Growing older is not what it used to be

Growing old is not what it used to be. Many self-care actions can enhance one's chance of growing old without illness or disease. This necessitates preparing for old age while one is young. Preparation for second adulthood can vastly improve physical and emotional health in old age. It is important that nurses and other health care professionals teach health promotion strategies to persons at all ages in order to assist individuals to live life to its fullest throughout their lifetime.     

Clinical governance: what it is, what it isn't and what it should be

Clinical governance is as much about setting standards and putting in place management systems to achieve them as it is about poorly performing doctors. Medical Royal Colleges are well placed to support individual hospital doctors in setting and monitoring clinical standards appropriate to their specialty.     

Medicare reform: what it means to the future of dietetics

A considerable amount of work will be required to fully implement these provisions. New guides for practice and evidence-based practices will have to be developed and implemented. However, the demand for the services of ADA members should significantly increase as this bill and the regulations go into effect.Expansion of the MNT benefits within Medicare was the result of many years of hard work by ADA members in educating Congress about the benefits of dietitian services. Enactment of these benefits is a milestone that should not pass unnoticed. Increasingly, dietitian services are being seen as an essential element of any comprehensive health plan. This has long been the goal of the ADA and its members. In reaching that goal, the ADA and its members have reason to celebrate before getting down to the tremendous work that will be required to successfully meet the challenges of implementing the new benefits.     

Why simulation-based team training has not been used effectively and what can be done about it

Advanced medical education simulators are broadly used today to train both technical/procedural and team-based skills. While there is convincing evidence of the benefits of training technical skills, this is not the case for team-based skills. Research on medical expertise could drive the creation of a new regime of simulation-based team training. The new regime includes first the understanding of complex systems such as the hospital and the operating room; then the performance of work-place assessment; thirdly, the deliberate training of weaknesses and team performance skills; and lastly the understanding of the underlying mechanisms of team competence. A new regime of deliberate training proposed by the author, which would need to be evaluated and validated, could elucidate the underlying mechanisms of team competence while providing evidence of the effect of simulation-based team training.     

Where future emerging pathogens will come from and what approaches can be used to find them, besides VFARs

A consideration of available evidence for some known and well-characterized waterborne pathogens suggests that the diversity of pathogen virulence mechanisms and properties is too great to specifically predict the emergence and future human health impacts of new waterborne pathogens. However, some future emerging pathogens are existing microbes that will be discovered to cause disease. Some will arise from existing ones by either predictable evolutionary and adaptation changes or by unpredictable changes involving a variety of biotic and abiotic mechanisms. Many, and perhaps most, emerging waterborne human pathogens will be zoonotic agents or come from other non-human reservoirs. The emergence of some waterborne pathogens will be related to antibiotic use, resulting in emerging antibiotic-resistant waterborne pathogens. Reliably predicting pathogen emergence and human health effects based on VFARs or other properties of microbes and their hosts is not possible at this time. This is because of (1) the diversity of microbes and their virulence and pathogenicity properties, (2) their ability to change unpredictably, (3) their intimate and diverse interrelationships with a myriad of hosts and dynamic natural and anthropogenic environments and (4) the subtle variations in the immune status of individuals. The best available approach to predicting waterborne pathogen emergence is through vigilant use of microbial, infectious disease and epidemiological surveillance. Understanding the microbial metagenome of the human body can also lead to a better understanding of how we define and characterize pathogens, commensals and opportunists.     

The Danish health care system: it ain't broke... so don't fix it.

The organisation and financing of the Danish health care system was evaluated within a framework of analysis of strengths, weaknesses, opportunities and threats (a SWOT analysis) by a panel of five members with a background in health economics. The evaluation was based on reading an extensive amount of selected documents and literature on the Danish health care system, and a 1 week-visit to health care authorities, providers and key persons. This paper includes the main findings by one of the panel members. The international competition 'wave' passed by Denmark, and the Danish might rightly say 'thank goodness'. Funding is very largely public and there is a single dominant authority, i.e. the county, which makes planning easier. Low levels of patient payments and the smaller size of the private sector reflect Danish 'solidarity' and promote equity. Planning is good. Exceptions to this are the over-concern with hospital waiting lists and the flirting with DRG based funding. Greater investment in planning approaches would make the system yet better. The GP blended remuneration system with capitation and fee for service is a major strength. The fact that the system has such potential for technical and allocative efficiency and also equity but is not fully exploited suggests the need for more investment in health services research. While there is scope for improving the health care system in Denmark, the rest of the world has as much to learn from the Danes as the Danes have from the rest of the world.     

EDMS: what it was,is, and could be

The decision to implement an Electronic Document Management System (EDMS) should not be made lightly. Such is the advice of a health are provider organization that pioneered the technology a decade ago. University Health Systems of Eastern Carolina's largest facility, Pitt County Memorial Hospital (PCMH), implemented an EDMS in February 1992 and converted to its current EDMS in December 1999. This article describes PCMH's transition from paper to automation, the many trials along the way, and the advantages an EDMS offers.     

OR integration: what it is--and what it isn't

Integrated operating rooms are generating much interest, and they are often considered an essential, or at least very beneficial, component of OR design. But there are some common misunderstandings about the technology. This article provides information you can use to determine whether you need an integrated OR and dispels the myths frequently associated with the topic.