Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Provision

  • Qo provision
  • care provision
  • constitutional provision
  • current provision
  • dietetic provision
  • education provision
  • good provision
  • health care provision
  • health service provision
  • healthcare provision
  • information provision
  • infrastructure provision
  • legal provision
  • of service provision
  • private provision
  • public good provision
  • public provision
  • public service provision
  • quality of service provision
  • regulatory provision
  • residential provision
  • service provision
  • services provision
  • social provision
  • social service provision
  • state provision
  • support provision
  • treatment provision
  • welfare provision

  • Selected Abstracts


    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]


    ECONOMIC AFFAIRS, Issue 3 2006
    Nick Bosanquet
    The case for competition in healthcare has become much stronqer. Health economists have failed to notice the erosion of the old arguments for state monopoly. [source]


    ECONOMIC INQUIRY, Issue 4 2007
    A growing number of field and experimental studies focus on the institutional arrangements by which individuals are able to solve collective action problems. Important in this research is the role of reciprocity and institutions that facilitate cooperation via opportunities for monitoring, sanctioning, and rewarding others. Sanctions represent a cost to both the participant imposing the sanction and the individual receiving the sanction. Rewards represent a zero-sum transfer from participants giving to those receiving rewards. We contrast reward and sanction institutions in regard to their impact on cooperation and efficiency in the context of a public goods experiment. (JEL C92) [source]


    ADDICTION, Issue 2 2008
    No abstract is available for this article. [source]

    FS13.3 Development of risk reduction strategies for preventing dermatitis

    CONTACT DERMATITIS, Issue 3 2004
    Terry Brown
    Introduction:, A recent survey of the UK printing industry found a prevalence of 11% of occupational contact dermatitis (OCD), much higher than previously identified. Objective:, This pilot study aimed to evaluate risk reduction strategies derived from recommendations of a literature review of preventive intervention studies and a series of focus groups of printers and observations of printers undertaking their normal duties. Methods:, Four interventions were evaluated: (1) Provision of gloves of the correct size/type, plus use of an after-work skin cream; (2) Provision of information; (3) Provision of skin checks; (4) Development of best practice skin care policy. Each intervention was evaluated in two companies over a three-month period, at the end of which printers and managers were interviewed as to the effectiveness and acceptability of each intervention. Results:, Although this pilot study was short, all interventions were acceptable to some extent. The prevalence of frank dermatitis fell over the study period, particularly in intervention (3). Intervention (1) achieved an improvement of awareness in both management and workforce and an increase in the use of both gloves and cream. Intervention (2) highlighted problems of dissemination and the need for relevant information in an appropriate format. However. no single intervention was completely effective. Conclusions:, This qualitative research approach forms an essential first stage to improving understanding of ways in which OCD may be reduced among workers in the printing industry, and points towards the need for further testing of preventive strategies in larger-scale intervention trials, in printing and other industries. [source]

    Private Provision of Infrastructure in Emerging Markets: Do Institutions Matter?

    Sudeshna Ghosh Banerjee
    Governments in developing countries have encouraged private sector investment to meet the growing demand for infrastructure. According to institutional theory, the role of institutions is paramount in private sector development. A longitudinal dataset of 40 developing economies between 1990 and 2000 is used to test empirically how different institutional structures affect private investment in infrastructure, in particular its volume and frequency. The results indicate that property rights and bureaucratic quality play a significant role in promoting private infrastructure investment. Interestingly, they also suggest that countries with higher levels of corruption attract greater private participation in infrastructure. [source]

    When Popular Participation Won't Improve Service Provision: Primary Health Care in Uganda

    Frederick Golooba-Mutebi
    Advocates of participatory approaches to service delivery see devolution as key to empowering people to take charge of their own affairs. Participation is portrayed as guaranteeing the delivery of services that are in line with user preferences. It is assumed that people are keen to participate in public affairs, that they possess the capacity to do so, and that all they need is opportunities. Using evidence from ethnographic research in Uganda, this article questions these views. It shows that, to succeed in the long term, devolution and participation must take place in the context of a strong state, able to ensure consistent regulation, and a well-informed public backed up by a participatory political culture. [source]

    Survey of dietetic provision for patients with diabetes

    DIABETIC MEDICINE, Issue 8 2000
    M. Nelson
    SUMMARY Aims To survey dietitians involved in diabetes care regarding the provisions for patients with diabetes. Methods A national survey of 512 dietitians known to be engaged in provision of diabetes care was conducted in 1997 and 391 (76%) responded. Results Nationally the median provision of dietetic care for diabetes reported was 10.7 h per 100 000 general population per week, but the provision was uneven ranging from 2.0 to 27.6 h per 100 000. Eighty-five per cent of dietitians worked in areas where the provision was less than 22 h per 100 000 general population per week (the current recommended minimum standard). Dietetic provision was greater in secondary care (median 9.1 h per 100 000 general population per week) than in general practice, residential homes and other locations (median 4.4 h per 100 000 general population per week). Provision was greater in those areas in which a designated dietitian had responsibility for co-ordinating the dietetic service for diabetes than in areas where the co-ordinator was not a dietitian or where there was no co-ordinator. Over 90% of dietitians reported following British Diabetic Association (BDA) recommendations regarding advice on carbohydrate, sugar, fat and fibre consumption, but only one-third routinely advised on salt restriction. Of the 17% of dietitians who continue to use carbohydrate exchanges, all combine this method with other approaches. Of the recommendations made by the Clinical Standards Group, only 69% of dietitians reported seeing more than half of newly diagnosd adult patients within four weeks, and less than 50% reported offering half or more of their patients an annual review. Amongst the literature in current use, 98% of dietitians use BDA literature for teaching patients and 90% use BDA publications in their own education. Seventy-six per cent of dietitians believed that there was a role for commercial slimming organizations in weight management of people with diabetes Conclusions Given the proven value of dietetic input in diabetes management, there would be advantages to correcting the regional inequalities in dietetic provision for diabetes care in the UK. [source]

    The Need to Look Beyond the Production and Provision of Relief Seed: Experiences from Southern Sudan

    DISASTERS, Issue 4 2002
    Richard B. Jones
    Free distribution of seeds in selected areas of southern Sudan has been widespread as a way of increasing food security. Field research in areas targeted for seed relief found that farmer seed systems continue to meet the crop and varietal needs of farmers even following the 1998 famine. Donor investments in seed multiplication of improved sorghum have not been sustained due to a lack of effective demand for the improved seed beyond that created by the relief agencies. The article argues that rather than imposing outside solutions, whether through seed provisioning or seed production enterprises, greater attention needs to be given to building on the strengths of existing farmer systems and designing interventions to alleviate the weaknesses. The case is made to support dynamically the process of farmer experimentation through the informed introduction of new crops and varieties that can potentially reinforce the strength and diversity of local cropping systems. [source]

    Provision of information for cancer patients: an appraisal and review

    C. SMITH ba, mba
    This article is based on an appraisal of Cancer Information and Support Services in Britain supported by the UK-based charity Macmillan Cancer Relief. Commissioned in 2002, the appraisal formed part of a wider review aimed at extending knowledge about Cancer Information and Support Services. It was also designed to ensure that the Macmillan Cancer Information and Support Service Model continues to reflect the needs of people whose lives are affected by cancer. The individual services reviewed for the appraisal vary widely in terms of resources, staffing and organizational structure, but many common themes emerge. The importance of outreach and networking are highlighted, along with the problem of isolation. Many post-holders saw a need to include a hospital base, while the role played by volunteers is widely acknowledged. A key aim of the review was to start to identify the factors that contribute to the success of a service, and a number of these emerge from the study. The creation of a culture that enables such a service to thrive appears to be as important as securing financial and other resources. The contribution made by Macmillan is explored, and ways in which the organization can support the dissemination of knowledge are put forward. [source]

    Provision of oncology services in remote rural areas: a Scottish perspective

    S.M. SMITH research assistant
    There is a paucity of research into rural health care services. In particular little is known about the provision of specialist cancer services for patients who live in remote rural areas of the UK. This study set out to investigate current models of medical and clinical oncology care in Scotland. A national survey with key health professionals was conducted to identify rural oncology schemes currently in operation. Detailed quantitative data about the schemes together with qualitative data on how health professionals view current models of care were collected by a computer-assisted telephone survey. Schemes that currently provide outpatient and chemotherapy oncology services for remote rural patients fell into three categories: central clinics (5); shared care outreach clinics with chemotherapy provision (11); and shared care outreach clinics without chemotherapy provision (7). All radiotherapy was conducted at central clinics (5). Widely varying practices in delivery of cancer care were found across the country. The main issues for professionals about current models of care involved expertise, travelling and accessibility (for patients), communication and expansion of the rural service. Nation-wide consistency in cancer care has still to be achieved. Travelling for treatment was seen to take its toll on all patients but particularly for the very remote, elderly and poor. Most professionals believe that an expansion of rural services would be of benefit to these patients. It is clear, however, that the proper infrastructure needs to be in place in terms of local expertise, ensured quality of care, and good communication links with cancer centres before this could happen. [source]

    Estimating uncertainty in fish stock assessment and forecasting

    FISH AND FISHERIES, Issue 2 2001
    Kenneth Patterson
    Abstract A variety of tools are available to quantify uncertainty in age-structured fish stock assessments and in management forecasts. These tools are based on particular choices for the underlying population dynamics model, the aspects of the assessment considered uncertain, and the approach for assessing uncertainty (Bayes, frequentist or likelihood). The current state of the art is advancing rapidly as a consequence of the availability of increased computational power, but there remains little consistency in the choices made for assessments and forecasts. This can be explained by several factors including the specifics of the species under consideration, the purpose for which the analysis is conducted and the institutional framework within which the methods are developed and used, including the availability and customary usage of software tools. Little testing of either the methods or their assumptions has yet been done. Thus, it is not possible to argue either that the methods perform well or perform poorly or that any particular conditioning choices are more appropriate in general terms than others. Despite much recent progress, fisheries science has yet to identify a means for identifying appropriate conditioning choices such that the probability distributions which are calculated for management purposes do adequately represent the probabilities of eventual real outcomes. Therefore, we conclude that increased focus should be placed on testing and carefully examining the choices made when conducting these analyses, and that more attention must be given to examining the sensitivity to alternative assumptions and model structures. Provision of advice concerning uncertainty in stock assessments should include consideration of such sensitivities, and should use model-averaging methods, decision tables or management procedure simulations in cases where advice is strongly sensitive to model assumptions. [source]

    Collaboration of a dentist and speech-language pathologist in the rehabilitation of a stroke patient with dysarthria: a case study

    GERODONTOLOGY, Issue 2 2005
    Takahiro Ono
    Objective:, To elucidate the effectiveness of the collaboration of a dentist and speech-language pathologist (SLP) in the rehabilitation of a stroke patient with dysarthria. Design:, A clinical case report treated in the rehabilitation hospital and dental surgery. Subject:, A 71-year-old Japanese man who was admitted to the rehabilitation hospital for speech rehabilitation 2 years and 5 months after a stroke. Methods:, Provision of prosthesis (palatal lift prosthesis + palatal augmentation prosthesis) for improving velopharyngeal incompetence (VPI) and articulation by dentist, and speech behavioural management by SLP including self-monitoring and bio-feedback training using the See-Scape. Results:, Speech behavioural management proved useful for promoting improvement in speech intelligibility to a functionally sufficient level after improving VPI by prosthesis. Conclusion:, The collaborative efforts of the dentist and SLP in the rehabilitation of post-stroke patients with velopharyngeal incompetence should be encouraged. [source]

    Public Provision for Urban Water: Getting Prices and Governance Right

    GOVERNANCE, Issue 4 2008
    Public sector monopolies are often associated with inefficiencies and inability to meet rising demand. Scholars attribute this to fundamental problems associated with public provision: (1) a tradition of below-cost pricing due to populist pressures, (2) owner,regulator conflicts of interest, and (3) perverse organizational incentives arising from non-credible threat of bankruptcy, weak competition, rigidities, and agency and performance measurement problems. Many governments worldwide have shifted to private provision, but recent experience in urban water utilities in developing countries has shown their limitations because of weak regulatory regimes compounded by inherent problems of information, incentives, and commitment. This article examines the paradoxical case of the Phnom Penh Water Supply in Cambodia to illustrate how public provision of urban water can be substantially improved by getting prices and governance right. Findings have implications for the search for solutions to provide one billion people worldwide with better access to potable water. [source]

    Poverty and Local Governments: Economic Development and Community Service Provision in an Era of Decentralization

    GROWTH AND CHANGE, Issue 3 2009
    ABSTRACT Social scientists have given substantial attention to poverty across U.S. localities. However, most work views localities through the lens of population aggregates, not as units of government. Few poverty researchers question whether governments of poorer localities have the capacity to engage in economic development and service activities that might improve community well-being. This issue is increasingly important as responsibilities for growth and redistribution are decentralized to local governments that vary dramatically in resources. Do poorer communities have less activist local governments? Are they more likely to be engaged in a race to the bottom, focusing on business attraction activities but neglecting services for families and working people? We bring together two distinct literatures, critical research on decentralization and research on local development efforts, that provide contrasting views about the penalty of poverty. Data are from a unique, national survey of county governments measuring activity across two time points. The most consistent determinants of activity are local government capacity, devolutionary pressures, and inertia or past use of strategies. Net of these factors, levels and changes in poverty do not significantly impact government activity. There is no evidence the nations' poorest counties are racing to the bottom. Findings challenge views that poverty is a systematic structural barrier to pursuing innovative economic development policies and suggest that even poorer communities can take steps to build local capacity, resources, and networks that expand programs for local businesses and low-wage people. [source]

    Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: A randomized 12-month trial,

    HEPATOLOGY, Issue 2 2008
    Lindsay D. Plank
    Patients with liver cirrhosis exhibit early onset of gluconeogenesis after short-term fasting. This accelerated metabolic reaction to starvation may underlie their increased protein requirements and muscle depletion. A randomized controlled trial was conducted to test the hypothesis that provision of a late-evening nutritional supplement over a 12-month period would improve body protein stores in patients with cirrhosis. A total of 103 patients (68 male, 35 female; median age 51, range 28,74; Child-Pugh grading: 52A, 31B, 20C) were randomized to receive either daytime (between 0900 and 1900 hours) or nighttime (between 2100 and 0700 hours) supplementary nutrition (710 kcal/day). Primary etiology of liver disease was chronic viral hepatitis (67), alcohol (15), cholestatic (6), and other (15). Total body protein (TBP) was measured by neutron activation analysis at baseline, 3, 6, and 12 months. Total daily energy and protein intakes were assessed at baseline and at 3 months by comprehensive dietary recall. As a percentage of values predicted when well, TBP at baseline was similar for the daytime (85 2[standard error of the mean]%) and nighttime (84 2%) groups. For the nighttime group, significant increases in TBP were measured at 3 (0.38 0.10 kg, P = 0.0004), 6 (0.48 0.13 kg, P = 0.0007), and 12 months (0.53 0.17 kg, P = 0.003) compared to baseline. For the daytime group, no significant changes in TBP were seen. Daily energy and protein intakes at 3 months were higher than at baseline in both groups (P < 0.0001), and these changes did not differ between the groups. Conclusion: Provision of a nighttime feed to patients with cirrhosis results in body protein accretion equivalent to about 2 kg of lean tissue sustained over 12 months. This improved nutritional status may have important implications for the clinical course of these patients. (HEPATOLOGY 2008.) [source]

    Mechanisms for sensitization to TNF-induced apoptosis by acute glutathione depletion in murine hepatocytes

    HEPATOLOGY, Issue 6 2003
    Katsuhiko Matsumaru
    We previously reported that depletion of glutathione in murine hepatocytes by diethylmaleate (DEM) or acetaminophen (APAP) leads to oxidative stress,dependent necrosis and sensitizes to tumor necrosis factor (TNF)-induced apoptosis in an oxidative stress,independent fashion, which could not be explained by interference with nuclear factor ,B (NF-,B) nuclear translocation. The present report explores the mechanisms of these effects. We observed that DEM led to necrosis when both mitochondrial and cytosol glutathione were depleted profoundly but sensitized to TNF-induced apoptosis when cytosol glutathione was depleted selectively. DEM and APAP lead to a significant decrease in reduced glutathione (GSH)/glutathione disulfide (GSSG) ratio. Glutathione depletion by DEM or APAP was associated with inhibition of TNF-induced NF-,B transactivation of anti-apoptotic genes, including inducible nitric oxide synthase (i-NOS). Provision of exogenous NO partially abrogated the sensitization to TNF in response to glutathione depletion. Glutathione depletion alone led to sustained increase in phospho-jun levels and c-Jun-N-terminal kinase (JNK) activity. JNK inhibitor partially blocked the sensitization to TNF-induced apoptosis accompanying glutathione depletion. In conclusion, these findings suggest that extramitochondrial glutathione depletion alters the thiol-disulfide redox state, leading to inhibition of NF-,B transactivation of survival genes and to sustained activation of JNK, both of which contribute to the sensitization to TNF-induced apoptosis. [source]

    Does Decentralisation Improve Equity and Efficiency in Public Service Delivery Provision?

    IDS BULLETIN, Issue 1 2007
    Mark Robinson
    First page of article [source]

    Monopoly and Oligopoly Provision of Addictive Goods

    Robert Driskill
    This article investigates monopoly and oligopoly provision of an addictive good. Consumer preferences are modeled as in Becker and Murphy (1988). Addictive goods have characteristics that create interesting strategic issues when suppliers are noncompetitive. We characterize the perfect Markov equilibrium of a market with noncompetitive supply of an addictive good and compare it with the efficient solution. Depending on particular parameter values, we find a wide variety of possible steady-state outcomes, including ones with output above the efficient level and price below marginal cost. We also find that market power can be disadvantageous. [source]

    Evaluation of the cost-effectiveness of root canal treatment using conventional approaches versus replacement with an implant

    M. W. Pennington
    Abstract Aim, To evaluate the cost-effectiveness of root canal treatment for a maxillary incisor tooth with a pulp infection, in comparison with extraction and replacement with a bridge, denture or implant supported restoration. Methodology, A Markov model was built to simulate the lifetime path of restorations placed on the maxillary incisor following the initial treatment decision. It was assumed that the goal of treatment was the preservation of a fixed platform support for a crown without involving the adjacent teeth. Consequently, the model estimates the lifetime costs and the total longevity of tooth and implant supported crowns at the maxillary incisor site. The model considers the initial treatment decisions, and the various subsequent treatment decisions that might be taken if initial restorations fail. Results, Root canal treatment extended the life of the tooth at an additional cost of 5,8 per year of tooth life. Provision of orthograde re-treatment, if the root canal treatment fails returns further extension of the expected life of the tooth at a cost of 12,15 per year. Surgical re-treatment is not cost-effective; it is cheaper, per year, to extend the life of the crown by replacement with a single implant restoration if orthograde endodontic treatment fails. Conclusion, Modelling the available clinical and cost data indicates that, root canal treatment is highly cost-effective as a first line intervention. Orthograde re-treatment is also cost-effective, if a root treatment subsequently fails, but surgical re-treatment is not. Implants may have a role as a third line intervention if re-treatment fails. [source]

    Alzheimer's disease in real life , the dementia carer's survey

    Jean Georges
    Abstract Background Informal care from relatives provides the foundation of care for people with Alzheimer's disease (AD). It is important to understand the conditions under which carers perform their, often neglected, task. The dementia carer's survey aimed to identify carers' needs, differences between countries with regard to dementia care and the level of satisfaction of carers with utilised services. Methods The survey was conducted through Alzheimer Europe's member organisations in France, Germany, Poland, Spain and UK (Scotland). The survey was in the form of a questionnaire, and topics addressed included: demographics of carers and people with AD; time spent caring; disclosure of diagnosis; symptoms prompting diagnosis; diagnostic process; current and most distressing symptoms; carers' information requirements; evaluation of services. Results Each country had ,200 responders. Time spent caring increases with disease severity, and 50% of carers of people with late-stage dementia spent more than 10,h/day caring. Activities of daily living and behaviour were cited as the most problematic symptoms, reported by 68% and 50% of carers, respectively. Provision of information on all aspects of AD was felt to be inadequate, with key services such as home support not available to the majority of carers. Only 17% of carers considered the level of care for the elderly in their country as good. Conclusions Further development of services and information provision are required to help carers in their everyday caring, including coping with problematic symptoms influencing areas such as activities of daily living and behaviour. Copyright 2008 John Wiley & Sons, Ltd. [source]

    Provision and financial burden of TB services in a financially decentralized system: a case study from Shandong, China

    Qingyue Meng
    Abstract Both challenges and opportunities have been created by health sector reforms for TB control programmes in developing countries. China has initiated radical economic and health reforms since the late 1970s and is among the highest TB endemic countries in the world. This paper examines the operation of TB control programmes in a decentralized financial system. A case study was conducted in four counties of Shandong Province and data were collected from document reviews, and key informant and TB patient interviews. The main findings include: direct government support to TB control weakened in poorer counties after its decentralization to township and county governments; DOTS programmes in poorer counties was not implemented as well as in more affluent ones; and TB patients, especially the low-income patients, suffered heavy financial burdens. Financial decentralization negatively affects the public health programmes and may have contributed to the more rapid increase in the number of TB cases seen over the past decade in the poorer areas of China compared with the richer ones. Establishing a financial transfer system at central and provincial levels, correcting financial incentives for health providers, and initiating pro-poor projects for the TB patients, are recommended. Copyright 2004 John Wiley & Sons, Ltd. [source]

    Screening for antisocial personality disorder in drug users , a qualitative exploratory study on feasibility

    Benedikt Fischer
    Abstract Knowledge about co-occurring personality disorders in drug users is important for planning therapy and prevention. The objective of this study was to assess whether the SCID-II (Structured Clinical Interview for DSM-III-R) Screen for antisocial personality disorder was feasible and acceptable in a population of opioid users. A qualitative study on veridicality and emotional quality in responses to SCID-II Screen was carried out by personal interview in a multifunctional addiction centre. The subjects were 10 outpatient participants (six female, four male) in methadone substitution treatment. The SCID-II Screen triggered a high level of emotions. Some questions were mainly interpreted from a victim's perspective, even though the intention was the perpetrator's view. Questions were seen as sex-biased. Provision of support to deal with potential emotional problems should be supplied. Potential revision should be considered to include the female perspective in the screen. Copyright 2003 Whurr Publishers Ltd. [source]

    Provision of Atraumatic Restorative Treatment (ART) restorations to Chinese pre-school children , a 30-month evaluation

    Summary.Objectives. The objectives of this study were: to provide restorations using the ART approach to pre-school children in Southern China in a kindergarten environ-ment, using a high-strength glass-ionomer restorative material; to assess the accept-ability of this approach and to evaluate on a longitudinal basis the restorations placed. Sample and methods. A total of 170 ART restorations were placed in 95 children, aged 51 07 years, by seven final-year dental students using standard ART procedures and hand instruments. The restorations were evaluated every six months thereafter by two calibrated independent examiners using explorers and mouth-mirrors. Results. 93% of the children reported that they did not feel pain during treatment and 86% were willing to receive ART restorations again. The cumulative 12- and 30-month survival rates of Class I restorations were 91% and 79%, respectively. The corresponding figures for Class V restorations were 79% and 70%, while those for Class II restorations were 75% and 51%. The failure rates of Class III and IV restor-ations were high with more than half of them scored as missing within the first year. Conclusions. The ART approach was shown to be acceptable to Chinese pre-school children for providing restorative dental care outside the traditional clinical setting. The success rates were high for Class I and V restorations in primary teeth, modest for Class II, and low for Class III and IV restorations. [source]

    Education Provision in Wound Care , Does It Make a Difference?

    Jacqui Fletcher Senior Professional Tutor
    No abstract is available for this article. [source]

    Genetics education in the nursing profession: literature review

    Sarah Burke BA MA
    Aim., This paper reports a literature review exploring genetics education for nursing professionals. The aim was to contribute to the debate about the future direction of such education. Background., Advances in genetics science and technology have profound implications for health care and the growing importance and relevance of genetics for everyday nursing practice is increasingly recognized. Method., A search was conducted in February 2005 using the CINAHL and Google Scholar databases and the keywords nurse, midwife, health visitor, education and genetics. Papers were included if they were published in English between 1994 and 2005 and included empirical data about genetics education in nursing. In addition, attempts were made to access the grey literature, with requests for information on research, for example, to members of the Association of Genetic Nurses and Counsellors and searches of relevant websites. Findings., Agreement on the relevance of genetics for nursing practice is extensive. Empirical evidence of the learning needs of practitioners highlights widespread deficits in knowledge and skills, and low confidence levels. Provision of nursing education in genetics is patchy and insubstantial across a number of countries, further hampered by lack of strategic development. Significant progress has been made in the identification of learning outcomes for nurses. Research on the delivery of genetics education is limited, but the role of skills-based training, use of clinical scenarios, and importance of assessment have all been identified as factors that can promote learning. Conclusion., Whilst areas of good performance were revealed, many studies identified gaps in professional competence and/or education. New initiatives are underway to support genetics education and its integration into professional practice, but further research is needed on the most effective forms of educational delivery, and an international collaborative approach to this should be considered. [source]

    Prospective Payment for Nursing Homes Increased Therapy Provision without Improving Community Discharge Rates

    Evelyn Hutt MD
    First page of article [source]

    Residential Provision for Adult Persons with Intellectual Disabilities in Ireland

    Fiona Mulvany
    Background, The type of accommodation provided for persons with an intellectual disability is a major indicator of the social policy for this client group. This is likely to vary within and across countries; hence the importance of undertaking national and international comparisons. Estimations of future need are also required to assist service planning. Method, A database of all persons in receipt of intellectual disability services has been operating in the Republic of Ireland since 1995. In Northern Ireland, regional databases were used to provide similar information. Results, Around 10 000 people live in some form of residential provision: 56% in special settings, 35% in ordinary housing and 9% in hospitals. Most residents were classed as having ,severe' disabilities and were aged over 35 years. There were marked differences in the amount and type of provision provided in the two parts of the island. This was also mirrored in differences across health service areas within each country. The demand for future places was greater in Northern Ireland. Conclusions, A planning target of 3.5 places per 1000 adult population is proposed although substantial investments in services is required to achieve this. Longitudinal surveys are an important way of monitoring the impact of new policy initiatives. [source]

    Quality of Life Outcomes for People with Intellectual Disabilities Living in Staffed Community Housing Services: a Stratified Random Sample of Statutory, Voluntary and Private Agency Provision

    Jonathan Perry
    Background, Small scale, community-based, staffed housing is a significant form of residential provision for people with intellectual disabilities. Such services are provided by health and local authorities, and voluntary and private agencies, yet little is known about how provision varies between provider sectors. Methods, This study compared sectors in terms of the processes operating within residential services, and objectively and subjectively assessed quality of life (QOL) resident outcomes. Measures of setting structure and processes and resident outcomes were undertaken on a stratified random sample of 47 small scale, community-based residential settings which accommodated a total of 154 people with intellectual disabilities. Results, In general, provider agencies did not differ in terms of the characteristics of the residents they served, the structure of settings, the processes underlying service operation or resident outcomes. However, across agencies there was considerable variation in residents' life conditions when they were measured objectively. Better outcome tended to be significantly correlated with the ability of residents. This was not the case with results on subjective measures (which were also higher than those on objective measures). Conclusions, The results reinforce the need to design services which effectively support people across the ability spectrum. Also, an argument is made for the continued utility of objective measurement in the assessment of service quality. [source]

    The Moderating Effect of Situation Strength on the Relationship Between Personality and Provision of Effort,

    Michael J. Withey
    In this research, we examine whether effort-allocation decisions are influenced by the strength of the situation, the personality characteristics of the people involved, and the interaction between these factors. Two role-playing scenarios were created using contextual information (e.g., availability of suitable alternatives) that varied in situation strength. We measured the Big Five personality factors (emotional stability, extraversion, openness to experience, agreeableness, and conscientiousness) of 418 students prior to the role-playing task and assessed effort-provision decisions after they were exposed to one of the role-playing scenarios. As predicted, our results showed that the effect of personality on provision of effort depended on the strength of the situation. The implications for personality research are discussed. [source]