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Nominal group technique: A process for identifying diabetes self-care issues among patients and caregivers

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DIABETES EDUCATOR 2000年第2期26卷 305-+页

作者： Miller, D Shewchuk, R Elliot, TR Richards, S So Univ Dept Psychol & Rehabil Counseling Baton Rouge LA 70811 USA

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Applying disease management strategies to Medicare

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MILBANK QUARTERLY 1999年第4期77卷 461-+页

作者： Tompkins, CP Bhalotra, S Trisolini, M Brandeis Univ Schneider Inst Hlth Policy Heller Grad Sch Waltham MA 02454 USA

Medicare coverage begins for many when they have already developed one or more chronic diseases, and it often pays for the latest and costliest phases. Population-based disease modeling, patient screening, and monitoring would be appropriate interventions for chronic renal disease. Patients who have not get advanced to end-stage renal disease would benefit from management of diabetes and hypertension, avoidance of nephrotoxic substances, and better preparation for dialysis. Administrative support could take the form of clinical guidelines, physician-led multidisciplinary teams, integrated delivery systems, provider and patient education, and new information technologies. Medicare reflects the long-term public perspective, and thus should further this new direction by supporting education, reimbursing for prevention efforts and allied health services, encouraging efficiency, and monitoring cost and quality outcomes.

关键词：社区卫生计划/组织和管理费用控制疾病管理预测肾功能衰竭慢性/经济学肾功能衰竭慢性/治疗长期医疗/组织和管理普查/组织和管理 Medicare/组织和管理需求估价/组织和管理诊疗准则(主题) 一级预防/组织和管理质量保证卫生保健/组织和管理美国人类

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APIC state-of-the-art report: The role of infection control during construction in health care facilities

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AMERICAN JOURNAL OF INFECTION CONTROL 2000年第2期28卷 156-169页

作者： Bartley, JM APIC Washington DC 20005 USA

The Association for Professionals in Infection Control and Epidemiology, Inc (APIC). is a multidisciplinary organization of more than 12,000 health care professionals who practice infection control and epidemiology within a variety of health care settings. This report reviews issues the infection control professional should consider related to construction and renovation projects in health care facilities. Preventing transmission of infectious agents to vulnerable patient populations, health care workers. and visitors remains an important component of infection control programs. Environmental dispersal of microorganisms during construction, resulting in nosocomial infections, has been described previously, and select examples are provided in Table I as a reminder that there is a solid, scientific basis for these concerns. Environmental airborne contaminants and infectious agents are closely related to water and moisture-related conditions and figure prominently in construction activity. Weems et al have established construction activity as an independent variable for infectious risks in such circumstances. Construction-related outbreak literature will not be revisited in detail;however, pertinent citations will identify resources as appropriate.

关键词：交叉感染/微生物学交叉感染/预防和控制交叉感染/传播环境监测/方法卫生政策医院设计和建设感染控制/方法感染控制/标准需求估价/组织和管理结果与过程评价(卫生保健)/组织和管理规划技术诊疗准则(主题) 研究危险因素人类

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A conceptual model of emergency department crowding

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ANNALS OF EMERGENCY MEDICINE 2003年第2期42卷 173-180页

作者： Asplin, BR Magid, DJ Rhodes, KV Solberg, LI Lurie, N Camargo, CA Reg Hosp Dept Emergency Med St Paul MN 55101 USA HealthPartners Res Fdn St Paul MN 55101 USA Univ Minnesota Sch Med Dept Emergency Med Minneapolis MN 55455 USA Univ Colorado Hlth Sci Ctr Div Emergency Med Denver CO USA Univ Colorado Hlth Sci Ctr Dept Prevent Med & Biometr Denver CO 80262 USA Univ Colorado Hlth Sci Ctr Clin Res Unit Colorado Permanente Med Grp Denver CO 80262 USA Univ Chicago Hosp Sect Emergency Med Chicago IL 60637 USA HealthPartners Res Fdn Minneapolis MN USA RAND Corp Arlington VA USA Harvard Univ Sch Med Channing Lab Dept Med Boston MA 02115 USA Massachusetts Gen Hosp Dept Emergency Med Boston MA 02114 USA

Emergency department (ED) crowding has become a major barrier to receiving timely emergency care in the United States. Despite widespread recognition of the problem, the research and policy agendas needed to understand and address ED crowding are just beginning to unfold. We present a conceptual model of ED crowding to help researchers, administrators, and policymakers understand its causes and develop potential solutions. The conceptual model partitions ED crowding into 3 interdependent components: input, throughput, and output. These components exist within an acute care system that is characterized by the delivery of unscheduled care. The goal of the conceptual model is to provide a practical framework on which an organized research, policy, and operations management agenda can be based to alleviate ED crowding.

关键词：急性病/治疗病床利用率/统计学和数值数据拥挤效率组织急诊室医院/组织和管理健康计划/组织和管理卫生政策卫生服务易得程度/组织和管理卫生服务研究住院时间/统计学和数值数据模型组织管理需求估价/组织和管理运筹学结果与过程评价(卫生保健)/组织和管理病人入院/统计学和数值数据病人出院/统计学和数值数据研究设计全面质量管理/组织和管理伤病员分拣/组织和管理美国

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Research Priorities Project, year 2000: Establishing a direction for infection control and hospital epidemiology

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AMERICAN JOURNAL OF INFECTION CONTROL 2001年第2期29卷 73-78页

作者： Lynch, P Jackson, M Saint, S Epidemiol Associates Seattle WA USA Univ Calif San Diego Med Ctr Dept Educ Dev & Res San Diego CA 92103 USA Univ Michigan Sch Med Ann Arbor MI USA

Background: The field called "infection control" has expanded beyond hospitals to include many health care locations, some aspects of personnel health, elements of noninfectious complications, and occasionally the epidemiology of other problems that occur in care facilities. A research agenda that addresses these newer segments and provides a framework for answering fundamental questions is essential for the field and for the work of The Research Foundation for Prevention of Complications Associated with Health Care (formerly APIC Research Foundation). Methods: We used a multiple-round iterative consensus process (Delphi technique) with 50 experts and a validation round among participants at the 4th Decennial Conference. Results: The expert panel reduced 102 separate items to 21 high-ranked research priorities. The highest-ranked subject areas involved research to improve compliance 4 with excellent practices, to study antibiotic usage and resistance, to measure the financial impact of complications and value of interventions, to perform surveillance of infectious and noninfectious complications across the spectrum of care delivery, and to study effectiveness of interventions to prevent complications at specific sites. There were differences in education and discipline between the expert panel and the 4th Decennial participants and with respect to ranking some of the individual priorities Among respondents from outside the United States and Canada, occupational health issues were ranked more highly. Conclusions: The research priorities provide a blueprint for future progress and will require a collaborative, multicenter, multinational approach.

关键词：医务工作者的态度费用效益分析德尔菲技术流行病学/组织和管理预测基金会/组织和管理卫生工作重点卫生服务研究/组织和管理感染控制/组织和管理需求估价/组织和管理组织目标研究设计全面质量管理/组织和管理成年人老年人人类中年人

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Diabetes education needs of family members caring for American Indian elders

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DIABETES EDUCATOR 1999年第5期25卷 747-754页

作者： Hennessy, CH John, R Anderson, LA Ctr Dis Control & Prevent Hlth Care & Aging Studies Branch Atlanta GA 30341 USA

PURPOSE this qualitative study investigated diabetes care management among family members of American Indian elders with self-care limitations. Focus groups were used to examine the reasons for and content of diabetes care management, the challenges faced, and the support services needed. METHODS Five focus groups were conducted with family caregivers from six tribes. Caregivers' responses related to care management were identified and categorized into themes. RESULTS Participants reported that they provided assistance with a wide range of diabetes care tasks leg, skin and wound care, in-home dialysis) depending on the elder's level of impairment. Caregivers described three major challenges related to diabetes care management: (1) anxiety about in-home care, (2) coping with psychosocial issues, and (3) decision making and communication problems with other family members. They emphasized the importance of developing a care routine for successful diabetes management. CONCLUSIONS Based on these findings, we suggest areas where diabetes educators can assist American Indian family caregivers in meeting the needs of frail elders in the home.

关键词：适应心理学医疗护理提供者/教育医疗护理提供者/心理学信息交流糖尿病 2型/人种学糖尿病 2型/护理家庭/心理学集中研讨小组家庭护理(非专业)/教育印第安人北美洲/心理学需求估价/组织和管理新墨西哥护理方法学研究俄克拉何马老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Hydroxocobalamin: Improved public health readiness for cyanide disasters

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 635-641页

作者： Sauer, SW Keim, ME Ctr Dis Control & Prevent Natl Ctr Environm Hlth Atlanta GA 30341 USA Emory Univ Sch Med Dept Emergency Med Atlanta GA USA Univ Hawaii Manoa USA Med Corps Honolulu HI 96822 USA Univ Hawaii Manoa Sch Publ Hlth Honolulu HI 96822 USA

The United Stales is under the constant threat of a mass casualty cyanide disaster from industrial accidents, hazardous material transportation incidents, and deliberate terrorist attacks. The current readiness for cyanide disaster by the emergency medical system in the United States is abysmal. We, as a nation, are simply not prepared for a significant cyanide-related event. The standard of care for cyanide intoxication is the cyanide antidote kit, which is based on the use of nitrites to induce methemoglobinemia. This kit is both expensive and ill suited for out-of-hospital use. It also has its own inherent toxicity that prevents rapid administration. Furthermore, our hospitals frequently fail to stock this life-saving antidote or decline to stock more than one. Hydroxocobalamin is well recognized as an efficacious, safe, and easily administered cyanide antidote. Because of its extremely low adverse effect profile, it is ideal for out-of-hospital use in suspected cyanide intoxication. To effectively prepare for a cyanide disaster, the United States must investigate, adopt, manufacture, and stockpile hydroxocobalamin to prevent needless morbidity and mortality.

关键词：事故职业亚硝酸异戊酯/治疗应用解毒药/供应和分配解毒药/治疗应用化学战氰化物/中毒救灾计划/组织和管理急救医疗服务/方法急救医疗服务/标准急诊处理/方法急诊处理/标准危害物质/中毒羟钴胺/供应和分配羟钴胺/治疗应用需求估价/组织和管理中毒/药物疗法中毒/流行病学中毒/病因学公共卫生工作/标准亚硝酸钠/治疗应用恐怖主义硫代硫酸盐类/治疗应用运输美国/流行病学人类

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Preparation for future care needs by West and East German older adults

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JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES 2000年第6期55卷 S357-S367页

作者： Sörensen, S Pinquart, M Utah State Univ Logan UT 84322 USA Univ Jena D-6900 Jena Germany

Objectives. We evaluated a model of the process of preparation for future care needs. This model predicted that less concrete preparation activities (e.g., becoming aware and gathering information) would predict more concrete ones (e.g., deciding on preferences and making concrete plans), and that attitudes (expectations of needing care and negative beliefs about the usefulness of planning) would mediate the effect of vulnerability (age, ADL/IADL deficits) and resources (socioeconomic status, social network) on preparation activities. Methods. The Preparation for Future Care Needs Measure was used to assess two attitudes toward preparation (Cronbach's alpha range:.66-.86), four planning processes (Cronbach's alpha range:.75-.86), and the content of planning for future care needs. In addition, demographic variables, social network, and ADL/IADL limitations were assessed. Using path analysis, the model was first developed on a West German sample (n = 280), and then validated on an East German sample (n = 294). Results. The best-fitting path models suggested that more concrete preparation activities were predicted by less concrete ones, but not always in the expected sequence. Gathering information, deciding on preferences, and age predicted concrete planning. Indicators of vulnerability were mediated by expectations of needing care in the future and several preparation activities, especially becoming aware and gathering information. Negative beliefs about the usefulness of planning inhibited gathering information and concrete planning. Discussion. The results suggest that preparation for future care needs may be conceptualized as a successive process. Some individuals, however, may skip steps in the preparation process. For example, relatives may offer to provide care before the older adult has to decide among her or his options.

关键词：日常生活活动老年人/心理学老年人/统计学和数值数据健康态度决策预测德国东部德国西部健康知识态度实践模型心理学需求估价/组织和管理规划技术社会支持社会经济因素老年人 80以上女(雌)性人类男(雄)性

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Executive summary: Developing objectives, content, and competencies for the training of emergency medical technicians, emergency physicians, and emergency nurses to care for casualties resulting from nuclear, biological, or chemical (NBC) incidents

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 587-601页

作者： Waeckerle, JF Seamans, S Whiteside, M Pons, PT White, S Burstein, JL Murray, R Amer Coll Emergency Phys Irving TX 75038 USA

Study Objective: The task force assessed the needs, demands, feasibility, and content of training for US civilian emergency medical responders (paramedics, nurses, and physicians) for nuclear/biological/chemical (NBC) terrorism. Methods: A task force representing key professional organizations, stakeholders, and disciplines involved in emergency medical response conducted an iterated instructional-design analysis on the feasibility and content of such training with input from educational professionals. We then analyzed 6 previously developed training courses for their congruence with our recommendations. Results: The task force produced descriptions of learning groups, content and learning objectives, and barriers and challenges to NBC education. Access to training and sustainment of learning (retention of knowledge) represent the significant barriers. The courses analyzed by the task force did not meet all objectives and challenges addressed. Conclusion: The task force recommends training programs and materials need to be developed to overcome the identified barriers and challenges to learning for these audiences. Furthermore, the task force recommends incorporating NBC training into standard training programs for emergency medical professionals.

关键词：生物恐怖化学战临床工作能力/标准课程/标准教育继续/组织和管理急救技师/教育急救医学/教育急症护理/教育可行性研究指导方针(主题) 在职培训/组织和管理医务人员医院/教育需求估价/组织和管理护理人员医院/教育组织目标规划制订辐射损伤/治疗美国人类

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Camberwell Assessment of Need for the Elderly (CANE) - Development, validity and reliability

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BRITISH JOURNAL OF PSYCHIATRY 2000年第5期176卷 444-452页

作者： Reynolds, T Thornicroft, G Abas, M Woods, B Hoe, J Leese, M Orrell, M Maudsley Hosp & Inst Psychiat Dept Old Age Psychiat London SE5 8AZ England Inst Psychiat Sect Community Psychiat PRiSM London England Inst Psychiat Old Age Psychiat Sect London SE5 8AF England Univ Wales Inst Med & Social Care Res Bangor Gwynedd Wales Glenfield Gen Hosp Bennion Ctr Forest Grange Day Hosp Leicester LE3 9QP Leics England UCL Sch Med Dept Psychiat & Behav Sci London W1N 8AA England

Background There exists no instrument specifically designed to measure comprehensively the needs of older people with mental disorders. Aim To develop such an instrument which would take account of patients', staff and carers' views on needs. Method Following an extensive development process, the assessment instrument was subjected to a test-retest and interrater reliability study, while aspects of validity were addressed both during development and with data provided by sites in the UK, Sweden and the USA. Results The Camberwell Assessment of Need for the Elderly (CANE) comprises 24 items (plus two items for carer needs), and records staff, carer and patient views. It has good content, construct and consensual validity. It also demonstrates appropriate criterion validity. Reliability is generally very high: kappa > 0.85 for all staff ratings of interrater reliability. Correlations of interrater and test-retest reliability of total numbers of needs identified by staff were 0.99 and 0.93, respectively. Conclusions The psychometric properties of the CANE seem to be highly acceptable. It was easily used by a wide range of professionals without formal training. Declaration of interest This study was funded by a grant from the North Thames National Health Service Executive.

关键词：日常生活活动医务工作者的态度健康态度混杂因素(流行病学) 老年人保健服务/标准老年人保健服务/供应和分配伦敦精神障碍/治疗需求估价/组织和管理需求估价/标准观察者偏差试点项目可重复性结果老年人女(雌)性人类男(雄)性中年人

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