CYTOPATHOLOGY, Issue 2006
M. Mohammed
That there is wide-spread variation in healthcare outcomes cannot be denied. The question is what does the variation mean and what can we do about it? Using a series of well-known case-studies, which include data from the Bristol and Shipman Inquiries, fundamental limitations of traditional methods of understanding variation will be highlighted. These methods, which include comparison with standards, league tables and statistical testing, have flaws and they offer little or no guidance on how to re-act to the variation. Fortunately, there is a theory of variation that overcomes these limitations and provides useful guidance on re-acting to variation, which was developed by Walter Shewhart in the 1920s in an industrial setting. Shewhart's theory of variation found widespread application and won him the accolade ,Father of modern quality control'. His work is central to philosophies of continual improvement. Application of Shewhart's theory of variation, also known as Statistical Process Control (SPC), to case-studies from healthcare will be demonstrated, whilst highlighting the implications and challenges for performance management/monitoring and continual improvement in the healthcare. References:, 1. M A Mohammed, KK Cheng, A Rouse, T Marshall. "Bristol, Shipman and clinical governance: Shewhart's forgotten lessons" The Lancet 2001; 357: 463,7. 2. P Adab, A Rouse, M A Mohammed, T Marshall. "Performance league tables: the NHS deserves better" British Medical Journal 2002; 324: 95,98 [source]

NHS AS STATE FAILURE: LESSONS FROM THE REALITY OF NATIONALISED HEALTHCARE

ECONOMIC AFFAIRS, Issue 4 2008
Helen Evans
The British National Health Service is often held up as a beacon of egalitarian healthcare, funded through general taxation and free at the point of use. Instituted by arguably the most socialist government in British history after World War II, it has manifested all the flaws that might be expected from a state monopoly: waste, inefficiency, under-investment, rationing and constant political interference. The result has been poor health outcomes for British citizens compared with other wealthy countries, and a failure by the NHS to live up to its founding principles of comprehensive, unlimited healthcare and egalitarianism. [source]

A NEW ROLE FOR CONSUMERS' PREFERENCES IN THE PROVISION OF HEALTHCARE

ECONOMIC AFFAIRS, Issue 3 2006
Harry Telser
In the present allocation of resources in healthcare, preferences of consumers as the ultimate financiers of healthcare services are judged to be of little relevance. This state of affairs is being challenged because the past decade has seen great progress in the measurement of preferences, or more precisely, willingness-to-pay (WTP) as applied to healthcare services. This article reports evidence on WTP of the Swiss population with regard to three hypothetical modifications of the drug benefit to be covered by social health insurance: delaying access to the most recent therapeutic innovations (among them, drugs) by two years in exchange for a reduction of the monthly premium; substituting original preparations by generics, again in return for a lowered premium; and the exclusion of preparations for the treatment of minor complaints from the drug benefit. Using discrete-choice experiments, WTP and its determinants are estimated. Average WTP for avoiding such a delay (which acts across the board) is much higher than for eschewing the exclusive use of generics (which are claimed to be largely equivalent to the original) or the retention of ,unimportant' drugs in the list of benefits , a rating predicted by economic theory. In addition, a great deal of preference heterogeneity between the French-speaking minority and the German-speaking majority was found, pointing to considerable efficiency losses caused by uniformity of social health insurance. [source]

Risperidone long-acting injection: a 6-year mirror-image study of healthcare resource use

ACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2009
D. Taylor
Objective:, To evaluate naturalistic use of risperidone long-acting injection (RLAI) and its effect on healthcare resource use. Method:, Mirror-image comparison of healthcare resource use for 3 years before RLAI initiation and 3 years after. Results:, In total, 211 of 277 patients consecutively prescribed RLAI were evaluable over the full 6-year study period. Median days in hospital/patient increased significantly in the 3 years after RLAI initiation [87 days (inter-quartile range 25,236) before vs. 192 days (47,426) after; P < 0.001]. Those 34 patients who continued RLAI for 3 years showed no change in median bed days [64 days (6.5,182) before vs. 64 days (12,180) after] and median number of admissions was decreased [1.5 (1,2.25) before vs. 1.00 (0,1.25) after; P = 0.001]. Healthcare costs more than doubled for the whole cohort (P < 0.001) and discontinuers (P < 0.001) and increased significantly for continuers (P = 0.010). Conclusion:, RLAI did not decrease either time spent in hospital or overall healthcare costs in this patient cohort. [source]

Diagnostic Accuracy of Handheld Echocardiography for Evaluation of Aortic Stenosis

ECHOCARDIOGRAPHY, Issue 5 2010
Arnd Schaefer M.D.
Background: Symptomatic severe aortic stenosis is associated with increased mortality and morbidity. Early identification of these patients by echocardiography is crucial. We conducted this study to evaluate a handheld ultrasound device (HCU) in patients with suspected severe aortic stenosis (AS) in comparison to a standard echocardiography device (SE). Methods: A HCU (Vivid I; GE Healthcare) and a SE device (Philips iE 33) were used to evaluate 50 consecutive patients with suspected severe AS. Two consecutive echocardiographic studies were performed by two experienced and blinded examiners using HCU and SE device. AS was graded by mean transaortic pressure, aortic valve area (AVA), and indexed AVA (AVA adjusted for body surface area). Results: Mean difference for mean transaortic gradient, AVA and indexed AVA for the SE and HCU device were 1.28 mmHg (,0.70 to 3.26 mmHg), ,0.02 cm2 (,0.06 to 0.01 cm2), and ,0.01 cm2/m2 (,0.03 to 0.01 cm2/m2), respectively. Discrepancies between both devices were not associated with misinterpretation of the degree of AS. Conclusion: Our study demonstrates that HCU can be used to evaluate patients with suspected AS. (ECHOCARDIOGRAPHY 2010;27:481-486) [source]

Facing the Age Wave and Economic Policy: Fixing Public Pension Systems with Healthcare in the Wings,

FISCAL STUDIES, Issue 1 2005
David A. Wise
Abstract There are two overriding problems faced by ageing societies. One is the financing of public pension (social security in US terms) programmes. The other is paying for healthcare. This paper considers the healthcare issue briefly, emphasising that the issue arises primarily because of advances in medical technology. Better medical technology will improve healthcare in the future, but more advanced technologies also cost more. The focus of the rest of the paper is on the public pension problem. The emphasis is on the early retirement incentives inherent in the provisions of most public pension programmes around the world, the reduction in the labour force participation of older people caused by these incentives, and the large fiscal implication of the inducement of older people to leave the labour force. These results are based on the Gruber,Wise ongoing international social security comparison project. [source]

Gendering the History of Women's Healthcare

GENDER & HISTORY, Issue 3 2008
Monica H. Green
This essay examines the genesis and continuing influence of certain core narratives in the history of western women's healthcare. Some derive from first-wave feminism's search for models of female medical practice, an agenda that paid little attention to historical context. Second-wave feminism, identifying a rift between pre-modern and modern times in terms of women's medical practices, saw the pre-modern European female healer as an exceptionally knowledgeable empiricist, uniquely responsible for women's healthcare and (particularly because of her knowledge of mechanisms to limit fertility) a victim of male persecution. Aspects of this second narrative continue subtly to effect scholarly discourse and research agendas on the history of healthcare both by and for women. This essay argues that, by seeing medical knowledge as a cultural product , something that is not static but continually re-created and sometimes contested , we can create an epistemology of how such knowledge is gendered in its genesis, dissemination and implementation. Non-western narratives drawn from history and medical anthropology are employed to show both the larger impact of the western feminist narratives and ways to reframe them. [source]

Healthcare in a land called PeoplePower: nothing about me without me

HEALTH EXPECTATIONS, Issue 3 2001
Tom Delbanco MD
In a 5-day retreat at a Salzburg Seminar attended by 64 individuals from 29 countries, teams of health professionals, patient advocates, artists, reporters and social scientists adopted the guiding principle of ,nothing about me without me' and created the country of PeoplePower. Designed to shift health care from ,biomedicine' to ,infomedicine', patients and health workers throughout PeoplePower join in informed, shared decision-making and governance. Drawing, where possible, on computer-based guidance and communication technologies, patients and clinicians contribute actively to the patient record, transcripts of clinical encounters are shared, and patient education occurs primarily in the home, school and community-based organizations. Patients and clinicians jointly develop individual ,quality contracts', serving as building blocks for quality measurement and improvement systems that aggregate data, while reflecting unique attributes of individual patients and clinicians. Patients donate process and outcome data to national data banks that fuel epidemiological research and evidence-based improvement systems. In PeoplePower hospitals, constant patient and employee feedback informs quality improvement work teams of patients and health professionals. Volunteers work actively in all units, patient rooms are information centres that transform their shape and decor as needs and individual preferences dictate, and arts and humanities programmes nourish the spirit. In the community, from the earliest school days the citizenry works with health professionals to adopt responsible health behaviours. Communities join in selecting and educating health professionals and barter systems improve access to care. Finally, lay individuals partner with professionals on all local, regional and national governmental and private health agencies. [source]

Developing clinical leaders in Australian aged care homes

INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 1 2006
Alan Pearson RN PhD FRCNA FAAG FRCN
Abstract The role of clinical leadership in implementing evidence based practice is increasingly recognised in the health and social care fields. This paper briefly reviews the literature on clinical leadership and evidence-based practice in aged care and describes the established of an aged care clinical fellowship program in Australia. The purpose of this paper is to introduce the reports of four aged care clinical fellows reported elsewhere in this issue of the International Journal of Evidence-Based Healthcare. [source]

Evidence-Based Practice in Healthcare: An Exploratory Cross-Discipline Comparison of Enhancers and Barriers

JOURNAL FOR HEALTHCARE QUALITY, Issue 3 2010
Joanna Asadoorian
Abstract: In order to improve health outcomes, healthcare providers need to base practice on current evidence. The purpose of this qualitative study was to explore and compare the understanding and experiences with evidence-based practice (EBP) in three different disciplines. Researchers conducted individual interviews with psychiatrists, nurses, and dental hygienists. The majority of study participants demonstrated an understanding of EBP and were able to identify enhancers and barriers to implementing EBP. Using a grounded theory approach, several major themes acting as enhancers and barriers to EBP emerged and revealed both differences and similarities within and across the three health disciplines. While saturation was not attempted, this exploratory research is important in contributing to understanding the cultural practice milieu in relation to individual characteristics in implementing evidence into practice with the overall aim of improving healthcare delivery and outcomes. [source]

Lead-Time Reduction Utilizing Lean Tools Applied to Healthcare: The Inpatient Pharmacy at a Local Hospital

JOURNAL FOR HEALTHCARE QUALITY, Issue 1 2010
Omar Al-Araidah
Abstract: The healthcare arena, much like the manufacturing industry, benefits from many aspects of the Toyota lean principles. Lean thinking contributes to reducing or eliminating nonvalue-added time, money, and energy in healthcare. In this paper, we apply selected principles of lean management aiming at reducing the wasted time associated with drug dispensing at an inpatient pharmacy at a local hospital. Thorough investigation of the drug dispensing process revealed unnecessary complexities that contribute to delays in delivering medications to patients. We utilize DMAIC (Define, Measure, Analyze, Improve, Control) and 5S (Sort, Set-in-order, Shine, Standardize, Sustain) principles to identify and reduce wastes that contribute to increasing the lead-time in healthcare operations at the pharmacy understudy. The results obtained from the study revealed potential savings of >45% in the drug dispensing cycle time. [source]

Interview with a Quality Leader: Paul Uhlig on Transforming Healthcare

JOURNAL FOR HEALTHCARE QUALITY, Issue 3 2009
Jason Trevor Fogg
In 2002 Dr. Uhlig and the cardiac surgery team he led at Concord Hospital, Concord, NH, received the John M. Eisenberg Patient Safety Award from the National Quality Forum and the Joint Commission. Dr. Uhlig has received international recognition for research concerning patient safety, teamwork, and healthcare culture, including a 2007,2008 King James IV Professorship of the Royal College of Surgeons of Edinburgh, Scotland. [source]

Sexual Healthcare Needs of Women Aged 65 and Older

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2004
Margaret R. H. Nusbaum DO
Objectives: To compare prevalence and type of sexual concerns and interest in and experience with discussing these concerns with physicians for women younger than 65 and 65 and older. Design: Cross-sectional survey. Setting: Departments of Family Practice and Obstetrics and Gynecology at Madigan Army Medical Center, Tacoma, Washington. Participants: Of 1,480 women seeking routine gynecological care, 964 (65%) responded; 163 (17%) were aged 65 and older. Measurements: Self-reported sexual concerns and interest in and experience with discussing these concerns with their physicians. Results: Older women had a similar number of sexual concerns as younger women and were more likely to be concerned about their partner's sexual difficulties. Older women were less likely to have ever had the topic of sexual health raised during healthcare visits. Even though these women were more likely to report youthful-appearing physicians as hindering the topic of sexual health, the majority indicated that they would have discussed their concerns had the physician raised the topic and were interested in a follow-up appointment to do so. Conclusion: Although the types of sexual concerns vary in frequency, women aged 65 and older have a similar number of sexual concerns as younger women. Older women want physicians to inquire about their sexual health. This discussion should include inquiries about their partner's sexual functioning. To overcome age as a barrier to this discussion, younger physicians should be particularly attentive to initiating the topic of sexual health. [source]

Healthcare for Older Persons, A Country Profile: Nigeria

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2002
Bola O. Akanji PhD
The Nigerian population is undergoing demographic transition, with an increasing population of older people. Nuclear and extended family members traditionally care for older persons at home. We have observed changes in home living conditions due to reduced family size, and urban migration for economic reasons are likely to affect the care of older people. The inadequately funded healthcare system has placed little emphasis on the care of older people because there are more-pressing health problems and funding for older people is limited. This paper advocates improved attention to the health needs of older people through improved budgetary allocation, revision of the training curriculum of all cadres of health staff to include geriatrics, and utilization of primary healthcare facilities. [source]

Access to Secondary Healthcare for People with Intellectual Disabilities: A Review of the Literature

JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 6 2009
Clare Backer
Background, There is growing evidence that people with intellectual disabilities have greater healthcare needs than the general population and that these needs are often unmet. Recently, increasing attention has been drawn to poor care received by people with intellectual disabilities when admitted to hospital. Method, A literature search was conducted to identify studies on experiences of secondary healthcare for people with intellectual disabilities. Studies were published between January 1990 and March 2008. Results, Thirteen studies were identified. Important influences on the experience of hospital care were: individual factors; the carer's role; the attitudes, knowledge and communicative style of health staff; and the physical environment. A range of recommendations and initiatives have been developed to improve hospital care. Conclusion, More research is needed, given that so few studies are published in this area. Initiatives to improve access to secondary healthcare need to be evaluated to inform the development of services. [source]

A review of hand-washing techniques in primary care and community settings

JOURNAL OF CLINICAL NURSING, Issue 6 2009
Sheree MS Smith
Aim., This review seeks to identify the most effective hand-washing and hand-cleansing practice that could be used in primary care. Background., Healthcare associated infection is a major problem in the UK causing 5000 deaths every year. Current guidelines indicate expert opinion is the level of evidence for hand washing as an activity to reduce infection. Design., Systematic review. Method., Publications on hand-washing, hand-cleansing studies, policy and practice-based documents were sought by searching several databases. Terms used included hand washing, hand cleansing, hand hygiene, hand decontamination, infection control and primary care. Results., Few articles described the hand-washing technique in detail and some publications simply referred to either the European and British Standards or the Centre for Disease Control statement on hand washing. Major discrepancies in hand position and water flow direction were found. Several methodological problems were also identified and few studies were undertaken in primary care. Conclusion., This review has found a lack of evidence for hand-washing techniques being undertaken in practice today. Findings from hand-washing technique studies were inconclusive and methodological issues exist resulting in sparse reliable evidence. There is an urgent need to undertake methodologically sound studies of hand-washing techniques for use in the ever expanding scope of primary care practice. Relevance to clinical practice., Evidence for hand-washing and hand-cleansing techniques will inform healthcare professional practice, and contribute to the overall management of infection control in primary care. [source]

Amersham radiochemistry to GE Healthcare,

JOURNAL OF LABELLED COMPOUNDS AND RADIOPHARMACEUTICALS, Issue 9-10 2007
Sean L. Kitson
Abstract I was invited by Professor John R. Jones (University of Surrey) to write a paper to celebrate 50 years of the Journal of Labelled Compounds and Radiopharmaceuticals. The aim of this paper is to outline briefly the history of radiochemistry from The Radiochemical Centre at Amersham in the 1940s to the acquisition by General Electric in 2004 and the formation of GE Healthcare. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Intermuscular adipose tissue (IMAT): Association with other adipose tissue compartments and insulin sensitivity

JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2009
Michael Boettcher MD
Abstract Purpose To quantify intermuscular adipose tissue (IMAT) of the lower leg as well as to investigate associations with other adipose tissue (AT) compartments. The relationship between IMAT and insulin sensitivity was also examined. Materials and Methods Standardized quantification of IMAT was performed in a large cohort (N = 249) at increased risk for type 2 diabetes in the right calf by T1-weighted fast spin-echo imaging at 1.5T (Magnetom Sonata; Siemens Healthcare). Additionally, whole-body AT distribution was assessed. Insulin sensitivity was determined by glucose clamp. Results Males showed significantly more IMAT than females (2.1 ± 1.1 cm2 vs. 1.5 ± 0.9 cm2; P < 0.001). IMAT correlated well with other AT depots, especially with visceral AT (VAT; rfemales = 0.52, P < 0.0001 vs. rmales = 0.42, P < 0.0001). Moreover, IMAT showed a negative correlation with the glucose infusion rate (GIR; rfemales = ,0.43, P = 0.0002 vs. rmales = ,0.40, P = 0.0007). Conclusion Quantification of IMAT is possible by standard MR techniques. AT distribution of the lower leg is comparable to the visceral compartment with males having higher IMAT/VAT but lower subcutaneous AT (SCAT). IMAT seems to be involved in the pathogenesis of insulin resistance, as shown by the significant negative correlation with GIR. J. Magn. Reson. Imaging 2009. © 2009 Wiley-Liss, Inc. [source]

The relationship between bed rest and sitting orthostatic intolerance in adults residing in chronic care facilities

JOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 3 2010
Mary T Fox MSc
fox mt, sidani s & brooks d (2010) Journal of Nursing and Healthcare of Chronic Illness2, 187,196 The relationship between bed rest and sitting orthostatic intolerance in adults residing in chronic care facilities Aim., To examine the relationship between orthostatic intolerance and bed rest as it was used by/with 65 adults residing in chronic care facilities. Background., The evidence on the relationship between bed rest and orthostatic intolerance has been obtained from aerospace studies conducted in highly controlled laboratory settings, and is regarded as having high internal validity. In the studies, prolonged and continuous bed rest, administered in a horizontal or negative tilt body position, had a major effect on orthostatic intolerance in young adults. However, the applicability of the findings to the conditions of the real world of practice is questionable. Methods., Participants were recruited over the period of April 2005 to August 2006. A naturalistic cohort design was used. The cohorts represented different doses of bed rest that were naturally occurring. Comparisons were made between patients who had no bed rest (comparative dose group, n = 20), two to four days (moderate dose, n = 23) and five to seven days of bed rest (high dose, n = 22) during a one-week monitoring period. Orthostatic intolerance was measured by orthostatic vital signs and a self-report scale. Bed rest dose was measured by the total number of days spent in bed during one week. Results.,Post hoc comparisons, using Bonferroni adjustments, indicated significant differences in adjusted means on self-reported orthostatic intolerance between the comparative and high (CI: ,4·12, ,0·85; p < 0·001), and the moderate and high (CI: 0·35, 3·56, p < 0·01) bed rest dose cohorts. No group differences were found on orthostatic vital signs. Conclusions., A moderate dose of bed rest with intermittent exposure to upright posture may protect against subjective orthostatic intolerance in patients who are unable to tolerate being out of bed every day. Future research may examine the effects of reducing bed rest days on orthostatic intolerance in individuals with high doses of five to seven days of bed rest. [source]

The meaning of self-care for people with chronic illness

JOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 3 2010
Debbie Kralik RN
kralik d, price k & telford k (2010) Journal of Nursing and Healthcare of Chronic Illness2, 197,204 The meaning of self-care for people with chronic illness Aim., To reveal the meaning of self-care as described by men and women living with chronic conditions. Background., Chronic illness self-care and self-management are terms that have been used interchangeably in the literature. Self-care in the context of chronic illness has received some research attention, but remains an under-explored concept. Methods., Conversation data were gathered using longitudinal email groups facilitated by the first author over a 21-month period between 2003,2005, with 42 men and women living with chronic illness. Results., Self-care is a process of adaptation in response to learning about oneself and about ways to live well with illness. Developing capacity to self care impacted significantly on the way participants experienced illness, their view of themselves and of their future. Conclusions., People living with chronic illness describe the process of self-care as transformational in terms of feelings about their selves and reclaiming a sense of order. It enables them to move forward with a sense of the future. The primary health care principle of holistic assessment, taking account of the wider context of people's lives, is of heightened importance when educating about self-care. Relevance to clinical practice., Health care workers can assist people by acknowledging that chronic illness self-care is a process that gradually evolves and is borne out of listening to the person's priorities and finding ways for strategies to fit harmoniously alongside those priorities. [source]

Systematic review: role of health promotion in vascular dementia

JOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 2 2010
BSc(Hons), Rachel S Price MSc
price rs & keady j (2010) Journal of Nursing and Healthcare of Chronic Illness 2, 88,101 Systematic review: role of health promotion in vascular dementia Aims., This narrative synthesis of the literature investigates the areas of vascular dementia and modifiable risk factors in order to identify the evidence base and opportunities for specific health promotion work and nursing involvement. Background., Strategies for well-being, prevention and health promotion are becoming increasingly important determinants of a quality dementia care service. In England, this emphasis is manifest in the recently launched National Dementia Strategy (February 2009) and areas that address modifiable vascular risk factors are helpful starting points for the enactment of such goals. Design and methods., A comprehensive search strategy identified primary and secondary search terms that were used systematically in order to search for relevant information and literature; 128 articles were finally included in the overall design and these were broken down into 116 articles obtained through the formal search process using the online databases and 12 articles from the ,grey literature'. Results., A narrative synthesis of the included material generated a thematic framework that revealed four discrete but overlapping themes: vascular risk factors (1); prevention and reduction of vascular risk factors (2); treatment and intervention in vascular dementia (3); and vascular health promotion (4). Relevance to clinical practice., Nursing is in a prime position to undertake health promotion initiatives in modifiable risk behaviours in vascular dementia, an approach that should be commenced for the general population in mid-life (50 years and over). [source]

Dementia and risk: contested territories of everyday life

JOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 2 2010
Charlotte L Clarke DSocSc
clarke cl, keady j, wilkinson h, gibb ce, luce a, cook a & williams l (2010) Journal of Nursing and Healthcare of Chronic Illness 2, 102,112 Dementia and risk: contested territories of everyday life Aims., The project aimed to understand the construction of risk in dementia care from the perspective of the person with dementia, family carers and practitioners with the intention of developing negotiated partnerships in risk management. Background., This paper addresses a gap in the literature by embedding constructions of risk within everyday events and social contexts, and communicates such constructions through the voices of people with dementia, carers and practitioners. Method., This symbolic interactionalist study involved data collection by interview with 55 people with dementia (sometimes twice), and their nominated carer and practitioner. The sample was drawn from three regions of the United Kingdom. Data were collected during 2004. Conclusions., Five ,contested territories' of everyday living with dementia are outlined in this paper: friendships, smoking, going out, domestic arrangements, and occupation and activity. These contested territories are purposeful and allow for sense making, maintenance of self, claiming and relinquishing decision making, and creating purpose(lessness) in people's lives. Relevance to clinical practice., Assessing and managing risk in a way that respects the dynamics and purposes of contested territories will support care that is person centred, and moreover respectful of the relationships that contribute to maintaining the individual's sense of self and purpose. [source]

Health-related quality of life and symptom classification in patients with irritable bowel syndrome

JOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 1 2010
Graeme D Smith
smith gd, steinke dt, penny ki, kinnear m & penman id (2010) Journal of Nursing and Healthcare of Chronic Illness2, 4,12 Health- related quality of life and symptom classification in patients with irritable bowel syndrome Background., Previous research has established that health-related quality of life can be adversely affected by irritable bowel syndrome IBS. Irritable bowel syndrome has been classified to subgroups by predominant bowel symptom: constipation, diarrhoea or alternating between the two. Little is presently known about the specific impact of irritable bowel syndrome on health-related quality of life within disease sub-groups across time. Aims., To examine the health-related quality of life in a cohort of individuals with irritable bowel syndrome to explore the association between quality of life and disease subtype classification. Setting., The general population of the UK. Design., Longitudinal cohort survey was conducted. Methods., Individuals with symptoms of irritable bowel syndrome were recruited via a UK-wide newspaper advertisement. The health-related quality of life was measured using a battery of validated questionnaires. Results., Data on 494 participants with a Rome II confirmed diagnosis of irritable bowel syndrome were examined. Measurement of generic health-related quality of life revealed lower median scores (poorer quality of life) in anxiety/depression and pain/discomfort domains of health. Conclusion., Health-related quality of life is impaired in community based individuals with IBS. Patients appear to fluctuate between sub-groups when irritable bowel syndrome is classified across time. This study suggests that the impact of irritable bowel syndrome may be greatly underestimated. Relevance for clinical practice., The use of sub-group classification and understanding of predictive factors may allow for a more flexible and efficient approach to healthcare assessment and patient care for people with irritable bowel syndrome. [source]

How nurse prescribing is being used in diabetes services: views of nurses and team members

JOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 1 2010
Nicola Carey MPH
carey n, stenner k & courtenay m (2010) Journal of Nursing and Healthcare of Chronic Illness2, 13,21 How nurse prescribing is being used in diabetes services: views of nurses and team members Aim., To explore the views of nurses, doctors, non-nurse prescribers and administrative staff on how nurse prescribing is being used in diabetes services. Background., Nurse-led services enhance care and improve outcomes for patients with diabetes. Research indicates that care delivered by nurse prescribers can improve efficiency and support new ways of working. There is no evidence reported that explores nurses and team member views on how nurse prescribing is being used in diabetes services. Method., A collective case study of nine practice settings across England in which nurses prescribed medicines for patients with diabetes. A thematic analysis of semi-structured interview data collected during 2007 and 2008. Participants were qualified nurse prescribers, administrative staff, doctors and non-prescribing nurses. Findings., Nurse prescribing was reported to enhance and support a variety of models of diabetes care. It enabled nurses to work more independently and provide a more streamlined service. Maintaining a team approach ensured that nurses continued to learn and maintained good relationships with doctors. Conclusion., Nurse prescribing is being successfully used to support and develop more streamlined services for patients with diabetes. Individual and organisational factors, as well as the interpretation of policy initiatives are reported to influence how prescribing is used in practice. Understanding the implications of these forces is important if the full potential of this new and developing role is to be realised. Relevance to clinical practice., Nurses have an important role to play in the medicines management of patients with diabetes. Nurse prescribing supports and enhances established diabetes services. Prescribing allows nurses to develop diabetes services around the needs of the individual and introduce new ways of working such as the single review process. [source]

Director of nursing and midwifery leadership: informed through the lens of critical social science

JOURNAL OF NURSING MANAGEMENT, Issue 4 2010
ANNETTE SOLMAN RN, Dip HSN, Masters NR
solman a. (2010) Journal of Nursing Management18, 472,476 Director of nursing and midwifery leadership: informed through the lens of critical social science Aims, Highlight the use of critical social science theories, practice development principles and a situational leadership framework within transformational leadership to inform Directors of Nursing and Midwifery (DoNM) practices as leaders. Background, Healthcare is constantly changing, unpredictable, strives for quality service and cost containment, which can result in stress and crisis for healthcare workers. DoNM leadership is critical to supporting and leading staff through these complex times within healthcare. Key issues, Understanding theories, frameworks and their application to real-world practice can assist in supporting individuals and teams to navigate through the changing healthcare environment. Conclusion, Blending critical social science theories with practice development principles and the situational leadership framework can assist the DoNM to enact transformational leadership to support the development of individuals and teams to meet the complex healthcare needs of patients within the clinical setting. Implications for nurse management, This article contributes through the practical application of critical social science theories, practice development principles and situational leadership framework within transformational leadership as an approach for enacting DoNM leadership. To further understand and develop in the role of the contemporary DoNM in leadership, these directors are encouraged to publish their work. [source]

Electroencephalogram spindle activity during dexmedetomidine sedation and physiological sleep

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2008
E. HUUPPONEN
Background: Dexmedetomidine, a selective ,2 -adrenoceptor agonist, induces a unique, sleep-like state of sedation. The objective of the present work was to study human electroencephalogram (EEG) sleep spindles during dexmedetomidine sedation and compare them with spindles during normal physiological sleep, to test the hypothesis that dexmedetomidine exerts its effects via normal sleep-promoting pathways. Methods: EEG was continuously recorded from a bipolar frontopolar,laterofrontal derivation with Entropy Module (GE Healthcare) during light and deep dexmedetomidine sedation (target-controlled infusions set at 0.5 and 3.2 ng/ml) in 11 healthy subjects, and during physiological sleep in 10 healthy control subjects. Sleep spindles were visually scored and quantitatively analyzed for density, duration, amplitude (band-pass filtering) and frequency content (matching pursuit approach), and compared between the two groups. Results: In visual analysis, EEG activity during dexmedetomidine sedation was similar to physiological stage 2 (S2) sleep with slight to moderate amount of slow-wave activity and abundant sleep spindle activity. In quantitative EEG analyses, sleep spindles were similar during dexmedetomidine sedation and normal sleep. No statistically significant differences were found in spindle density, amplitude or frequency content, but the spindles during dexmedetomidine sedation had longer duration (mean 1.11 s, SD 0.14 s) than spindles in normal sleep (mean 0.88 s, SD 0.14 s; P=0.0014). Conclusions: Analysis of sleep spindles shows that dexmedetomidine produces a state closely resembling physiological S2 sleep in humans, which gives further support to earlier experimental evidence for activation of normal non-rapid eye movement sleep-promoting pathways by this sedative agent. [source]

Nurse practitioners as an underutilized resource for health reform: Evidence-based demonstrations of cost-effectiveness

JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 4 2010
Jeffrey C. Bauer PhD
Healthcare reform in 2009 was motivated by an imperative to reduce the relentless increase in spending on medical care. Many efforts to solve the problem focused on applying proven principles of evidence-based practice and cost-effectiveness to find the least-expensive way to produce a specific clinical service of acceptable quality. This paper combines economic analysis and reviews published literature to show how the goals of healthcare reform can be accomplished by allowing independently licensed nurse practitioners to provide their wide range of services directly to patients in a variety of clinical settings. The paper presents extensive, consistent evidence that nurse practitioners provide care of equal or better quality at lower cost than comparable services provided by other qualified health professionals. [source]

Healthcare seeking for constipation: a population-based survey in the Mediterranean area of Spain

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2006
C. GÁLVEZ
Summary Background The use of healthcare resources for the management of constipation is not well-known. Aim To analyse healthcare seeking for constipation, defined by three different criteria, and its related factors and to assess the frequency of use of laxatives, suppositories and enemas for the treatment of constipation. Methods A cross-sectional study in the general community. A questionnaire comprising 21-items was developed and delivered by mail to a random sample of 506 subjects aged 18,65 years, and belonging to a Spanish population. Results Seeking of health care was high in the sample (16%) and was similar for all definitions of constipation (over 40% of constipated subjects). It was associated with female gender, a higher educational level and two symptoms, such as prolonged defecation and abdominal pain. A 14% of the sample used laxatives, and about a 25% of constipated subjects used laxatives at least once a week. Utilization was more frequent in women, with no differences by age group. Conclusions Chronic constipation is a problem that causes an important consumption of resources in our setting, derived from laxative use and the seeking of medical help to combat the problem. The use of these resources is higher in women. [source]

Standardization of allergen products: 1.

ALLERGY, Issue 7 2009
Detailed characterization of GMP-produced recombinant Bet v 1.0101 as biological reference preparation
Background:, Standardization of allergen extracts requires the availability of well-characterized recombinant allergens, which can be used as reference standards provided by the European regulatory authorities. The objective of this study was the detailed physicochemical and immunological characterization of rBet v 1.0101, which shall be used in a ring trial within the framework of the Biological Standardization Programme BSP090 of the European Directorate for Quality of Medicines and Healthcare. Methods:, Recombinant Bet v 1.0101 Y0487 was produced under good manufacturing practice conditions and analysed by an array of physicochemical and immunological methods for identity, quantity, homogeneity, folding and denaturation, aggregation state and stability in solution, as well as biological activity. Results:, Batch Y0487 was shown to contain monomeric and well-folded protein being identical with rBet v 1.0101, as determined by mass spectrometry. SDS-PAGE, isoelectric focusing, deamidation analysis and size-exclusion chromatography with light scattering revealed sample homogeneity of >99.9%. Upon storage at +4°C batch Y0487 retained the monomeric state up to 3 months. Protein quantification determined by amino acid analysis was found coinciding with half-maximal inhibition of serum IgE in ELISA. Biological activity of batch Y0487 was shown to be comparable to natural Bet v 1 by IgG and IgE immunoblotting, as well as basophil and T-cell activation. Conclusion:, Recombinant Bet v 1.0101 Y0487 was characterized extensively by physicochemical and immunological methods. It was shown highly stable, monomeric and immunologically equivalent to its natural counterpart. Thus, it represents an appropriate candidate reference standard for Bet v 1. [source]

Evaluation of the Acceptability and Usability of a Decision Support System to Encourage Safe and Effective Use of Opioid Therapy for Chronic, Noncancer Pain by Primary Care Providers

PAIN MEDICINE, Issue 4 2010
Jodie Trafton PhD
Abstract Objective., To develop and evaluate a clinical decision support system (CDSS) named Assessment and Treatment in Healthcare: Evidenced-Based Automation (ATHENA)-Opioid Therapy, which encourages safe and effective use of opioid therapy for chronic, noncancer pain. Design., CDSS development and iterative evaluation using the analysis, design, development, implementation, and evaluation process including simulation-based and in-clinic assessments of usability for providers followed by targeted system revisions. Results., Volunteers provided detailed feedback to guide improvements in the graphical user interface, and content and design changes to increase clinical usefulness, understandability, clinical workflow fit, and ease of completing guideline recommended practices. Revisions based on feedback increased CDSS usability ratings over time. Practice concerns outside the scope of the CDSS were also identified. Conclusions., Usability testing optimized the CDSS to better address barriers such as lack of provider education, confusion in dosing calculations and titration schedules, access to relevant patient information, provider discontinuity, documentation, and access to validated assessment tools. It also highlighted barriers to good clinical practice that are difficult to address with CDSS technology in its current conceptualization. For example, clinicians indicated that constraints on time and competing priorities in primary care, discomfort in patient-provider communications, and lack of evidence to guide opioid prescribing decisions impeded their ability to provide effective, guideline-adherent pain management. Iterative testing was essential for designing a highly usable and acceptable CDSS; however, identified barriers may limit the impact of the ATHENA-Opioid Therapy system and other CDSS on clinical practices and outcomes unless CDSS are paired with parallel initiatives to address these issues. [source]