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PubMedDate not supplied

The use of automated assessment with seriously mentally ill clients.

Despite the skepticism of many behavioral healthcare practitioners that their clients are "much too ill" to interact positively with a computer-based assessment system, this article describes a successful program that integrates computerized interactions for seriously mentally ill adults into its overall information management. At the core of this information system is a 30- to 45-minute assessment using eight basic scales plus clinical data. According to a satisfaction survey, clients generally are quite open to interacting with the computer--when it is presented as an adjunct to the work of clinicians.

Ambulatory Care Information Systems↗
PubMedDate not supplied

The tumor conference: an integral component of the oncology program.

This periodic meeting of individuals with oncologic expertise represents the best that modern medicine can be: a true multidisciplinary approach to patient care. Nowhere else in healthcare will you find a better example of combining different expertise for the express purpose of improving the delivery of care for an individual patient.

Education, Medical, Continuing↗
PubMed1998

Going it alone.

A delivery system in Western New York has developed many of its own software programs, saving big bucks. Now, it's buying certain clinical programs and integrating them with the home-grown software.

Cost Control↗
PubMed1999

The Women and Infants Demonstration Project: an integrated approach to AIDS prevention and research.

The Women and Infants Demonstration Project is a multisite, behavioral intervention research effort funded by the Centers for Disease Control. The project is evaluating a theory-based, integrated intervention model to increase the use of condoms for prevention of both sexually transmitted diseases (STDs) and unintended pregnancy among women and their partners at risk of infection with HIV. The importance of utilizing carefully targeted, credible and persistent risk reduction interventions to effect lasting behavior change has become evident over the last ten years of the AIDS epidemic. The theory-based intervention components being evaluated in this intervention study involve one-on-one stage-tailored outreach; the development and distribution of community-tailored HIV prevention materials, called role-model stories; and the development of organizational and peer networking, all within a community mobilization framework. This article describes each of the intervention components being evaluated during this 5-year study. Such an intervention effort represents an important contribution in the design of community-level AIDS prevention intervention efforts which support individual-level behavioral changes by women at risk for HIV and other sexually transmitted infections.

Adolescent↗
PubMed1978

The collective approach to psychiatric practice in the People's Republic of China.

This paper describes and analyzes the effects of the dramatic changes of social values in China on the approach to treatment of the mentally ill since the 1949 revolution. It is mainly based on observations, interviews, and experiences in mental hospitals during three recent trips to the People's Republic of China. Attention here is focused on the effects of four new social values on psychiatric practice: first, the value of collective responsibility as reflected in the new program to integrate mental hospitals with the community; second, the application of the value of sharing and "serving the people" to methods of psychiatric therapy; third, the value of "minimization of elitism" as practiced in the role relationships among members of different categories in mental hospitals; and fourth, the reaffirmation of faith in human ability to conquer difficulties, as shown in changes of patients' outlook on life and behavior. Finally, the implications of this alternative approach on our established assumptions and methods of psychiatric therapy in the West are discussed, and the future direction of theoretical formulation is suggested.

Attitude of Health Personnel↗
PubMedDate not supplied

Socio-economic profile and performance of CHVs in Gujarat: implications for selection and support.

What type of person should be selected as Community Health Volunteer (CHV) has been a matter of debate. This study relates socio-economic characteristics--age, sex, marital status, education, caste, organisation membership and landownership--with performance on direct patient care, mother and child health, family welfare and environmental sanitation. The paper further suggests strategies for selection, training and support in case of CHVs whose performance is poor.

Community Health Workers↗
PubMed1984

Hospital space planning: what happened to all the magic numbers?

"Magic numbers" and user "wish lists" have traditionally been used to determine space needs in health care institutions. Today, however, combining functional and space planning to yield a space program that integrates with the facility's long-range strategic plan can be accomplished through a user needs approach. These three approaches are discussed in light of their positive and negative aspects and their contributions to the planning process. In particular, a methodology for examining a department's potential "space generators" is provided. Along with this methodology is the reasoning behind beginning the detailed analysis early in the planning process.

Health Services Needs and Demand↗
PubMed1986

Hospitals and self-help groups: opportunity and challenge.

Mutual aid self-help (MASH) groups can be a positive means of enabling persons to cope effectively with their health and personal problems. MASH groups provide emotional support, decrease anxiety, foster referrals to the hospital, reduce lengths of stay, and facilitate the discharged patient's reentry into the home and community. Yet this potentially valuable resource has been largely untapped by hospitals. Hospitals can take a number of steps to integrate their programs and services with MASH networks: Identify self-help groups in the hospital's service area. Establish liaison with groups that are of key interest to various hospital departments and programs. Make referrals to appropriate MASH groups as part of the discharge-planning process. Promote the development of MASH groups by appropriate hospital departments. Provide logistic support to self-help groups. Promote awareness of MASH Groups through specialized directories or tapes. Educate professional staff on the value, variety, and limitations of self-help groups. Provide consultation and speakers.

Attitude of Health Personnel↗
PubMed1999

What is the future for nurse executives?

This article describes the future role of nurse executives as designers of health care rather than respondents to internal and external environmental forces. The successful executives will be proactive, dedicated, and politically astute. These individuals will engineer vertical organizations that are empowered, fluid, and flexible. These new organizational skills will be developed through innovative executive educational programs designed at the master's and doctoral levels. Well-established executives from business, education, public health, medicine, administration, health systems, and education will become the faculty preparing these individuals. These programs will integrate other health care disciplines through an integrated and flexible approach to learning. The development of these roles will influence policy and decision making at all levels within health care.

Education, Nursing, Graduate↗
PubMed1998

Microcomputer decision support system for intensive care.

This article describes a computer system to support decisions in Intensive Medicine developed for a multipurpose Intensive Care Unit (13 beds and about 700 yearly patients). The system is used in a microcomputer (486DX4). Works done in this area are mentioned; and the different programs which integrate the system, the advantages of its use and the results accomplished are described. Some of the most important results are the quality increment of the medical care given, physicians' possibilities of dedicating more time to their patients, cost reductions, and improvements in the development of teaching and in the conditions to carry out research work in the Intensive Care Unit (ICU). An analysis is made of the system requirements that guarantee its integration to the Unit work, and the easy and safe use of it by the physicians and nurses.

Critical Care↗
PubMed1999

Treatment in Kenyan rural health facilities: projected drug costs using the WHO-UNICEF integrated management of childhood illness (IMCI) guidelines.

Guidelines for the integrated management of childhood illness (IMCI) in peripheral health facilities have been developed by WHO and UNICEF to improve the recognition and treatment of common causes of childhood death. To evaluate the impact of the guidelines on treatment costs, we compared the cost of drugs actually prescribed to a sample of 747 sick children aged 2-59 months in rural health facilities in western Kenya with the cost of drugs had the children been managed using the IMCI guidelines. The average cost of drugs actually prescribed per child was US$ 0.44 (1996 US$). Antibiotics were the most costly component, with phenoxymethylpenicillin syrup accounting for 59% of the cost of all the drugs prescribed. Of the 295 prescriptions for phenoxymethylpenicillin syrup, 223 (76%) were for treatment of colds or cough. The cost of drugs that would have been prescribed had the same children been managed with the IMCI guidelines ranged from US$ 0.16 per patient (based on a formulary of larger-dose tablets and a home remedy for cough) to US$ 0.39 per patient (based on a formulary of syrups or paediatric-dose tablets and a commercial cough preparation). Treatment of coughs and colds with antibiotics is not recommended in the Kenyan or in the IMCI guidelines. Compliance with existing treatment guidelines for the management of acute respiratory infections would have halved the cost of the drugs prescribed. The estimated cost of the drugs needed to treat children using the IMCI guidelines was less than the cost of the drugs actually prescribed, but varied considerably depending on the dosage forms and whether a commercial cough preparation was used.

Child Health Services↗
PubMedDate not supplied

Outcomes of a community pharmacy-based diabetes monitoring program.

PRIMARY OBJECTIVE: Evaluate the effects of a point-of-dispensing (POD) pharmaceutical care model on outcomes of self-monitored blood glucose (SMBG) results, SMBG frequency, and medication adherence rates for patients with diabetes. SECONDARY OBJECTIVE: Measure the rate at which physicians implemented therapy recommendations made by community pharmacists. DESIGN: 12-month, noncrossover, single-group trial. SETTING: Two independent community pharmacies in Richmond, Va. PATIENTS: 101 patients were initially identified as potential participants; of the 82 that elected to participate in the study, 62 (76%) completed the first 6 months and 52 (63%) completed the entire 12-month study period. INTERVENTION: This pharmaceutical care program was integrated into the dispensing function: subjective and objective data related to diabetes care were gathered with each prescription refill. Recommendations were made to patients and their physicians. MAIN OUTCOME MEASURES: SMBG values and frequency at baseline, 6, and 12 months. Diabetic medication adherence rates for 1 year before and during participation were evaluated. Community pharmacist recommendations and implementation status were followed over the 12-month period. RESULTS: Average morning blood glucose values (n = 27) decreased from 178.6 mg/dL to 159.3 mg/dL, from baseline to 6 months, respectively (p = .07). Blood glucose values (n = 23) at baseline and 12 months decreased from 179.0 mg/dL to 149.7 mg/dL, respectively (p < .05). There was no statistical difference in SMBG frequency. A diabetes medication adherence rate of 90% was maintained over the 12-month study period. Physicians implemented 15 of 20 (75%) recommendations. CONCLUSION: This model offers an effective and efficient mechanism for providing pharmaceutical care for patients with diabetes.

Adult↗
PubMed2000

The effects of an advanced practice nurse-directed heart failure program.

A study was conducted to determine if an inpatient heart failure program directed by an advanced practice nurse (APN) affects the following patient outcomes: length of hospital stay, mortality, readmission rates, and adherence to the recommended clinical regimen. Evaluating APN-directed heart failure programs may assist hospitals and clinics to determine whether such programs should be replaced, modified, continued, or replicated. For those facilities that are considering beginning a heart failure program, the data provided in this study may help establish the necessity of developing such a program or provide ideas for program design. The APN has an integral role in program design and can assist in achieving positive patient outcomes.

Aged↗
PubMed1999

[Coexistence of mass hysteria, konzo and HTLV-1 virus in the Democratic Republic of the Congo].

A cross-sectional study was carried out in Pindi located 115 kilometers from Kikwit, Democratic Republic of the Congo to characterize a local school epidemic involving paralysis of the lower extremities, identify risk factors, and establish differential diagnosis with konzo and spastic paralysis related to human T-lymphotropic virus type 1 (HTLV-1). Data was obtained using a qualitative approach based on records, interviews, focus group technique, and neurological examination. Blood tests using the ELISA and western blot tests were performed to detect HTLV-1 and HIV 1 and 2. A total of 41 cases of paralysis were observed between 1994 and 1998. All patients were female and most (n = 28) were between the ages of 16 and 20 at the time of the study. The majority of cases were recorded in 1998 (31 prevalent cases and 16 incidents). Epidemiological data, clinical findings, and laboratory tests suggested that the etiology was mass hysteria with somatic conversion rather than toxic or viral causes in most cases. The psychosocial environment played an important role in the spread of the epidemic. These findings demonstrate the crucial role of the psychosocial environment in the occurrence of mass hysteria and support use of integrated health programs in developing countries.

Adolescent↗