Emergency physicians have a duty to advance the care of pediatric patients in the emergency medical services (EMS) system. This policy resource and education paper, designed to support the American College of Emergenc...
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Emergency physicians have a duty to advance the care of pediatric patients in the emergency medical services (EMS) system. This policy resource and education paper, designed to support the American College of Emergency Physicians policy paper "The Role of the Emergency Physician in Emergency Medical Services for Children," describes the development of the federal EMS for Children Program, the importance of the integration of EMS for children into EMS systems, and the role of the emergency physician in EMS for children.
The Accident & Emergency (A&E) liaison nurse service (LNS) was introduced at the Mater Misericordiae Hospital, Dublin as a quality improvement initiative in June 1996. It aimed to improve and enhance communica...
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Purpose: To propose a system for the provision of comprehensive, coordinated rehabilitation services that would meet all the needs of persons with disability in a timely and cost-effective manner. Methods: Study of th...
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Purpose: To propose a system for the provision of comprehensive, coordinated rehabilitation services that would meet all the needs of persons with disability in a timely and cost-effective manner. Methods: Study of the literature pertaining to features of settings available for the delivery of medical rehabilitation in developed countries;presentation of the evolution of a tertiary rehabilitation centre into an institution practicing community-oriented rehabilitation. Review of various issues and implications of integrating institutional-based and community-based rehabilitation. Results: Rehabilitation settings differ in skills and resources and consequently, in the treatment, care and concern they are able to offer. It is essential to find the balance between medical, nursing and social needs of persons with disability and their requirements for skills and resources at a given time, and to provide rehabilitation, support and guidance in the setting most appropriate to these requirements and needs at the lowest cost possible. Conclusion: The integration of the rehabilitation institution of a region with secondary and primary care of the region, into one functional entity for the purposes of providing the needed services, would enable finding the most appropriate setting, and facilitate addressing all needs, as well as increase the availability and accessibility of comprehensive rehabilitation at an affordable cost. This could be a viable way of providing rehabilitation in developed countries of Europe, where the need for it is expected to rise in excess of the population increase.
Cancer care extends from diagnosis through the late stages Of advanced illness as patients confront dying and their families cope with caregiving and grief Palliative care is a rapidly developing area of clinical focu...
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Cancer care extends from diagnosis through the late stages Of advanced illness as patients confront dying and their families cope with caregiving and grief Palliative care is a rapidly developing area of clinical focus that offers valuable services to patients in terms of symptom management and adjustment to illness, including issues of life completion and life closure. It is often appropriate to offer certain elements of palliative care early in the course of illness. As disease progresses, physical comfort and enhancing quality of life increasingly become primary goals of cancer care. Specialized palliative care programs, epitomized by hospice, are invaluable resources for patients with far-advanced illness and their families. Current regulations and prevailing payment structures limit access to and the scope of hospice services and highlight the need for innovative models of delivering and financing palliative care.
Rural communities have not kept pace with the recent dramatic changes in health care financing and organization. However, the Medicare provisions in the Balanced Budget Act of 1997 will require rural providers to part...
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Rural communities have not kept pace with the recent dramatic changes in health care financing and organization. However, the Medicare provisions in the Balanced Budget Act of 1997 will require rural providers to participate in the new systems. Case studies revealed the degree of readiness for change in six rural communities and charted their progress along a continuum, as reflected in three sets of activities: the development of networking;the creation of new strategies for managing patient care;and the adoption of new methods for contracting with health insurers. Some communities had constructed highly integrated systems, whereas others were just beginning to change their billing practices;a few were signing contracts fbr capitated fare, in contrast to those that were resisting discounts in current fee structures. These six rural areas still have considerable ground to cover before their health fare organization and financing reach the levels achieved by urban communities.
The objective of this study was to determine what physicians perceive to be necessary for high-quality dis charge summaries. One-on-one surveys of 100 hospital-based physicians in-training and community family physici...
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The objective of this study was to determine what physicians perceive to be necessary for high-quality dis charge summaries. One-on-one surveys of 100 hospital-based physicians in-training and community family physicians were conducted. Participants indicated the amount that 56 items contributed to discharge summary quality on a 15-category ordinal scale. Results were transformed to a continuous scale, extending from -6.6 ("item makes summary useless") through 0 ("item has no effect on discharge summary quality") to 10 ("item is so essential that summary is useless without it"). Quality decreased significantly when summary length exceeded 2 pages and when the delay from patient discharge to summary delivery increased. Summary content that increased quality most included admission diagnosis (mean 8.2;95% confidence interval [7.7, 8.6]), pertinent physical examination findings (6.6 [6.0, 7.2]) and laboratory results (6.8 [6.3, 7.4]), procedures (7.1 [6.7, 7.6]) and complications in hospital (7.1 [6.6, 7.5]), discharge diagnosis (8.8 [8.4, 9.1]), discharge medications (7.9 [7.4, 8.4]), active medical problems at discharge (7.8 [7.4, 8.2]), and follow up (6.6 [6.0, 7.1]). With minor exceptions, hospital and family physicians agreed on contributors to summary quality. For this sample of physicians, summaries were of high quality when they were short, delivered quickly, and contained pertinent data that concentrated upon discharge information.
Maternal substance abuse is a significant contributor to infant morbidity and mortality. The setting of prenatal care has long been the focus of interventions and policies to prevent these adverse outcomes. However, s...
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Maternal substance abuse is a significant contributor to infant morbidity and mortality. The setting of prenatal care has long been the focus of interventions and policies to prevent these adverse outcomes. However, substance abuse programs and policies that are designed for women who are not yet pregnant can have a significant impact upon this problem. Thus it is essential to view the female life course from a broader perspective in order to consider the full range of policy options for reducing the infant mortality and morbidity caused by maternal substance abuse. This framework also allows comparisons across and between substances and offers new directions for policy development.
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