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PubMed1993

How hyper are we? A look at hypermedia management in academic health sciences libraries.

Advances in instruction-delivery technology have a direct impact on academic media centers. New technology challenges librarians philosophically, financially, and ethically to provide access to information and instructional systems. Each institution has a unique set of circumstances governing decisions to provide access to hypermedia. If patron needs are met satisfactorily through labs outside the library, it may not be necessary for the library to incorporate hypermedia into its collection. Other library media centers may serve as a main point of access, or a substantial alternative computing resource may exist in departments or professional schools. Regardless of which route is taken, hypermedia is a viable instructional delivery system and can coexist with traditional services. Future studies on various aspects of hypermedia and multimedia management should be encouraged. Academic health sciences librarians would benefit from the study of hypermedia and multimedia collection-development policies, equipment, and personnel management. As computer networking of multimedia and image databases becomes available, it will be interesting to see the role academic health sciences libraries assume in integrating these data-bases with traditional information-delivery systems. Changing technology and instructional methods will affect budgets as well as library relationships with academic departments and computing centers.

Computer Communication Networks↗
PubMed1995

Radiation therapy in the treatment of localized prostate cancer: an alternative to an emerging consensus.

Optimal treatment for patients with localized carcinoma of prostate is controversial. Radiation therapy is an established modality; reports indicate that results are comparable to those of radical prostatectomy. A retrospective review was carried out of 963 patients with carcinoma of the prostate treated with definitive irradiation (65 to 71 Gy in 6.5 to 7 weeks). Survival, incidence of local recurrence and distant metastases, and postirradiation PSA data were analyzed. Ten-year disease-free survival with external irradiation was 100% for clinical stage A1 (T1a), 69% for stage A2 (T1b,c), 57% for clinical stage B (T2), and 41% for stage C (T3). Initial PSA level closely correlated with probability of freedom from chemical failure (PSA elevation) after definitive irradiation in 317 patients with stage T1b,c and T2 tumors (96% and 89%, respectively, with initial PSA of < 10 ng/ml and 75% and 65% with higher PSA levels). Although modern irradiation techniques produce results comparable to those of radical prostatectomy in localized prostate carcinoma, we must continue to critically assess treatment policies, develop appropriately designed prospective clinical trials, and define optimal management of these patients.

Disease-Free Survival↗
PubMedDate not supplied

Dimensions of homelessness.

Investigations of homelessness have been hampered by the lack of operational definitions sensitive enough to achieve subgroup differentiation and simple enough to permit replication. As a consequence, programming and policy development have often proceeded based on varying assessments of the composition, size, and needs of the homeless population. This paper describes the empirical use of duration of homelessness and dwelling place as elements of an operational definition of homelessness. The approach reflects a conceptualization of homelessness as a continuous variable that can be described by coordinates of time and place. A screening instrument that quantified the homeless experience was developed and evaluated in conjunction with a federally funded demonstration project for homeless substance-abusing men and women. Eight hundred and thirty-nine men and women from six public detoxification centers were screened over a two-year period that began in August 1988. Respondents were asked eight questions to assess duration (time) and location (place) of homelessness before they entered the detoxification center. A simple index was constructed retrospectively and found to differentiate the sample into homeless and near-homeless subgroups. Between-group differences were statistically significant in demographics, presenting problems, and probability for successful intervention. These data paralleled previously reported differences between homeless subgroups and support the concurrent validity of the index. Cronbach's alpha (.72) showed the index to be moderately reliable. Differentiation of homeless persons into meaningful subgroups appears possible and programmatically recommended. Homelessness is not a unitary phenomenon, and it is unlikely to respond to therapeutic interventions that fail to consider individual differences.

Boston↗
PubMedDate not supplied

Analysis of the current status of public health practice in local health departments.

This article describes the performance by local health departments of core public health functions. A post hoc analysis based on these essential functions was implemented using the 1994 dataset from a cooperative project with the Centers for Disease Control and Prevention (CDC) and National Association of County and City Health Officials, which involved a survey of the nation's 2,888 local health departments. Applying guidelines for each functional area drafted by the Office of Disease Prevention and Health Promotion/Office of the Assistant Secretary for Health, CDC, and the Public Health Foundation in conjunction with the health officers in five states, a score was created for each core public health function: (1) health-related data collection, surveillance, and outcomes monitoring, (2) protection of environment, housing, food, and water, (3) investigation and control of diseases and injuries, (4) public information and education, (5) accountability and quality assurance, (6) laboratory services, (7) training and education, and (8) leadership, policy development, and administration. The individual and summary scores provide a mechanism to measure and describe the 2,079 local health departments' performance of these core functions and to examine their relationship to several characteristics and practices--planning, administrative units, annual total expenditures, and jurisdiction population size. This article shows that the core performance index is highest for the data function and for local health departments serving a population of 50,000 or more people. In addition, the performance index increases as budget increases and is greater for all eight functions in those local health departments using health planning models such as Assessment Protocol for Excellence in Public Health (APEX-PH), Planned Approach to Community Health (PATCH), Healthy People 2000, or Healthy Communities 2000. These results may be used to facilitate cooperation between local, state, and federal health agencies and the communities they serve; strengthen the core functions at the local, state, and federal levels; and improve public health practice.

Health Expenditures↗
PubMedDate not supplied

Quantifying the adequacy of prenatal care: a comparison of indices.

OBJECTIVES: In spite of the widespread use of prenatal care utilization indices in the scientific literature, little attention has been given to the extent to which these indices are comparable. This investigation contrasts the way five indices classified cases into categories of prenatal care use. METHODS: From the 1989-1991 South Carolina Public Use data files, single live births to resident mothers were selected for analysis (N = 169,082). Five prenatal care indices were compared: (a) the modified Institute of Medicine (Kessner) index, (b) a variation of the IOM index using the full American College of Obstetrics and Gynecology visit recommendation, (c) an index derived from the recommendations of the U.S. Public Health Service Expert Panel on Prenatal Care, (d) the GINDEX, and (e) the APNCU index. RESULTS: The proportion of cases assigned to prenatal care utilization categories by each index varied markedly, ranging from 33.6% to 58.1% for adequate care, 9.2% to 20.3% for inadequate care, and 7.4% to 22.6% for intensive utilization. CONCLUSIONS: The selection of a prenatal care utilization index for research and policy development purposes requires a careful consideration of the intent, criteria for defining adequacy, and coding assumptions of each index. As these indices are conceptually distinct in their measurement approach, they are likely to yield different patterns of prenatal care use in a population and cannot be used interchangeably. Recommendations for their use are provided.

Algorithms↗
PubMedDate not supplied

A regional integrated information system to assure maternal-child health services: a progress report.

Priorities for improving the health of our nation include rebuilding the public health infrastructure through increasing assessment, policy development, and assurance capacities in our communities. Capacity building necessitates formalizing and strengthening public health practice linkages to achieve Year 2000 objectives. Determining progress in achieving objectives requires development of public health infrastructure surveillance and data system capabilities. The Tracking Center of Tracking and Outreach Program for St. Louis (TOPS), through unique collaboration among academic and practice partners, laid the foundation for a Regional Integrated Information System (RIIS) by developing a centralized maternal-child health data base for prenatal and pediatric care providers. The RIIS model provides an example of a capacity building system designed to provide public health surveillance, assessment, planning, and evaluation capabilities. Medical Subject Headings (MeSH): health information systems, prenatal care, immunization, maternal-child health care, public health surveillance.

Child↗
PubMed1997

A survey of state health department compliance with the recommendations of the Institute of Medicine report, The Future of Public Health.

We repeated a survey of state health agencies (SHAs) designed to ascertain the extent that the recommendations of the Institute of Medicine's report, The Future of Public Health, have been implemented. This survey was originally done in 1989 and we repeated the same survey in 1996. While there has been progress in some of the recommendations, such as a separate department of health, agreed-upon public health duties, outreach, infrastructure, and scope of responsibilities, there continue to be problems with the implementation of some of the recommendations. For example, the proportion of agencies reporting that the core public health function of policy development is extant has actually declined since 1989. There continue to be problems, with developing linkages of public health with environmental health and mental health, with strengthening the public health infrastructure, and with expansion of the scope of public health responsibilities. We encourage the continued monitoring of the implementation of the IOM recommendations.

Guidelines as Topic↗
PubMed1997

Migration and health-the international perspective.

Mass movement of people is not a new phenomenon. There are significant differences, however, between contemporary migration and that of yesterday. Modern communication and transportation makes it possible for people and their health problems to travel further and more quickly than ever before. The Plan of Action produced by the 1994 International Conference on Population in Cairo estimates that there are 125 million migrants world-wide. The cause of concern is not only linked to the numbers, but also to the new patterns and categories of migrants that give the strong feeling that the problem is getting out of control. This presents a challenge which urgently asks for response and action on various levels including health and social services. European states started to develop policies that would link immigration to health care policies. "Health for All" strategies, only towards the end of the 1980s, if at all. There are six areas, where health policies and programmes explicitly should take the needs of the immigrants into consideration: (1) communication and understanding, (2) control of infectious diseases, (3) mother and child care, (4) occupational health, (5) violence and (6) health indicators among migrants. To improve the health status of migrant families immigrant receiving countries need to put ethnic policies high on the public health agenda, they need to provide adequate health services to immigrants and there is a crucial need for training and preparing health professionals to understanding perspectives that differ from their own ethnic orientation, and to provide adequate and effective responses.

Communicable Disease Control↗
PubMed1997

Integration of undergraduate and postgraduate general practice education--does it work?

Academic general practice remains a small part of most medical schools. One topical method of creating larger units is to integrate the undergraduate and postgraduate education roles. This paper describes the structure of the General Practice and Rural Health Unit at the North Queensland Clinical School, where education, clinical service and policy development roles are combined to create one of Australia's larger academic general practice centres. Issues which have facilitated and challenged the development are discussed in this reflective paper describing the first 3 years of operation.

Education, Medical, Continuing↗
PubMed1997

Strategies to address the methodological challenges of client-satisfaction research in home care.

While there is an abundance of recent client satisfaction research, methodological difficulties continue. This paper addresses common methodological challenges in securing useful feedback from elderly clients receiving home-care services. The methodological challenges include socially desirable response sets (SDRS), fear of reprisal, acquiescent response sets (ARS), and negative or positive wording of items. These contribute to an inability to capture salient dimensions of satisfaction and dissatisfaction important to home-care clients. Several data-collection strategies are proposed: guided interactive interviews, story-telling, scenarios, and rating of the importance of the dimensions of satisfaction and dissatisfaction identified from interview data. Each strategy is discussed using illustrations from a study on elderly clients' satisfaction with home-care services. Nurses and other health-care providers require credible feedback about client satisfaction in order to develop policy and to provide more appropriate and effective services to home-care clients.

Home Care Services↗
PubMed1997

Technology: nursing the system. Technology and the potential for entrepreneurship.

Many nurses are stepping beyond the boundaries of traditional practice and creating their own business or service centers. New entrepreneurial opportunities include working on computer-based patient records, providing consulting services, developing policies and more. Getting involved--joining informatics groups, taking classes--is the first step.

Clinical Competence↗
PubMedDate not supplied

Advances in meta-analysis as a research method.

Meta-analysis is a method of data analysis applied to summarizing research findings, both quantitative and qualitative summaries of individual studies. Rooted in the fundamental values of the scientific enterprise of replicability, causal and correlational analysis, it is useful for answering three general questions: What is the central tendency or typical study outcome? How much variability exists among study outcomes? What is the explanation of the variability? Advanced statistical and mathematical techniques are being used in counting studies with significant and non-significant findings; in combining effect size estimates based on fixed- or random-effects models; in the use of general linear models; and, Bayesian procedures. The methodology of meta-analysis and suggestions for publications are presented as well as appropriate software programs available for use in the meta-analytic process are explored. The benefits of meta-analysis as a research method in effecting health policy development is offered as a pragmatic perspective for future consideration. Conclusions have implications for the use of meta-analysis as a teaching strategy and as a methodology in nursing research and other applied sciences. In view of the rapid pace of knowledge development and increased public demand for accountability, meta-analysis offers an opportunity for organizing phenomena which gives direction for provision of quality health care.

Humans↗
PubMed1997

Exposure workups.

Exposure workups are an important responsibility for infection control personnel. A well-designed plan for investigating exposures, which includes appropriate algorithms, will enable infection control personnel to evaluate exposures rapidly and consistently so that nosocomial transmission is minimized. Infection control personnel should use their own data to develop policies and procedures that suit the needs of their facility. After they have implemented the plan, infection control personnel should continue to collect data on exposures so they can continuously improve their performance.

Algorithms↗
PubMed1998

Health-related quality of life and activity limitation--eight states, 1995.

Since January 1993, CDC's Behavioral Risk Factor Surveillance System (BRFSS) has included four general questions concerning health-related quality of life (HRQOL). The results of these HRQOL measures are useful for population health assessment, epidemiologic research, and policy development, but they are less useful for identifying specific public health interventions because they track general deficiencies such as poor health. Since 1995, state health departments have had the option of including in the BRFSS an expanded set of 14 HRQOL questions; these questions ask about specific types of activity limitation and common physical and emotional symptoms. This report summarizes preliminary findings from the eight states (i.e., Delaware, Indiana, Kansas, Mississippi, Missouri, New Mexico, North Carolina, and Tennessee) in which these other questions were included in the 1995 BRFSS.

Adult↗
PubMed1998

Practical considerations of intravenous sedation for the perioperative nurse.

There has been a recent increase in the number and types of cases performed with conscious sedation in the operating room and in minor operative suites (endoscopy, plastics, etc.), with nurse administering conscious sedation to healthy, uncomplicated patients under the direction of a physician. The literature is replete with articles which proffer guidelines, discuss the basics of conscious sedation, the role of the nurse, training and competency issues, and policy development. This article provides perioperative nurses with some practical, hands-on information to aid them in providing safe, quality care to their patients. There are detailed sections which address required equipment, perioperative patient assessment and monitoring, and information on commonly used medications and their side effects. The author offers this information based on literature review, education, and experience, and does not reflect the official position of any one organization.

Anesthesia, Intravenous↗
PubMedDate not supplied

Intravenous conscious sedation. Physiologic, pharmacologic, and legal implications for nurses.

Nurses with proper additional training can safely assist in the care of patients receiving intravenous conscious sedation for a variety of procedures. Sedation exists along a continuum, with subtle differences between lighter and deeper levels of sedation. The primary goal of conscious sedation is to achieve a minimally sedated patient with intact protective airway reflexes. Pharmacologic agents may provide anxiolysis, amnesia, sedation, or analgesia. Legal considerations, policy development, and educational requirements for nurses choosing to practice in this expanded role are examined.

Clinical Competence↗
PubMed1998

Abortion in Puerto Rico: the limits of a colonial legality.

This paper situates the current abortion practice and policy in Puerto Rico within the historical, political, and economic context of the colonial domination of the United States (US) over Puerto Rico. In particular, we pay attention to the hurdles that women face to obtain abortion services in Puerto Rico as a result of its colonial legality. Of particular significance is the overall low abortion ratio, and differential abortion ratio and access issues faced by women when grouped by an age-ethnicity category: unmarried teenagers, adult Puerto Rican women and, adult immigrant women from the Dominican Republic. The present hurdles to abortion access--related to information, abortion providers, economic situation, and government policies--are discussed within the colonial legality of abortion based on the US Supreme Court decision Roe v. Wade. Puerto Rico's case is situated within its broader history of population policies developed by the State since the 1930's. Of particular relevance is the antagonism that State managers have had towards abortion in spite of its legality. In this sense, abortion in Puerto Rico continues to be an unfinished business, in spite of its legality.

Abortion, Legal↗
PubMedDate not supplied

Opening minds. Values clarification via electronic meetings.

Values clarification for nursing practice is one of the most challenging aspects of nursing education. Use of electronic meeting software has been demonstrated to be effective in overcoming typical barriers to student growth. Inhibitions related to fear of censorship are overcome by anonymity of the system. Monopolizing by dominant members is controlled when the ability to speak in parallel exists. Overall, this application of electronic meeting software in the classroom demonstrated involvement of all students in an innovative approach to understand the effect of personal values on health policy development in a graduate nursing course.

Computer-Assisted Instruction↗