Ethics in the clinic: a comparison of two Dutch teaching programmes

This paper compares ethics programmes in clinical education in two medical schools in the Netherlands. Ethics education in the University of Maastricht is case oriented, whereas the emphasis in ethics teaching in the Catholic University of Nijmegen is focused on the methods of ethics and moral reasoning. The general objectives, format and evaluation are discussed. Both programmes assume that in clinical decision-making normative and technical issues are intertwined; if a normative dimension is intrinsic to medical practice itself, students should learn during clinical training how to explicate and evaluate the moral quandaries of their profession. The positive characteristics of the Maastricht programme (student-centred approach, relevant cases, team-teaching of ethicist and clinician), if combined with those of the Nijmegen programme (a coherent theoretical framework and method for case analysis and interpretation), would create a new, powerful model for clinical ethics teaching. In a recent report such a model is advocated for all Dutch medical schools.     

Prioritisation of telemedicine services for large scale implementation in Norway

In late 2005, the Northern Norway Regional Health Authority requested an evaluation of all tested telemedicine services in northern Norway to clarify which were suitable for large scale implementation. A total of 282 reports from the Norwegian Centre for Telemedicine, the University Hospital of North Norway and the University of Troms? were included in the study. Projects not focusing on secondary health care were excluded and 46 studies representing 21 topics entered the final analysis. They were analysed with a self-developed scoring tool focusing on five items. Eleven topics were concluded as being candidates for large scale implementation and grouped according to priority. The first priority topics were teleradiology, digital communication/integration of patient records and education. The second priority topics were teledialysis, pre-hospital thrombolysis, telepsychiatry and teledermatology. The third priority topics were paediatrics, district medical centres, tele-ophthalmology and tele-otorhinolaryngology. No priority was suggested for the projects in cardiology, endocrinology, geriatrics, gynaecology/obstetrics, pathology and nursing/care. User support, training, research ability, financial incentives and interaction between clinicians and ICT-personnel were considered as important factors in motivating health-care personnel to use telemedicine.     

An evaluation of two large scale demand side financing programs for maternal health in India: the MATIND study protocol

ABSTRACT: BACKGROUND: High maternal mortality in India is a serious public health challenge. Demand side financing interventions have emerged as a strategy to promote access to emergency obstetric care. Two such state run programs, Janani Suraksha Yojana (JSY)and Chiranjeevi Yojana (CY), were designed and implemented to reduce financial access barriers that preclude women from obtaining emergency obstetric care. JSY, a conditional cash transfer, awards money directly to a woman who delivers in a public health facility. This will be studied in Madhya Pradesh province. CY, a voucher based program, empanels private obstetricians in Gujarat province, who are reimbursed by the government to perform deliveries of socioeconomically disadvantaged women. The programs have been in operation for the last seven years.Methods/designsThe study outlined in this protocol will assess and compare the influence of the two programs on various aspects of maternal health care including trends in program uptake, institutional delivery rates, maternal and neonatal outcomes, quality of care, experiences of service providers and users, and cost effectiveness. The study will collect primary data using a combination of qualitative and quantitative methods, including facility level questionnaires, observations, a population based survey, in-depth interviews, and focus group discussions. Primary data will be collected in three districts of each province. The research will take place at three levels: the state health departments, obstetric facilities in the districts and among recently delivered mothers in the community. DISCUSSION: The protocol is a comprehensive assessment of the performance and impact of the programs and an economic analysis. It will fill existing evidence gaps in the scientific literature including access and quality to services, utilization, coverage and impact. The implementation of the protocol will also generate evidence to facilitate decision making among policy makers and program managers who currently work with or are planning similar programs in different contexts.     

Integrated dementia care in The Netherlands: a multiple case study of case management programmes

The number of dementia patients is growing, and they require a variety of services, making integrated care essential for the ability to continue living in the community. Many healthcare systems in developed countries are exploring new approaches for delivering health and social care. The purpose of this study was to describe and analyse a new approach in extensive case management programmes concerned with long‐term dementia care in The Netherlands. The focus is on the characteristics, and success and failure factors of these programmes. A multiple case study was conducted in eight regional dementia care provider networks in The Netherlands. Based on a literature study, a questionnaire was developed for the responsible managers and case managers of the eight case management programmes. During 16 semistructured face‐to‐face interviews with both respondent groups, a deeper insight into the dementia care programmes was provided. Project documentation for all the cases was studied. The eight programmes were developed independently to improve the quality and continuity of long‐term dementia care. The programmes show overlap in terms of their vision, tasks of case managers, case management process and the participating partners in the local dementia care networks. Differences concern the targeted dementia patient groups as well as the background of the case managers and their position in the local dementia care provider network. Factors for success concern the expert knowledge of case managers, investment in a strong provider network and coherent conditions for effective inter‐organizational cooperation to deliver integrated care. When explored, caregiver and patient satisfaction was high. Further research into the effects on client outcomes, service use and costs is recommended in order to further analyse the impact of this approach in long‐term care. To facilitate implementation, with a focus on joint responsibilities of the involved care providers, policy recommendations are to develop incentives for collaborative financial contracts between insurers and providers.     

Evaluation of school-based life skills programmes in a high-risk sample: a controlled longitudinal multi-centre study

Aim  

Previous studies have demonstrated a positive effect of school-based life skills programmes on the prevention of substance abuse and other health-risk behaviours in children and adolescents. However, the comparison and interpretation of study results is difficult due to methodological problems. In particular, the effectiveness of such programmes within high-risk groups remains uncertain. In this study, we investigated the effects of two school-based life skills programmes on substance abuse and subjective health in a sample with a high proportion of socially disadvantaged pupils.     

Health systems and the implementation of disease programmes: Case studies from South Africa

Abstract

This paper analyses the transfer and implementation of two internationally formulated infectious disease strategies in South Africa, namely, directly observed therapy (DOTS) for TB and syndromic management (SM) for sexually transmitted infections (STIs). Using the tools of policy analysis, this paper seeks to draw conclusions from contrasting experiences with the two strategies. DOTS and SM differ with respect to styles of engagement by World Health Organization (WHO), the international agency promoting the ideas, in the following ways: continuity and networking between policy makers, practitioners and researchers nationally; and approaches to sub-national implementation. We show how these factors may have been important to national uptake, and conclude on the need for a context sensitive approach to policy transfer and a balance between bottom-up and top-down implementation strategies. These insights may have relevance for the current global wave of treatment programmes for HIV and other infectious diseases.     

Evaluation of implementation of a cholesterol management program in physicians' offices

This article describes an evaluation of the implementation of a cholesterol management program in family physicians' offices as part of the Physician-Based Nutrition Program to Lower Coronary Heart Disease Risk (PBNP). The evaluation, conducted through a partnership evaluation model, used multiple case study methodology and combined the use of quantitative and qualitative methods. Data sources included office staff reports and interviews, records of contacts with study personnel, patient care data, and patient telephone interviews. Data from these sources revealed gradual program implementation and considerable variation in practitioner and clinic involvement in cholesterol management. Clinic staff reported that the support provided by PBNP in the form of training, operations materials, patient education materials and ongoing assistance was very useful. This formative evaluation has implications for refinement of the PBNP and for other prevention programs in primary care settings. It demonstrates the feasibility and acceptability of a systems approach to physicians, cholesterol/nutrition educators and clinic support staff. It also suggests ways in which researchers and clinicians can implement and evaluate health care innovations.     

Evaluation of geoimputation strategies in a large case study

Background

Health data usually has missing or incomplete location information, which impacts the quality of research. Geoimputation methods are used by health professionals to increase the spatial resolution of address information for more accurate analyses. The objective of this study was to evaluate geo-imputation methods with respect to the demographic and spatial characteristics of the data.

Methods

We evaluated four geoimputation methods for increasing spatial resolution of records with known locational information at a coarse level. In order to test and rigorously evaluate two stochastic and two deterministic strategies, we used the Texas Sex Offender registry database with over 50,000 records with known demographic and coordinate information. We reduced the spatial resolution of each record to a census block group and attempted to recover coordinate information using the four strategies. We rigorously evaluated the results in terms of the error distance between the original coordinates and recovered coordinates by studying the results by demographic sub groups and the characteristics of the underlying geography.

Results

We observed that in estimating the actual location of a case, the weighted mean method is the most superior for each demographic group followed by the maximum imputation centroid, the random point in matching sub-geographies and the random point in all sub-geographies methods. Higher accuracies were observed for minority populations because minorities tend to cluster in certain neighborhoods, which makes it easier to impute their location. Results are greatly affected by the population density of the underlying geographies. We observed high accuracies in high population density areas, which often exist within smaller census blocks, which makes the search space smaller. Similarly, mapping geoimputation accuracies in a spatially explicit manner reveals that metropolitan areas yield higher accuracy results.

Conclusions

Based on gains in standard error, reduction in mean error and validation results, we conclude that characteristics of the estimated records such as the demographic profile and population density information provide a measure of certainty of geographic imputation.

     

Anxious and depressive symptoms in adolescents: Epidemiological data of a large scale study in Dresden

Objectives  

The present large scale epidemiological study was designed to assess the prevalence of mental disorders in adolescents     

Anxious and depressive symptoms in adolescents: Epidemiological data of a large scale study in Dresden

SummaryObjectives The present large scale epidemiological study was designed to assess the prevalence of mental disorders in adolescentsMethods Two cross-sectional studies have been performed in adolescents in Dresden and the results of the examination of 627 high school and 485 secondary school students (mean age 15.5 years) are presented. Self rating procedures like the Beck Depression Inventory (BDI) and clinical Interviews have been used to enhance validity.Results The results underline the high prevalence rates of anxiety and depression in adolescents. Up to 30% of the 9^th and 10^th grades students suffer from mental disorders or are at risk for the development of mental disorders.Conclusions Therefore primary prevention of mental disorders is desirable.

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ZusammenfassungFragestellung Die vorliegende Arbeit beschreibt das Design einer umfangreichen epidemiologischen Studie zur Prävalenz psychischer Störungen bei Jugendlichen.Methoden Zwei Querschnittstudien an Dresdner Jugendlichen werden vorgestellt und die Untersuchungsergebnisse von 627 Gymnasiasten und 485 Mittelschülern (Durchschnittsalter 15,5 Jahre) werden berichtet. Zur Verbesserung der Validität der Untersuchungsergebnisse wurden Selbstbeurteilungsinstrumente wie das Beck Depressions Inventar (BDI) zusammen mit klinischen Interviews verwendet.Ergebnisse Die Ergebnisse unterstreichen die hohe Prävalenz von Angststörungen und Depression bei Jugendlichen. Bis zu 30% der Schüler der 9, und 10. Klassen von Gymnasien und Mittelschulen weisen manifeste psychische Störungen oder eine erhöhtes Risiko an einer solchen zu erkranken auf.Schlussfolgerungen Die Ergebnisse unterstreichen die Bedeutung der primären Prävention psychischer Störungen.

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RésuméeObjectifs Le travail présent décrit la conception d'une large enquête sur la fréquence des troubles psychiques chez l'adolescent.Méthodes Deux études d'échantillon effectuées sur des adolescents de Dresden sont exposées et les résultats d'enquêtes menés sur 627 lycéens et 485 collégiens (âge moyen 15,5 ans) sont présentés. Des procédures d'auto=evaluation telles que le Beck Depression Inventory (BDI) et des entretiens cliniques ont été utilisés pour améliorer la validité des résultats obtenus.Résultats Ces derniers démontrent un taux élevé de troubles liés à l'anxiété et de dépressions chez l'adolescent. Jusqu'à 30% des élèves des 3ème et Secondes des classes de collèges et lycées manifestent des troubles psychiques ou présentent un risque élevé de développer de tels troubles.Conclusions Ces résultats soulignent l'importance d'un dépistage précoce de ces troubles psychiques.

     

The effectiveness of local child weight management programmes: an audit study

Background Many different child weight management programmes exist, with varying degrees of evaluation to provide evidence of their success. The purpose of this research was to use a standardized approach to audit the effectiveness of weight management intervention programmes in the West Midlands region of the UK, specifically to assess the benefits to participating children in terms of health improvement and behaviour change. Methods An audit of seven family‐based intervention programmes currently in place in the West Midlands. Programmes were audited against the Standard Evaluation Framework. Results The programmes provided a partial data set relating to a change in weight from the baseline to the end of the programme; none of the programmes provided all of the measures indicated by the Standard Evaluation Form as being essential for evaluation. Weight change ranged from an increase in group mean of 0.4 kg to a decrease of 0.9 kg. Body Mass Index SD decreased by 0.1–0.2 points in four programmes and remained unchanged in two programmes. Four programmes collected long‐term follow‐up data at 6 months. This was often limited because of participant dropout. Improvement in diet and exercise were reported by participants in all programmes which measured these behaviours. Conclusions Ongoing evaluation of all programmes, using a standard approach, is essential in order to improve the evidence base and support future commissioning.     

The lipid management nutrition outcomes project: perspectives from a national experience in protocol implementation and nutrition outcomes tracking

The Lipid Management Nutrition Outcomes Project was a multicenter prospective noncontrolled observational study in which a network of 51 registered dietitians (RDs) from practice settings across the United States implemented the 1998 Medical Nutrition Therapy Hyperlipidemia Protocol and collected outcomes. Difficulty recruiting RDs and enrolling patients revealed a gap between practice guidelines and clinical practice. Many RDs did not have laboratory values or follow-up visits required by the protocol. RDs able to follow protocol recommendations had the expected positive results. Within a 6-month period, 377 new patients presenting for lipid management met inclusion/exclusion criteria. Some follow-up data were available on 280 (74.3%) patients. There were follow-up lipid data prior to lipid-lowering medication changes for 219 patients. Reported mean dietary fat intake was reduced to <30% (P<0.0001). The population lost weight and increased exercise frequency (P<0.001, P<0.001). In the 175 patients with initial triglycerides <400 mg/dL (4.52 mmol/L), 44.6% had either a 15% drop in low-density lipoprotein cholesterol or reached low-density lipoprotein cholesterol goal. Lipid response occurred in 34.7+/-16.5 weeks with 3.0+/-1.4 RD visits. The Lipid Management Nutrition Outcomes Project highlights frustrations and values of outcomes monitoring in actual practice and identifies areas for practice advancement.     

某军队医院大型设备合作效益与管理探讨

开展设备合作促进了军队医院的良性发展。笔者对某军队中心医院设备合作的运行和管理作了分析与探讨,着重阐述了伽玛刀、磁共振、PET/CT的合作效益,介绍了大型设备合作的管理要点和体会,并针对存在的问题提出了建议。     

Oral contraception and ear disease: findings in a large cohort study

A number of authors have suggested that oral contraceptives may increase the risk of certain ear diseases, especially otosclerosis and vestibular disorders, although the amount of published information on this topic is limited. We have analyzed the available data on ear disease in the Oxford-Family Planning Association contraceptive study that includes 17,032 women followed for periods of up to 26 years. No evidence of any adverse effect of oral contraceptives on ear disease was detected. A protective effect of oral contraceptives against wax in the ear has been described in the Royal College of General Practitioners oral contraception study. The amount of data available in the Oxford-Family Planning Association study was too small to permit confirmation or refutation of this finding.     

计算机在综合医院药品量化管理中的应用

1 建立药库药品管理程序 将药库所有药品相关信息输入微机(采用四角号码),设置相应的口令。详细反映每种药品的购入、发出、损耗、升溢、调价、效期、批号等情况。过程如下: (1) 对综合性医院,一些常用且销量大的药品,根据往年的消耗情况,结合本年工作及病种组合变化情况,制订出合理的储备量,设置一反馈菜单,使有储备定额的药品,在储备积压或不足定额(即库存超过储备定额正负多少支、瓶、包)时微机     

Going to scale: exploring implementation of positive behaviour intervention and supports within and across different types of early childhood programmes

Despite calls to better prepare children for school entry, children with social, emotional, or behavioural needs continue to experience limited access to care that meets their needs. Despite frameworks for Positive Behaviour Intervention and Support (PBIS) that may aid in addressing children’s needs, bringing those frameworks to scale in early childhood requires examination. This study explores the impact of a state agency-sponsored professional development system on the implementation of a PBIS framework by 132 educators representing seven different types of early childhood programmes (i.e. Head Start, child care centre, special education, etc.). Significant differences in implementation were observed by programme type in both the initial level of implementation and changes in implementation after receiving training and monthly coaching. Implications and future research are discussed relative to implementation supports that may need to vary by programme type when trying to bring a PBIS framework to scale in early childhood.     

大型综合医院开展健康管理服务的SWOT分析

健康管理不仅是一个概念,也是一种方法,更是一套完善、周密的服务体系。目前,国内开展该项服务的机构主要集中在大型综合性医院和商业化的健康管理服务机构。笔者运用SWOT分析方法,对大型综合医院开展健康管理服务存在的主要优势、劣势、机会和威胁进行分析,并综合运用SO策略、ST策略、WO策略、WT策略提出了7条发展策略。