children's access to health services, including the opportunities, challenges, and roles for funders. This Issue Dialogue, entitled More Coverage, Better Care: Improving Children's Access to Health Services, covered how the current health care system succeeds and fails for children, emerging policy developments, and what grantmakers are currently doing to promote children's access to health services. The meeting also explored the lessons learned by grantmakers to help guide future work.

Charities↗