Operationalising emergency care delivery in sub-Saharan Africa: consensus-based recommendations for healthcare facilities.

Science.gov (United States)

Calvello, Emilie J B; Tenner, Andrea G; Broccoli, Morgan C; Skog, Alexander P; Muck, Andrew E; Tupesis, Janis P; Brysiewicz, Petra; Teklu, Sisay; Wallis, Lee; Reynolds, Teri

2016-08-01

A major barrier to successful integration of acute care into health systems is the lack of consensus on the essential components of emergency care within resource-limited environments. The 2013 African Federation of Emergency Medicine Consensus Conference was convened to address the growing need for practical solutions to further implementation of emergency care in sub-Saharan Africa. Over 40 participants from 15 countries participated in the working group that focused on emergency care delivery at health facilities. Using the well-established approach developed in the WHO's Monitoring Emergency Obstetric Care, the workgroup identified the essential services delivered-signal functions-associated with each emergency care sentinel condition. Levels of emergency care were assigned based on the expected capacity of the facility to perform signal functions, and the necessary human, equipment and infrastructure resources identified. These consensus-based recommendations provide the foundation for objective facility capacity assessment in developing emergency health systems that can bolster strategic planning as well as facilitate monitoring and evaluation of service delivery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Complications to evaluate adult trauma care: An expert consensus study.

Science.gov (United States)

Moore, Lynne; Lauzier, François; Stelfox, Henry Thomas; Le Sage, Natalie; Bourgeois, Gilles; Clément, Julien; Shemilt, Michèle; Turgeon, Alexis F

2014-08-01

Complications affect up to 37% of patients hospitalized for injury and increase mortality, morbidity, and costs. One of the keys to controlling complications for injury admissions is to monitor in-hospital complication rates. However, there is no consensus on which complications should be used to evaluate the quality of trauma care. The objective of this study was to develop a consensus-based list of complications that can be used to assess the acute phase of adult trauma care. We used a three-round Web-based Delphi survey among experts in the field of trauma care quality with a broad range of clinical expertise and geographic diversity. The main outcome measure was median importance rating on a 5-point Likert scale (very low to very high); complications with a median of 4 or greater and no disagreement were retained. A secondary measure was the perceived quality of information on each complication available in patient files. Of 19 experts invited to participate, 17 completed the first (brainstorming) round and 16 (84%) completed all rounds. Of 73 complications generated in Round 1, a total of 25 were retained including adult respiratory distress syndrome, hospital-acquired pneumonia, sepsis, acute renal failure, deep vein thrombosis, pulmonary embolism, wound infection, decubitus ulcers, and delirium. Of these, 19 (76%) were perceived to have high-quality or very high-quality information in patient files by more than 50% of the panel members. This study proposes a consensus-based list of 25 complications that can be used to evaluate the quality of acute adult trauma care. These complications can be used to develop an informative and actionable quality indicator to evaluate trauma care with the goal of decreasing rates of hospital complications and thus improving patient outcomes and resource use. DRG International Classification of Diseases codes are provided.

Geriatric Assessment-Guided Care Processes for Older Adults: A Delphi Consensus of Geriatric Oncology Experts.

Science.gov (United States)

Mohile, Supriya Gupta; Velarde, Carla; Hurria, Arti; Magnuson, Allison; Lowenstein, Lisa; Pandya, Chintan; O'Donovan, Anita; Gorawara-Bhat, Rita; Dale, William

2015-09-01

Structured care processes that provide a framework for how oncologists can incorporate geriatric assessment (GA) into clinical practice could improve outcomes for vulnerable older adults with cancer, a growing population at high risk of toxicity from cancer treatment. We sought to obtain consensus from an expert panel on the use of GA in clinical practice and to develop algorithms of GA-guided care processes. The Delphi technique, a well-recognized structured and reiterative process to reach consensus, was used. Participants were geriatric oncology experts who attended NIH-funded U13 or Cancer and Aging Research Group conferences. Consensus was defined as an interquartile range of 2 or more units, or 66.7% or greater, selecting a utility/helpfulness rating of 7 or greater on a 10-point Likert scale. For nominal data, consensus was defined as agreement among 66.7% or more of the group. From 33 invited, 30 participants completed all 3 rounds. Most experts (75%) used GA in clinical care, and the remainder were involved in geriatric oncology research. The panel met consensus that "all patients aged 75 years or older and those who are younger with age-related health concerns" should undergo GA and that all domains (function, physical performance, comorbidity/polypharmacy, cognition, nutrition, psychological status, and social support) should be included. Consensus was met for how GA could guide nononcologic interventions and cancer treatment decisions. Algorithms for GA-guided care processes were developed. This Delphi investigation of geriatric oncology experts demonstrated that GA should be performed for older patients with cancer to guide care processes. Copyright © 2015 by the National Comprehensive Cancer Network.

Lessons from Oil Pollution Research: Consensus, Controversy, and Education of Policy Makers and the Public.

Science.gov (United States)

Farrington, J. W.

2007-12-01

Controversies concerning scientific research findings, consensus of a majority of expert scientists, and attempts by vested interest groups to offer alternative interpretations from the consensus with the goal of influencing policy makers" and the public's understanding is not a new phenomenon with respect to complex environmental issues. For example, controversies about new scientific research findings from studies of oil spills and other aspects of petroleum and petroleum refined product inputs, fates and effects in the marine environment intensified in the late 1960s to early 1970s and continues today as evidenced by ongoing debates surrounding the Exxon Valdez Oil Spill. This paper provides an overview of the interactions between authentic new scientific findings with respect to oil pollution in the marine environment in the late 1960s and early 1970s, the consensus gained in the ensuing years by continued research, and through various science - policy processes, and a spectrum of concomitant public education efforts. Lessons learned from this ongoing process may be instructive to current debates in other arenas of environmental science.

Consensus development of core competencies in intensive and critical care medicine training in China

OpenAIRE

Hu, Xiaoyun; Xi, Xiuming; Ma, Penglin; Qiu, Haibo; Yu, Kaijiang; Tang, Yaoqing; Qian, Chuanyun; Fang, Qiang; Wang, Yushan; Yu, Xiangyou; Xu, Yuan; Du, Bin

2016-01-01

Background The aim of this study is to develop consensus on core competencies required for postgraduate training in intensive care medicine. Methods We used a combination of a modified Delphi method and a nominal group technique to create and modify the list of core competencies to ensure maximum consensus. Ideas were generated modified from Competency Based Training in Intensive Care Medicine in Europe collaboration (CoBaTrICE) core competencies. An online survey invited healthcare professio...

Chiropractic Integrated Care Pathway for Low Back Pain in Veterans: Results of a Delphi Consensus Process.

Science.gov (United States)

Lisi, Anthony J; Salsbury, Stacie A; Hawk, Cheryl; Vining, Robert D; Wallace, Robert B; Branson, Richard; Long, Cynthia R; Burgo-Black, A Lucille; Goertz, Christine M

2018-02-01

The purpose of this study was to develop an integrated care pathway for doctors of chiropractic, primary care providers, and mental health professionals who manage veterans with low back pain, with or without mental health comorbidity, within Department of Veterans Affairs health care facilities. The research method used was a consensus process. A multidisciplinary investigative team reviewed clinical guidelines and Veterans Affairs pain and mental health initiatives to develop seed statements and care algorithms to guide chiropractic management and collaborative care of veterans with low back pain. A 5-member advisory committee approved initial recommendations. Veterans Affairs-based panelists (n = 58) evaluated the pathway via e-mail using a modified RAND/UCLA methodology. Consensus was defined as agreement by 80% of panelists. The modified Delphi process was conducted in July to December 2016. Most (93%) seed statements achieved consensus during the first round, with all statements reaching consensus after 2 rounds. The final care pathway addressed the topics of informed consent, clinical evaluation including history and examination, screening for red flags, documentation, diagnostic imaging, patient-reported outcomes, adverse event reporting, chiropractic treatment frequency and duration standards, tailored approaches to chiropractic care in veteran populations, and clinical presentation of common mental health conditions. Care algorithms outlined chiropractic case management and interprofessional collaboration and referrals between doctors of chiropractic and primary care and mental health providers. This study offers an integrative care pathway that includes chiropractic care for veterans with low back pain. Copyright © 2018. Published by Elsevier Inc.

Processes for consensus building and role sharing. Lessons learned from HLW policies in European countries

International Nuclear Information System (INIS)

Nagano, Koji

2003-01-01

This report attempts to obtain lessons in implementation of HLW management policies for Japan by reviewing past experiences and present status of policy formulation and implementation as well as reflection of public opinions and consensus building of selected European countries, such as Finland, Sweden and others. After examining the situations of those countries, the author derives four key aspects that need to be addressed; separation of nuclear energy policies and HLW policies, fundamental support shared among national public, sense of controllability, and proper scheme of responsibility sharing. (author)

Developing the Australasian Hepatology Association's Consensus-based Guidelines for the Nursing Care of Patients with Liver Disease.

Science.gov (United States)

Richmond, Jacqueline; Wheeler, Emily; Warner, Sherryne; Mason, Susan

2014-05-03

Abstract Purpose: Hepatology nursing is an emerging speciality. To define best practice, the Australasian Hepatology Association developed consensus-based guidelines for the nursing care of patients with liver disease. Methods: Using the Delphi technique, six rounds of consultation were conducted with Australian hepatology nurses and non-nursing hepatology professionals. Input was captured through face-to-face and electronic communication and questionnaires. Results: The experts' opinions were collated and consensus on the delivery of hepatology nursing care was achieved. In total, 90 consensus guidelines were developed. The principles underpinning the Guidelines include patient-centred care, non-discriminatory practice, cultural competence, collaboration and partnership and working within own scope of practice. Conclusion: Internationally, the Australasian Hepatology Association Guidelines are the first to document a consensus on the scope of hepatology nursing practice. The Guidelines reflect the expansion of hepatology nursing, from viral hepatitis to caring for patients with advanced liver disease and hepatocellular carcinoma, and provides a framework for future nursing practice.

Policy analysis: palliative care in Ireland.

LENUS (Irish Health Repository)

Larkin, P

2014-03-01

Palliative care for patients with advanced illness is a subject of growing importance in health services, policy and research. In 2001 Ireland became one of the first nations to publish a dedicated national palliative care policy. This paper uses the \\'policy analysis triangle\\' as a framework to examine what the policy entailed, where the key ideas originated, why the policy process was activated, who were the key actors, and what were the main consequences. Although palliative care provision expanded following publication, priorities that were unaddressed or not fully embraced on the national policy agenda are identified. The factors underlying areas of non-fulfilment of policy are then discussed. In particular, the analysis highlights that policy initiatives in a relatively new field of healthcare face a trade-off between ambition and feasibility. Key policy goals could not be realised given the large resource commitments required; the competition for resources from other, better-established healthcare sectors; and challenges in expanding workforce and capacity. Additionally, the inherently cross-sectoral nature of palliative care complicated the co-ordination of support for the policy. Policy initiatives in emerging fields such as palliative care should address carefully feasibility and support in their conception and implementation.

Restricting marketing to children: consensus on policy interventions to address obesity.

Science.gov (United States)

Raine, Kim D; Lobstein, Tim; Landon, Jane; Kent, Monique Potvin; Pellerin, Suzie; Caulfield, Timothy; Finegood, Diane; Mongeau, Lyne; Neary, Neil; Spence, John C

2013-05-01

Obesity presents major challenges for public health and the evidence is strong. Lessons from tobacco control indicate a need for changing the policy and environments to make healthy choices easier and to create more opportunities for children to achieve healthy weights. In April 2011, the Alberta Policy Coalition for Chronic Disease Prevention convened a consensus conference on environmental determinants of obesity such as marketing of unhealthy foods and beverages to children. We examine the political environment, evidence, issues, and challenges of placing restrictions on marketing of unhealthy foods and beverages within Canada. We recommend a national regulatory system prohibiting commercial marketing of foods and beverages to children and suggest that effective regulations must set minimum standards, monitor compliance, and enact penalties for non-compliance.

Continuity and consensus

DEFF Research Database (Denmark)

Abrahamson, Peter

2010-01-01

maternal leave. These changes can be explained as adjustments to post-industrial conditions within a political culture relying on class compromises and a broad consensus informed by expert advice coming from civil servants and ad hoc policy commissions. The paper concludes that changes in Danish family...... policy reflect changing conditions for employment and the minding of children and that there has been a high degree of continuity and consensus about the change, as indicated by the strong increase in female labour market involvement....

The effect of the Accreditation Council for Graduate Medical Education Duty Hours Policy on plastic surgery resident education and patient care: an outcomes study.

Science.gov (United States)

Basu, Chandrasekhar Bob; Chen, Li-Mei; Hollier, Larry H; Shenaq, Saleh M

2004-12-01

The Accreditation Council for Graduate Medical Education (ACGME) Work-Hours Duty Policy became effective on July 1, 2003, mandating the reduction of resident duty work hours. The Baylor College of Medicine Multi-Institutional Integrated Plastic Surgery Program instituted a resident duty work-hours policy on July 1, 2002 (1 year ahead of the national mandate). Outcomes data are needed to facilitate continuous improvements in plastic surgical residency training while maintaining high-quality patient care. To assess the effect of this policy intervention on plastic surgery resident education as measured through the six core competencies and patient/resident safety, the investigators surveyed all categorical plastic surgery residents 6 months after implementation of the policy. This work represents the first empiric study investigating the effect of duty hours reduction on plastic surgery training and education. The categorical plastic surgery residents at the Baylor College of Medicine Multi-Institutional Integrated Plastic Surgery Program completed a 68-item survey on a five-point Likert scale (1 = strongly disagree to 5 = strongly agree). Residents were asked to rate multiple parameters based on the ACGME six core competencies, including statements on patient care and clinical/operative duties, resident education, resident quality of life, and resident perceptions on this policy. All surveys were completed anonymously. The sample size was n = 12 (program year 3 through program year 6), with a 100 percent response rate. Univariate and bivariate statistical analysis was conducted with SPSS version 10.0 statistical software. Specifically, interquartile deviations were used to find consensus among resident responses to each statement. Descriptive statistics indicated higher percentages of agreement on a majority of statements in three categories, including patient care and clinical/operative duties, academic duties, and resident quality of life. Using interquartile

[A Reflection on the Policy of Transcultural Long-Term Care for the Indigenous Peoples in Taiwan].

Science.gov (United States)

Subeq, Yi-Maun; Hsu, Mutsu

2016-06-01

Giving high-profile attention to socio-cultural and traditional beliefs in the promotion of long-term care policies enjoys strong, consensus support in the field of transcultural nursing. To protect the rights of indigenous people in Taiwan, the Ministry of Health and Welfare incorporated the concept of cultural care into the Long-term Care Services Act, which was approved by the Legislature in May 2014. However, the policies, resource strategies, manpower allocations, and staff educations and trainings related to this act are still await implementation in indigenous areas. Beyond the concept of professional healthcare, which considers cultural sensitivity, suitability, and ability, cultural care gives greater priority to crossing cultural barriers, integrating with the lifestyle of clients, and addressing their concerns in order to improve the well-being of target populations. The present article reviews current long-term care policy to highlight the importance of considering the cultural needs of the indigenous peoples of Taiwan in order to enhance the efficiency and impact of long-term care programs. Furthermore, the findings strongly recommend that additional resources be provided in order to meet the long-term care needs of indigenous communities. Finally, cultural-specific, long-term care service strategies should be promulgated in order to upgrade well-being in order to ease and comfort the feelings of indigenous people.

Consensus development of core competencies in intensive and critical care medicine training in China.

Science.gov (United States)

Hu, Xiaoyun; Xi, Xiuming; Ma, Penglin; Qiu, Haibo; Yu, Kaijiang; Tang, Yaoqing; Qian, Chuanyun; Fang, Qiang; Wang, Yushan; Yu, Xiangyou; Xu, Yuan; Du, Bin

2016-10-16

The aim of this study is to develop consensus on core competencies required for postgraduate training in intensive care medicine. We used a combination of a modified Delphi method and a nominal group technique to create and modify the list of core competencies to ensure maximum consensus. Ideas were generated modified from Competency Based Training in Intensive Care Medicine in Europe collaboration (CoBaTrICE) core competencies. An online survey invited healthcare professionals, educators, and trainees to rate and comment on these competencies. The output from the online survey was edited and then reviewed by a nominal group of 13 intensive care professionals to identify each competence for importance. The resulting list was then recirculated in the nominal group for iterative rating. The online survey yielded a list of 199 competencies for nominal group reviewing. After five rounds of rating, 129 competencies entered the final set defined as core competencies. We have generated a set of core competencies using a consensus technique which can serve as an indicator for training program development.

Performance indicators for clinical practice management in primary care in Portugal: consensus from a Delphi study.

Science.gov (United States)

Basto-Pereira, Miguel; Furtado, Sara Isabel Félix; Silva, Ricardo Jorge Pereira; Fachado González, Francisco; Vara Fernandes, Tito Manuel; Correia de Sousa, Jaime; Yaphe, John

2015-03-01

Performance indicators assessing the quality of medical care and linked to pay for performance may cause disagreement. Portuguese indicators included in recent health care reform are controversial. To obtain consensus from opinion leaders in family medicine regarding the performance indicators for practice management used in the evaluation of Family Health Units in Portugal. Eighty-nine specialists in primary care were invited to answer the following question in an online Delphi study: 'Which performance indicators should be assessed regarding the organization and management of clinical practice in primary care in Portugal?' A Likert scale was used to evaluate validity, reliability, feasibility and sensitivity to change. Twenty-seven experts participated in the second round and achieved a high degree of consensus. Eight categories were created for analysis. The experts suggested the use of existing indicators as well as new indicators. Thirty-nine indicators suggested by the experts are currently in use in Portugal. The assessment of the number of clinical acts performed, the number of administrative acts, and evaluation of the clinical demographic profile achieved a high degree of consensus. The expert panel suggested fifty new indicators. Five categories of these new indicators had a high degree of consensus, and three categories had a low degree of consensus. The expert panel recommended that performance indicators of practice management should first assess the quantity of clinical and administrative activities undertaken. These indicators must take into account the human and financial resources available to the clinic and its demographic context.

Overlapping consensus versus discourse in climate change policy: The case of Norway's Sovereign Wealth Fund

International Nuclear Information System (INIS)

Nilsen, Heidi Rapp

2010-01-01

This paper is motivated by the mismatch between emission of greenhouse gases and effective mitigation policies. Science now calls for every tool to be considered in order for radical changes to mitigate the situation more effectively. This paper considers Norway's huge Sovereign Wealth Fund which, although withdrawing investment from firms causing severe environmental damage, does not categorize climate change as 'severe environmental damage'. The main reason is a basis of overlapping consensus, which also hinders argumentation for this practice. Overlapping consensus is part of the broader theory 'Justice as Fairness' as conceived by John Rawls. The consensus is with regard to having a socially just system. The word 'overlapping' refers to people having different reasons for supporting the system. However using overlapping consensus for investment-strategies represents an extension beyond its original intention, and moreover, removes mitigating climate change from the agenda. Removing the basis of overlapping consensus opens up scope for value-based discourse conceived by Habermas' communicative action and discourse ethics. The immense severity of climate change demands value-based and substantial arguments from powerful sovereign wealth funds, to consider the acceptability of their practice.

Therapeutic Residential Care for Children and Youth : A Consensus Statement of the International Work Group on Therapeutic Residential Care

NARCIS (Netherlands)

Whittaker, James K.; Holmes, Lisa; del Valle, Jorge F.; Ainsworth, Frank; Andreassen, Tore; Anglin, James P.; Bellonci, Christopher; Berridge, David; Bravo, Amaia; Canali, Cinzia; Courtney, Mark; Currey, Laura; Daly, Daniel L.; Gilligan, Robbie; Grietens, Hans; Harder, Annemiek T.; Holden, Martha J.; James, Sigrid; Kendrick, Andrew; Knorth, Erik J.; Lausten, Mette; Lyons, John S.; Martin, Eduardo; McDermid, Samantha; McNamara, Patricia; Palareti, Laura; Ramsey, Susan; Sisson, Kari M.; Small, Richard W.; Thoburn, June; Thompson, Ronald; Zeira, Anat

While the focus of this consensus statement and the review volume that preceded it (Whittaker, Del Valle, & Holmes, 2014) is on therapeutic residential care (TRC), a specialized form of group care, we view our work as supportive of a much wider effort internationally concerned with the quality of

WA42 Proving its worth - changing public policy for palliative care, end of life care and bereavement through advocacy and communications.

Science.gov (United States)

Edghill, Angela; Donohoe, Miriam

2015-04-01

The 2015 palliative care budget is €72 million (Euros) but up to €1.3 billion spent on end of life care annually - much of this larger figure unplanned and uncoordinated. Geographic and other inequities evident in palliative care provision. Build support for the development and implementation of a National Strategy on Palliative Care, End of Life and Bereavement. Multi-layered approach to raising awareness and building consensus: Targeting the correct audience who can make change happen Presenting robust evidence including costs justifying reform and investment Demonstrating that issues affect a significant number of people Sharing experience and knowledge Knowing their policy priorities Staying resilient - advancing and introducing new angles to argument Engaging directly as advocates within the political system at all political levels - developing relationships with politicians Identifying advocates in the public service to promote policy change Using a variety of new and existing projects and programmes Encouraging patients and families to be self-advocates - using a novel project for discussing and recording future care preferences Supporting healthcare professionals to become effective advocates for patients Creating alliances to lobby for policy development Using media opportunities to sell the message The recognition of the importance of a strategic approach to palliative and end of life care acknowledged in Parliamentary Committee Report affords an opportunity to develop further policy and practice. This a long - term exercise, dependent on supporting the implementation plan, building momentum and promoting a public dialogue on sensitive issues around dying, death and bereavement. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration

Directory of Open Access Journals (Sweden)

Lockey David

2011-10-01

Full Text Available Abstract Background Physician-manned emergency medical teams supplement other emergency medical services in some countries. These teams are often selectively deployed to patients who are considered likely to require critical care treatment in the pre-hospital phase. The evidence base for guidelines for pre-hospital triage and immediate medical care is often poor. We used a recognised consensus methodology to define key priority areas for research within the subfield of physician-provided pre-hospital critical care. Methods A European expert panel participated in a consensus process based upon a four-stage modified nominal group technique that included a consensus meeting. Results The expert panel concluded that the five most important areas for further research in the field of physician-based pre-hospital critical care were the following: Appropriate staffing and training in pre-hospital critical care and the effect on outcomes, advanced airway management in pre-hospital care, definition of time windows for key critical interventions which are indicated in the pre-hospital phase of care, the role of pre-hospital ultrasound and dispatch criteria for pre-hospital critical care services. Conclusion A modified nominal group technique was successfully used by a European expert group to reach consensus on the most important research priorities in physician-provided pre-hospital critical care.

[Critical aspects of the management of "hazardous" health care workers. Consensus document].

Science.gov (United States)

Magnavita, N; Cicerone, Marina; Cirese, Vania; De Lorenzo, G; Di Giannantonios, M; Fileni, A; Goggiamani, Angela; Magnavita, Giulia; Marchi, Edda; Mazzullo, D; Monami, F; Monami, S; Puro, V; Ranalletta, Dalila; Ricciardi, G; Sacco, A; Spagnolo, A; Spagnolo, A G; Squarcione, S; Zavota, Giovanna

2006-01-01

A worker is considered to be hazardous to others when, in the course of performing a specific work task, his/her health problems (e.g., substance dependence, emotional disorders, physical disability, transmissible diseases) pose a risk for other workers' or the public's health and safety, or begins to interfere with ability to function in profession life. The presence of certain illnesses or the fact that a health care worker is impaired because of them do not necessarily imply that he, or she, is hazardous for others. Working in health care increases the probability that an impaired worker being hazardous for others. Management of hazardous workers requires new techniques and procedures, and specific policies. An interdisciplinary group of experts from medical, bioethical, legal and administrative disciplines, together with trade union and employers' representatives, is currently attempting to define a way to put prevention measures into practice in accordance with state laws and individual rights. A consensus document is presented, covering critical aspects such as: social responsibility of the employer, risk management, informed consent, non compliance, confidentiality, responsibility of workers, disclosure of risk to patients, non-discrimination, counselling and recovery of impaired workers, effectiveness of international guidelines. Occupational health professionals are obliged to adhere to ethical principles in the management of "hazardous" workers; the assessment of ethical costs and benefits for the stakeholders is the basis for appropriate decisions.

The development of a consensus definition for healthcare improvement science (HIS) in seven European countries: A consensus methods approach.

Science.gov (United States)

Skela-Savič, Brigita; Macrae, Rhoda; Lillo-Crespo, Manuel; Rooney, Kevin D

2017-06-01

There is a limited body of research in the field of healthcare improvement science (HIS). Quality improvement and 'change making' should become an intrinsic part of everyone's job, every day in all parts of the healthcare system. The lack of theoretical grounding may partly explain the minimal transfer of health research into health policy. This article seeks to present the development of the definition for healthcare improvement science. A consensus method approach was adopted with a two-stage Delphi process, expert panel and consensus group techniques. A total of 18 participants were involved in the expert panel and consensus group, and 153 answers were analysed as a part of the Delphi survey. Participants were researchers, educators and healthcare professionals from Scotland, Slovenia, Spain, Italy, England, Poland, and Romania. A high level of consensus was achieved for the broad definition in the 2nd Delphi iteration (86%). The final definition was agreed on by the consensus group: 'Healthcare improvement science is the generation of knowledge to cultivate change and deliver person-centred care that is safe, effective, efficient, equitable and timely. It improves patient outcomes, health system performance and population health.' The process of developing a consensus definition revealed different understandings of healthcare improvement science between the participants. Having a shared consensus definition of healthcare improvement science is an important step forward, bringing about a common understanding in order to advance the professional education and practice of healthcare improvement science.

Home is where the future is: The BrightFocus Foundation consensus panel on dementia care.

Science.gov (United States)

Samus, Quincy M; Black, Betty Smith; Bovenkamp, Diane; Buckley, Michael; Callahan, Christopher; Davis, Karen; Gitlin, Laura N; Hodgson, Nancy; Johnston, Deirdre; Kales, Helen C; Karel, Michele; Kenney, John Jay; Ling, Shari M; Panchal, Maï; Reuland, Melissa; Willink, Amber; Lyketsos, Constantine G

2018-01-01

A national consensus panel was convened to develop recommendations on future directions for home-based dementia care (HBDC). The panel summarized advantages and challenges of shifting to HBDC as the nexus of care and developed consensus-based recommendations. The panel developed five core recommendations: (1) HBDC should be considered the nexus of new dementia models, from diagnosis to end of life in dementia; (2) new payment models are needed to support HBDC and reward integration of care; (3) a diverse new workforce that spans the care continuum should be prepared urgently; (4) new technologies to promote communication, monitoring/safety, and symptoms management must be tested, integrated, and deployed; and (5) targeted dissemination efforts for HBDC must be employed. HBDC represents a promising paradigm shift to improve care for those living with dementia and their family caregivers: these recommendations provide a framework to chart a course forward for HBDC. Copyright © 2017 the Alzheimer's Association. All rights reserved.

The Limits of Consensus.

Science.gov (United States)

Poster, John B.

Dynamics in the education policy arena suggest that, despite two generations of researchers extolling democratic leadership styles and consensus building over autocratic techniques, wide participation in policymaking and the broadest possible consensus are not always productive: American society has not yet agreed on what schools should…

Health Care Organizations and Policy Leadership: Perspectives on Nonsmoker-Only Hiring Policies.

Science.gov (United States)

McDaniel, Patricia A; Malone, Ruth E

2018-02-01

To explore employers' decisions to base hiring policies on tobacco or nicotine use and community perspectives on such policies, and analyze the implications for organizational identity, community engagement, and health promotion. From 2013 to 2016, 11 executives from six health care organizations and one non-health-care organization with nonsmoker-only hiring policies were interviewed about why and how their policies were created and implemented, concerns about the policies, and perceptions of employee and public reactions. Focus groups were conducted with community members (n = 51) who lived in or near cities where participating employers were based, exploring participants' opinions about why an employer would stop hiring smokers and their support (or not) for such a policy. Most employers excluded from employment those using all forms of nicotine. Several explained their adoption of the policy as a natural extension of a smoke-free campus and as consistent with their identity as health care organizations. They regarded the policy as promoting health. No employer mentioned engaging in a community dialogue before adopting the policy or reported efforts to track the policy's impact on rejected applicants. Community members understood the cost-saving appeal of such policies, but most opposed them. They made few exceptions for health care organizations. Policy decisions undertaken by health care organizations have influence beyond their immediate setting and may establish precedents that others follow. Nonsmoker-only hiring policies may fit with a health care organization's institutional identity but may not be congruent with community values or promote public health.

Involving patients in patient safety programmes: A scoping review and consensus procedure by the LINNEAUS collaboration on patient safety in primary care.

Science.gov (United States)

Trier, Hans; Valderas, Jose M; Wensing, Michel; Martin, Helle Max; Egebart, Jonas

2015-09-01

Patient involvement has only recently received attention as a potentially useful approach to patient safety in primary care. To summarize work conducted on a scoping review of interventions focussing on patient involvement for patient safety; to develop consensus-based recommendations in this area. Scoping review of the literature 2006-2011 about methods and effects of involving patients in patient safety in primary care identified evidence for previous experiences of patient involvement in patient safety. This information was fed back to an expert panel for the development of recommendations for healthcare professionals and policy makers. The scoping review identified only weak evidence in support of the effectiveness of patient involvement. Identified barriers included a number of patient factors but also the healthcare workers' attitudes, abilities and lack of training. The expert panel recommended the integration of patient safety in the educational curricula for healthcare professionals, and expected a commitment from professionals to act as first movers by inviting and encouraging the patients to take an active role. The panel proposed a checklist to be used by primary care clinicians at the point of care for promoting patient involvement. There is only weak evidence on the effectiveness of patient involvement in patient safety. The recommendations of the panel can inform future policy and practice on patient involvement in safety in primary care.

Selective mutism: a consensus based care pathway of good practice.

Science.gov (United States)

Keen, D V; Fonseca, S; Wintgens, A

2008-10-01

Selective mutism (SM) now acknowledged as an anxiety condition, tends to be a poorly understood, highly complex and vastly under-recognised clinical entity. Children with SM are a vulnerable group as the condition is not the remit of any one professional group. This inevitably leads to delay in formal diagnosis and management. There is a lack of systematic research on which to base guidelines for management. To develop, agree and validate key principles underlying the management of SM through a consensus process involving international experts, in order to create a local care pathway. A local multi-agency consultation process developed 11 statements, which were felt to be the key principles underpinning a potential care pathway for managing SM. Thirteen recognised experts from North America, Europe and Australia participated in a modified Delphi process involving two rounds using a Likert-scale and free commentary. Both quantitative and qualitative analyses were used in the validation or revision of the statements at each stage. Response rates were 100% for Round 1 and 84.6% for Round 2. Despite the differing professional backgrounds and service contexts, by successive revision and/or revalidation of statements, it was possible to arrive at a consensus about key principles relating to early recognition, assessment and intervention. The agreed key principles are presented together with the resulting local care pathway. Through a Delphi process, agreement was reached by a multidisciplinary group of professionals, on key principles that underpin the timely identification, assessment and management of children with SM. These include the potential for staff in school/preschool settings to identify SM and that intervention programmes should generally be based in these settings. Children with SM should receive assessment for possible coexisting disorders, whether developmental, emotional or behavioural and additional specific intervention given for these. Agreement was

Consensus on the back end of the fuel cycle urgently needed

International Nuclear Information System (INIS)

Strassburg, W.

1996-01-01

The lack of harmonization among the fields of environmental policy, energy policy, and economic policy in Germany is obvious. Returning to a basic consensus in energy policy, with an unbiased evaluation of all energy resources, is an indispensable step for all those to whom ecology is a truly serious concept. The positions of all energy resources must be assessed with a view to national and international developments. No source of primary energy must be excluded from that review. Nuclear power remains one of the important options in the energy mix especially from the points of view of CO 2 avoidance and preventive protection of the climate. A leading industrialized nation, such as the Federal Republic of Germany, ought to be able, in the more and more important discussion about globally sustainable development, to return to a consensus across all political parties at least about the back end of the nuclear fuel cycle. Or should the philosopher, Sir Karl Popper, finally be proven right in his statement that those wanting to establish a paradise on earth must be careful not to create hell? (orig.) [de

Canadian Consensus on Medically Acceptable Wait Times for Digestive Health Care

Directory of Open Access Journals (Sweden)

William G Paterson

2006-01-01

Full Text Available BACKGROUND: Delays in access to health care in Canada have been reported, but standardized systems to manage and monitor wait lists and wait times, and benchmarks for appropriate wait times, are lacking. The objective of the present consensus was to develop evidence- and expertise-based recommendations for medically appropriate maximal wait times for consultation and procedures by a digestive disease specialist.

A multiprofessional information model for Brazilian primary care: Defining a consensus model towards an interoperable electronic health record.

Science.gov (United States)

Braga, Renata Dutra

2016-06-01

To develop a multiprofessional information model to be used in the decision-making process in primary care in Brazil. This was an observational study with a descriptive and exploratory approach, using action research associated with the Delphi method. A group of 13 health professionals made up a panel of experts that, through individual and group meetings, drew up a preliminary health information records model. The questionnaire used to validate this model included four questions based on a Likert scale. These questions evaluated the completeness and relevance of information on each of the four pillars that composed the model. The changes suggested in each round of evaluation were included when accepted by the majority (≥ 50%). This process was repeated as many times as necessary to obtain the desirable and recommended consensus level (> 50%), and the final version became the consensus model. Multidisciplinary health training of the panel of experts allowed a consensus model to be obtained based on four categories of health information, called pillars: Data Collection, Diagnosis, Care Plan and Evaluation. The obtained consensus model was considered valid by the experts and can contribute to the collection and recording of multidisciplinary information in primary care, as well as the identification of relevant concepts for defining electronic health records at this level of complexity in health care. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Development of a Unifying Target and Consensus Indicators for Global Surgical Systems Strengthening: Proposed by the Global Alliance for Surgery, Obstetric, Trauma, and Anaesthesia Care (The G4 Alliance).

Science.gov (United States)

Haider, Adil; Scott, John W; Gause, Colin D; Meheš, Mira; Hsiung, Grace; Prelvukaj, Albulena; Yanocha, Dana; Baumann, Lauren M; Ahmed, Faheem; Ahmed, Na'eem; Anderson, Sara; Angate, Herve; Arfaa, Lisa; Asbun, Horacio; Ashengo, Tigistu; Asuman, Kisembo; Ayala, Ruben; Bickler, Stephen; Billingsley, Saul; Bird, Peter; Botman, Matthijs; Butler, Marilyn; Buyske, Jo; Capozzi, Angelo; Casey, Kathleen; Clayton, Charles; Cobey, James; Cotton, Michael; Deckelbaum, Dan; Derbew, Miliard; deVries, Catherine; Dillner, Jeanne; Downham, Max; Draisin, Natalie; Echinard, David; Elneil, Sohier; ElSayed, Ahmed; Estelle, Abigail; Finley, Allen; Frenkel, Erica; Frykman, Philip K; Gheorghe, Florin; Gore-Booth, Julian; Henker, Richard; Henry, Jaymie; Henry, Orion; Hoemeke, Laura; Hoffman, David; Ibanga, Iko; Jackson, Eric V; Jani, Pankaj; Johnson, Walter; Jones, Andrew; Kassem, Zeina; Kisembo, Asuman; Kocan, Abbey; Krishnaswami, Sanjay; Lane, Robert; Latif, Asad; Levy, Barbara; Linos, Dimitrios; Linz, Peter; Listwa, Louis A; Magee, Declan; Makasa, Emmanuel; Marin, Michael L; Martin, Claude; McQueen, Kelly; Morgan, Jamie; Moser, Richard; Neighbor, Robert; Novick, William M; Ogendo, Stephen; Omigbodun, Akinyinka; Onajin-Obembe, Bisola; Parsan, Neil; Philip, Beverly K; Price, Raymond; Rasheed, Shahnawaz; Ratel, Marjorie; Reynolds, Cheri; Roser, Steven M; Rowles, Jackie; Samad, Lubna; Sampson, John; Sanghvi, Harshadkumar; Sellers, Marchelle L; Sigalet, David; Steffes, Bruce C; Stieber, Erin; Swaroop, Mamta; Tarpley, John; Varghese, Asha; Varughese, Julie; Wagner, Richard; Warf, Benjamin; Wetzig, Neil; Williamson, Susan; Wood, Joshua; Zeidan, Anne; Zirkle, Lewis; Allen, Brendan; Abdullah, Fizan

2017-10-01

After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health Assembly resolution recognizing the role of surgical care and anaesthesia as part of universal health coverage. Momentum gained from these milestones highlights the need to identify consensus goals, targets and indicators to guide policy implementation and track progress at the national level. Through an open consultative process that incorporated input from stakeholders from around the globe, a global target calling for safe surgical and anaesthesia care for 80% of the world by 2030 was proposed. In order to achieve this target, we also propose 15 consensus indicators that build on existing surgical systems metrics and expand the ability to prioritize surgical systems strengthening around the world.

AFEM Consensus Conference, 2013. AFEM Out-of-Hospital Emergency Care Workgroup Consensus Paper: Advancing Out-of-Hospital Emergency Care in Africa-Advocacy and Development

Directory of Open Access Journals (Sweden)

N.K. Mould-Millman

2014-06-01

Future directions of the AFEM Out-of-Hospital Emergency Care Workgroup include creating an online Toolkit. This will serve as a repository of template documents to guide implementation and development of clinical care, education, transportation, public access, policy and governance.

American Burn Association Consensus Statements

Science.gov (United States)

2013-08-01

quality consensus conference was underwrit- ten in part by unrestricted educational grants from Molnlycke Health Care and Baxter Health Care. Address... nutrition , psychological outcomes, resuscitation, and wound repair. After reviewing the literature, debating the issues at the consensus conference and...need for intubation, concomitant trauma. 3. Resuscitation characteristics: Lab values (base defi- cit, lactate, hemoglobin /hematocrit, blood urea

The CARE guidelines: consensus-based clinical case report guideline development.

Science.gov (United States)

Gagnier, Joel J; Kienle, Gunver; Altman, Douglas G; Moher, David; Sox, Harold; Riley, David

2014-01-01

A case report is a narrative that describes, for medical, scientific, or educational purposes, a medical problem experienced by one or more patients. Case reports written without guidance from reporting standards are insufficiently rigorous to guide clinical practice or to inform clinical study design. Develop, disseminate, and implement systematic reporting guidelines for case reports. We used a three-phase consensus process consisting of (1) pre-meeting literature review and interviews to generate items for the reporting guidelines, (2) a face-to-face consensus meeting to draft the reporting guidelines, and (3) post-meeting feedback, review, and pilot testing, followed by finalization of the case report guidelines. This consensus process involved 27 participants and resulted in a 13-item checklist-a reporting guideline for case reports. The primary items of the checklist are title, key words, abstract, introduction, patient information, clinical findings, timeline, diagnostic assessment, therapeutic interventions, follow-up and outcomes, discussion, patient perspective, and informed consent. We believe the implementation of the CARE (CAse REport) guidelines by medical journals will improve the completeness and transparency of published case reports and that the systematic aggregation of information from case reports will inform clinical study design, provide early signals of effectiveness and harms, and improve healthcare delivery. Copyright © 2014 Reproduced with permission of Global Advances in Health and Medicine. Published by Elsevier Inc. All rights reserved.

ENETS Consensus Recommendations for the Standards of Care in Neuroendocrine Neoplasms

DEFF Research Database (Denmark)

Knigge, U.; Capdevila, J.; Bartsch, D. K.

2017-01-01

and coming WHO classification and ENETS/UICC recommendations for TNM staging. The recommendations for follow-up in patients with thymic, bronchopulmonary and gastroenteropancreatic NEN are given in Table 1. However, it should be stressed that evidence-based studies for follow-up are largely missing.......ENETS consensus recommendations for the standards of care in neuroendocrine neoplasms (NEN) concerning follow-up and documentation are considered in this review. The documentation of patients with NEN should include the most relevant data characterizing an individual patient from the first contact...... with his/her physician/hospital until his/her last presentation during follow-up. It is advocated that follow-up occurs in specialized NEN centers with regular NEN tumor boards with expert panels. The follow-up should be in accordance with the ENETS consensus guidelines from 2011 and 2016, the present...

Consensus statement on anaesthesia for day care surgeries

Directory of Open Access Journals (Sweden)

Satish Kulkarni

2017-01-01

Full Text Available The primary aim of day-care surgery units is to allow for early recovery of the patients so that they can return to their familiar 'home' environment; the management hence should be focused towards achieving these ends. The benefits could include a possible reduction in the risk of thromboembolism and hospital-acquired infections. Furthermore, day-care surgery is believed to reduce the average unit cost of treatment by up to 70% as compared to inpatient surgery. With more than 20% of the world's disease burden, India only has 6% of the world's hospital beds. Hence, there is an immense opportunity for expansion in day-care surgery in India to ensure faster and safer, cost-effective patient turnover. For this to happen, there is a need of change in the mindset of all concerned clinicians, surgeons, anaesthesiologists and even the patients. A group of nine senior consultants from various parts of India, a mix of private and government anaesthesiologists, assembled in Mumbai and deliberated and discussed on the various aspects of day-care surgery. They formulated a consensus statement, the first of its kind in the Indian scenario, which can act as a guidance and tool for day-care anaesthesia in India. The statements are derived from the available published evidence in peer-reviewed literature including guidelines of several bodies such as the American Society of Anesthesiologists, British Association of Day Surgery and International Association of Ambulatory Surgery. The authors also offer interpretive comments wherever such evidence is inadequate or contradictory.

Transforming long-term care pain management in north america: the policy-clinical interface.

Science.gov (United States)

Hadjistavropoulos, Thomas; Marchildon, Gregory P; Fine, Perry G; Herr, Keela; Palley, Howard A; Kaasalainen, Sharon; Béland, François

2009-04-01

The undertreatment of pain in older adults who reside in long-term care (LTC) facilities has been well documented, leading to clinical guideline development and professional educational programs designed to foster better pain assessment and management in this population. Despite these efforts, little improvement has occurred, and we postulate that focused attention to public policy and cost implications of systemic change is required to create positive pain-related outcomes. Our goal was to outline feasible and cost-effective clinical and public policy recommendations designed to address the undermanagement of pain in LTC facilities. We arranged a 2-day consensus meeting of prominent United States and Canadian pain and public policy experts. An initial document describing the problem of pain undermanagement in LTC was developed and circulated prior to the meeting. Participants were also asked to respond to a list of relevant questions before arriving. Following formal presentations of a variety of proposals and extensive discussion among clinicians and policy experts, a set of recommendations was developed. We outline key elements of a transformational model of pain management in LTC for the United States and Canada. Consistent with previously formulated clinical guidelines but with attention to readily implementable public policy change in both countries, this transformational model of LTC has important implications for LTC managers and policy makers as well as major quality of life implications for LTC residents.

Long-term care policy for older Americans: building a continuum of care.

Science.gov (United States)

Palley, Howard A

2003-01-01

This paper deals primarily with social policy considerations relevant to the development of long-term care policy for the frail elderly in the United States. However, it also includes some commentary on meeting the acute care needs of the frail elderly. It defines chronic care treatment as a mix of "short-term" and "long-term" modes of care. Furthermore, it explores the need for treatment of such long-term illnesses to recognize the importance of alternative modes of caring which include strategies, both medical and nonmedical, delivered within and outside of hospitals and nursing homes. The paper includes an analysis of public and private sector priorities based in data published by the U.S. Health Care Financing Administration. It also includes some discussion of the PACE program in the United States and some other efforts to stimulate more in-home and community-based alternatives to nursing home care. Furthermore, it includes a discussion of the policy goal of "appropriateness" in developing long-term care (as well as general health priorities) and provides a critical discussion of problems with utilizing "cost/benefit analysis." The study concludes that too exclusive a focus on nursing home care for the elderly in the United States is unfortunate-both in terms of the desires of the elderly, their families and friends and in terms of focusing on "appropriateness" as a legitimate policy goal in the development of long-term care policy for the elderly in the United States.

Two Different Views on Monetary Policy Impact: The New Consensus and Post-Keynesian Economics

Directory of Open Access Journals (Sweden)

Marius-Corneliu Marinas

2007-09-01

Full Text Available The objective of this study is to make a synthesis of the differences between two new macroeconomic views. A New Consensus has arisen among neoclassical and New-Keynesian economists, such as Romer, Taylor and Walsh. This new view seeks to redefine the application of monetary policy by re-specifying the most appropriate monetary rule, which is used for inflation targeting. The framework of the monetary policy impact requires the usage of a expectations augmented Phillips curve, characterized through the lack of trade-off inflation-unemployment in the long-run. Post-keynesian macroeconomic critical, whose promoters are Arestis, Lavoie and Satterfield, argues that for most of the production levels obtained output change has no effect on inflation. This is a re-formulation of the Keynesian aggregate supply curve, which is entirely horizontal.

[Consensus on improving the care integrated of patients with acute heart failure].

Science.gov (United States)

Llorens, Pere; Manito Lorite, Nicolás; Manzano Espinosa, Luis; Martín-Sánchez, Francisco Javier; Comín Colet, Josep; Formiga, Francesc; Jacob, Javier; Delgado Jiménez, Juan; Montero-Pérez-Barquero, Manuel; Herrero, Pablo; López de Sá Areses, Esteban; Pérez Calvo, Juan Ignacio; Masip, Josep; Miró, Òscar

2015-01-01

Acute heart failure (AHF) requires considerable use of resources, is an economic burden, and is associated with high complication and mortality rates in emergency departments, on hospital wards, or outpatient care settings. Diagnosis, treatment, and continuity of care are variable at present, leading 3 medical associations (for cardiology, internal medicine, and emergency medicine) to undertake discussions and arrive at a consensus on clinical practice guidelines to support those who manage AHF and encourage standardized decision making. These guidelines, based on a review of the literature and clinical experience with AHF, focus on critical points in the care pathway. Regarding emergency care, the expert participants considered the initial evaluation of patients with signs and symptoms that suggest AHF, the initial diagnosis, first decisions about therapy, monitoring, assessment of prognosis, and referral criteria. For care of the hospitalized patient, the group developed a protocol for essential treatment. Objectives for the management and treatment of AHF on discharge were also covered through the creation or improvement of multidisciplinary care systems to provide continuity of care.

Judicial Deference Allows European Consensus to Emerge

DEFF Research Database (Denmark)

Dothan, Shai

2018-01-01

jurisdiction. But the ECHR sometimes defers to countries, even if their policies fall short of the standard accepted by most of the countries in Europe. This deference is accomplished by using the so-called "margin of appreciation" doctrine. Naturally, emerging consensus and margin of appreciation are often......, the paper demonstrates that a correct application of the margin of appreciation doctrine actually helps emerging consensus reach optimal results, by giving countries an incentive to make their policies independently....

Optimizing the pre-referral workup for gastroenterology and hepatology specialty care: consensus using the Delphi method.

Science.gov (United States)

Ho, Chanda K; Boscardin, Christy K; Gleason, Nathaniel; Collado, Don; Terdiman, Jonathan; Terrault, Norah A; Gonzales, Ralph

2016-02-01

Specialty care referrals have doubled in the last decade. Optimization of the pre-referral workup by a primary care doctor can lead to a more efficient first specialty visit with the patient. Guidance regarding pre-referral laboratory testing is a first step towards improving the specialty referral process. Our aim was to establish consensus regarding appropriate pre-referral workup for common gastrointestinal and liver conditions. The Delphi method was used to establish local consensus for recommending certain laboratory tests prior to specialty referral for 13 clinical conditions. Seven conditions from The University of Michigan outpatient referral guidelines were used as a baseline. An expert panel of three PCPs and nine gastroenterologists from three academic hospitals participated in three iterative rounds of electronic surveys. Each panellist ranked each test using a 5-point Likert scale (strongly disagree to strongly agree). Local panellists could recommend additional tests for the initial diagnoses, and also recommended additional diagnoses needing guidelines: iron deficiency anaemia, abdominal pain, irritable bowel syndrome, fatty liver disease, liver mass and cirrhosis. Consensus was defined as ≥70% of experts scoring ≥4 (agree or strongly agree). Applying Delphi methodology to extrapolate externally developed referral guidelines for local implementation resulted in considerable modifications. For some conditions, many tests from the external group were eliminated by the local group (abdominal bloating; iron deficiency anaemia; irritable bowel syndrome). In contrast, for chronic diarrhoea, abnormal liver enzymes and viral hepatitis, all/most original tests were retained with additional tests added. For liver mass, fatty liver disease and cirrhosis, there was high concordance among the panel with few tests added or eliminated. Consideration of externally developed referral guidelines using a consensus-building process leads to significant local

A consensus guideline for antipsychotic drug use for dementia in care homes. Bridging the gap between scientific evidence and clinical practice

NARCIS (Netherlands)

Zuidema, Sytse U.; Johansson, Alice; Selbaek, Geir; Murray, Matt; Burns, Alistair; Ballard, Clive; Koopmans, Raymond T. C. M.

Background: To produce a practice guideline that includes a set of detailed consensus principles regarding the prescription of antipsychotics (APs) amongst people with dementia living in care homes. Methods: We used a modified Delphi consensus procedure with three rounds, where we actively specified

A consensus guideline for antipsychotic drug use for dementia in care homes. Bridging the gap between scientific evidence and clinical practice

NARCIS (Netherlands)

Zuidema, S.U.; Johansson, A; Selbaek, G.; Murray, M.; Burns, A.; Ballard, C.; Koopmans, R.T.C.M.

2015-01-01

BACKGROUND: To produce a practice guideline that includes a set of detailed consensus principles regarding the prescription of antipsychotics (APs) amongst people with dementia living in care homes. METHODS: We used a modified Delphi consensus procedure with three rounds, where we actively specified

Stem cell research ethics: consensus statement on emerging issues.

Science.gov (United States)

Caulfield, Timothy; Ogbogu, Ubaka; Nelson, Erin; Einsiedel, Edna; Knoppers, Bartha; McDonald, Michael; Brunger, Fern; Downey, Robin; Fernando, Kanchana; Galipeau, Jacques; Geransar, Rose; Griener, Glenn; Grenier, Glenn; Hyun, Insoo; Isasi, Rosario; Kardel, Melanie; Knowles, Lori; Kucic, Terrence; Lotjonen, Salla; Lyall, Drew; Magnus, David; Mathews, Debra J H; Nisbet, Matthew; Nisker, Jeffrey; Pare, Guillaume; Pattinson, Shaun; Pullman, Daryl; Rudnicki, Michael; Williams-Jones, Bryn; Zimmerman, Susan

2007-10-01

This article is a consensus statement by an international interdisciplinary group of academic experts and Canadian policy-makers on emerging ethical, legal and social issues in human embryonic stem cells (hESC) research in Canada. The process of researching consensus included consultations with key stakeholders in hESC research (regulations, stem cell researchers, and research ethics experts), preparation and distribution of background papers, and an international workshop held in Montreal in February 2007 to discuss the papers and debate recommendations. The recommendations provided in the consensus statement focus on issues of immediate relevance to Canadian policy-makers, including informed consent to hESC research, the use of fresh embryos in research, management of conflicts of interest, and the relevance of public opinion research to policy-making.

Ethical considerations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

Science.gov (United States)

Biddison, Lee Daugherty; Berkowitz, Kenneth A; Courtney, Brooke; De Jong, Col Marla J; Devereaux, Asha V; Kissoon, Niranjan; Roxland, Beth E; Sprung, Charles L; Dichter, Jeffrey R; Christian, Michael D; Powell, Tia

2014-10-01

Mass critical care entails time-sensitive decisions and changes in the standard of care that it is possible to deliver. These circumstances increase provider uncertainty as well as patients' vulnerability and may, therefore, jeopardize disciplined, ethical decision-making. Planning for pandemics and disasters should incorporate ethics guidance to support providers who may otherwise make ad hoc patient care decisions that overstep ethical boundaries. This article provides consensus-developed suggestions about ethical challenges in caring for the critically ill or injured during pandemics or disasters. The suggestions in this article are important for all of those involved in any pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. We adapted the American College of Chest Physicians (CHEST) Guidelines Oversight Committee's methodology to develop suggestions. Twenty-four key questions were developed, and literature searches were conducted to identify evidence for suggestions. The detailed literature reviews produced 144 articles. Based on their expertise within this domain, panel members also supplemented the literature search with governmental publications, interdisciplinary workgroup consensus documents, and other information not retrieved through PubMed. The literature in this field is not suitable to support evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. We report the suggestions that focus on five essential domains: triage and allocation, ethical concerns of patients and families, ethical responsibilities to providers, conduct of research, and international concerns. Ethics issues permeate virtually all aspects of pandemic and disaster response. We have addressed some of the most pressing issues, focusing on five essential domains: triage and allocation, ethical

Access to specialist gastroenterology care in Canada: Comparison of wait times and consensus targets

Science.gov (United States)

Leddin, Desmond; Armstrong, David; Barkun, Alan NG; Chen, Ying; Daniels, Sandra; Hollingworth, Roger; Hunt, Richard H; Paterson, William G

2008-01-01

BACKGROUND: Monitoring wait times and defining targets for care have been advocated to improve health care delivery related to cancer, heart, diagnostic imaging, joint replacements and sight restoration. There are few data on access to care for digestive diseases, although they pose a greater economic burden than cancer or heart disease in Canada. The present study compared wait times for specialist gastroenterology care with recent, evidence-based, consensus-defined benchmark wait times for a range of digestive diseases. METHODS: Total wait times from primary care referral to investigation were measured for seven digestive disease indications by using the Practice Audit in Gastroenterology program, and were benchmarked against consensus recommendations. RESULTS: Total wait times for 1903 patients who were undergoing investigation exceeded targets for those with probable cancer (median 26 days [25th to 75th percentiles eight to 56 days] versus target of two weeks); probable inflammatory bowel disease (101 days [35 to 209 days] versus two weeks); documented iron deficiency anemia (71 days [19 to 142 days] versus two months); positive fecal occult blood test (73 days [36 to 148 days] versus two months); dyspepsia with alarm symptoms (60 days [23 to 140 days] versus two months); refractory dyspepsia without alarm symptoms (126 days [42 to 225 days] versus two months); and chronic constipation and diarrhea (141 days [68 to 264 days] versus two months). A minority of patients were seen within target times: probable cancer (33% [95% CI 20% to 47%]); probable inflammatory bowel disease (12% [95% CI 1% to 23%]); iron deficiency anemia (46% [95% CI 37% to 55%]); positive occult blood test (41% [95% CI 28% to 54%]); dyspepsia with alarm symptoms (51% [95% CI 41% to 60%]); refractory dyspepsia without alarm symptoms (33% [95% CI 19% to 47%]); and chronic constipation and diarrhea (21% [95% CI 14% to 29%]). DISCUSSION: Total wait times for the seven indications exceeded the

Consensus builds on population policy as ICPD PrepCom meetings conclude. Vatican objections firm and vocal.

Science.gov (United States)

1994-04-29

In April, 1994, at UN headquarters in New York, delegates from almost 200 countries and nongovernmental organizations (NGOs) negotiated a Programme of Action to be ratified following more debate at the International Conference on Population and Development in Cairo in September. A sizable consensus emerged for this Preparatory Committee III (PrepCom) meeting. It has an expanded view of population policy that centers more on meeting individual needs and less on achieving strict demographic goals. Thus, it focuses on the unmet need for reproductive health services (family planning, basic women's health care, and services linked to sexually transmitted diseases). It considers women's status and female education as being important themselves as well as key determinants of fertility rates. Disagreement over access to abortion services and reproductive health services for adolescents remain. Unlike earlier world conferences, most of the world is working towards a consensus, while the Vatican and just a few small countries (Benin, Malta, Honduras, and Nicaragua) object to these services. Some topics that US National Conference of Catholic Bishops did not want in the Programme of Action were references to reducing the incidence of unsafe abortion, promoting condom use to prevent HIV/AIDS, and even safe motherhood. The US and Japan have committed sizable increases in population assistance. Some European countries are concerned about how their contributions would be allocated. US Undersecretary for Global Affairs and a mostly female 23-member US delegation attended PrepCom III. Most of the US delegates were from NGOs. Many country delegates were women. Many countries accepted recommendations of the women's caucus. The US's priorities are promotion of universal access to the full range of high quality family planning and reproductive health services; increasing women's status; child survival promotion; serving adolescent needs; augmenting the role and responsibility of men in

Changing policies, changing patterns of care

DEFF Research Database (Denmark)

Rostgaard, Tine; Szebehely, Marta

2012-01-01

Despite pursuing the policy of ageing in place, the two Nordic countries of Denmark and Sweden have taken diverse roads in regard to the provision of formal, public tax-financed home care for older people. Whilst Sweden has cut down home care and targeted services for the most needy, Denmark has...... continued the generous provision of home care. This article focuses on the implication of such diverse policies for the provision and combination of formal and informal care resources for older people. Using data from Level of Living surveys (based on interviews with a total of 1,158 individuals aged 67...... countries tax-funded home care is used across social groups but targeting of resources at the most needy in Sweden creates other inequalities: Older people with shorter education are left with no one to resort to but the family, whilst those with higher education purchase help from market providers...

Scientific consensus and climate change: the codification of a global research agenda

International Nuclear Information System (INIS)

Boehmer-Christiansen, S.

1993-01-01

The 'scientific consensus' which influenced the Framework Convention on Climate Change was carefully drafted by the Intergovernmental Panel on Climate Change (IPCC) between 1988 and 1992. In spite of it, there have been divergent national responses and policy controversy continues. The willingness of States to reduce the emission of greenhouse gases appears to be declining. An explanation for this is proposed which stresses the question of whether the nature of the scientific advice as sought and given bears some responsibility for the weak policy response. Institutional and personality factors in the formulation of IPCC advice are explored, as is the policy model upon which advice was given. It is concluded that this model is intrinsically unable to generate decisive environmental policy, but rather invites the institutions of the natural sciences and macro-economics to endow their research agendas with claims to policy relevance through the production of future 'findings'. (Author)

Developing recommendations to improve the quality of diabetes care in Ireland: a policy analysis.

Science.gov (United States)

Mc Hugh, Sheena M; Perry, Ivan J; Bradley, Colin; Brugha, Ruairí

2014-09-18

In 2006, the Health Service Executive (HSE) in Ireland established an Expert Advisory Group (EAG) for Diabetes, to act as its main source of operational policy and strategic advice for this chronic condition. The process was heralded as the starting point for the development of formal chronic disease management programmes. Although recommendations were published in 2008, implementation did not proceed as expected. Our aim was to examine the development of recommendations by the EAG as an instrumental case study of the policy formulation process, in the context of a health system undergoing organisational and financial upheaval. This study uses Kingdon's Multiple Streams Theory to examine the evolution of the EAG recommendations. Semi-structured interviews were conducted with a purposive sample of 15 stakeholders from the advisory group. Interview data were supplemented with documentary analysis of published and unpublished documents. Thematic analysis was guided by the propositions of the Kingdon model. In the problem stream, the prioritisation of diabetes within the policy arena was a gradual process resulting from an accumulation of evidence, international comparison, and experience. The policy stream was bolstered by group consensus rather than complete agreement on the best way to manage the condition. The EAG assumed the politics stream was also on course to converge with the other streams, as the group was established by the HSE, which had the remit for policy implementation. However, the politics stream did not converge due to waning support from health service management and changes to the organisational structure and financial capacity of the health system. These changes trumped the EAG process and the policy window remained closed, stalling implementation. Our results reflect the dynamic nature of the policy process and the importance of timing. The results highlight the limits of rational policy making in the face of organisational and fiscal upheaval

Staff immunisation: policy and practice in child care.

Science.gov (United States)

Spokes, Paula J; Ferson, Mark J; Ressler, Kelly-Anne

2011-08-01

The aims of this study were to determine the level of knowledge among child-care centre directors regarding the National Health and Medical Research Council (NHMRC) recommendations for the immunisation of child-care workers, the extent to which this knowledge was translated into practice and any organisational barriers to the development and implementation of staff immunisation policy. A cross-sectional survey, conducted in August 2006, in which a postal questionnaire was sent to a random sample of 784 NSW child-care centres. Centre directors were asked to complete the questionnaire on immunisation knowledge, policy and practice for the centre. A multivariate logistic-regression model was used to identify factors independently associated with centres with an immunisation policy for staff and centres that offered to pay all or part of the cost of vaccination of staff. Directors from 437 centres participated in the study for a response rate of 56%. Of these, 49% were aware of the NHMRC recommendations, and 57% had a staff immunisation policy in place. In the logistic regression model, centres with a written immunisation policy for staff were more likely to be aware of the NHMRC guidelines and offer long day care services. Centres that offered to pay all or part of the cost of immunisation for staff were more likely to be aware of the NHMRC guidelines, offer other child-care services and not operate for profit. Barriers to staff immunisation were related to the implementation of policy and included cost, time and access to information. The level of awareness of specific staff immunisation recommendations was relatively low. The transition of knowledge to policy was encouraging, although implementation of policies requires further commitment. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

The diagnostic work up of growth failure in secondary health care ; An evaluation of consensus guidelines

NARCIS (Netherlands)

Grote, F.K.; Oostdijk, W.; Muinck Keizer-Schrama, S.M.P.F. de; Dommelen, P. van; Buuren, S. van; Dekker, F.W.; Ketel, A.G.; Moll, H.A.; Wit, J.M.

2008-01-01

Background: As abnormal growth might be the first manifestation of undetected diseases, it is important to have accurate referral criteria and a proper diagnostic work-up. In the present paper we evaluate the diagnostic work-up in secondary health care according to existing consensus guidelines and

Reconciling patient and provider priorities for improving the care of critically ill patients: A consensus method and qualitative analysis of decision making.

Science.gov (United States)

McKenzie, Emily; Potestio, Melissa L; Boyd, Jamie M; Niven, Daniel J; Brundin-Mather, Rebecca; Bagshaw, Sean M; Stelfox, Henry T

2017-12-01

Providers have traditionally established priorities for quality improvement; however, patients and their family members have recently become involved in priority setting. Little is known about how to reconcile priorities of different stakeholder groups into a single prioritized list that is actionable for organizations. To describe the decision-making process for establishing consensus used by a diverse panel of stakeholders to reconcile two sets of quality improvement priorities (provider/decision maker priorities n=9; patient/family priorities n=19) into a single prioritized list. We employed a modified Delphi process with a diverse group of panellists to reconcile priorities for improving care of critically ill patients in the intensive care unit (ICU). Proceedings were audio-recorded, transcribed and analysed using qualitative content analysis to explore the decision-making process for establishing consensus. Nine panellists including three providers, three decision makers and three family members of previously critically ill patients. Panellists rated and revised 28 priorities over three rounds of review and reached consensus on the "Top 5" priorities for quality improvement: transition of patient care from ICU to hospital ward; family presence and effective communication; delirium screening and management; early mobilization; and transition of patient care between ICU providers. Four themes were identified as important for establishing consensus: storytelling (sharing personal experiences), amalgamating priorities (negotiating priority scope), considering evaluation criteria and having a priority champion. Our study demonstrates the feasibility of incorporating families of patients into a multistakeholder prioritization exercise. The approach described can be used to guide consensus building and reconcile priorities of diverse stakeholder groups. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Consensus Based Nuclear Public-Hearing System Model

International Nuclear Information System (INIS)

Young Wook Lee; Suk Hoon Kim; Young Ho Cho; Hyun Seok Ko; Dong Hoon Shin; Chang Sun Kang; Joo Hyun Moon

2006-01-01

Although the government admit the benefit of construction of a nuclear facility for national electric source, related policy could be developed and carried out only if the public, especially who have some stake on it, recognize the benefit and accept the policy. For public participation, Korea has a system of public-hearing in accordance with the law. Because of the absence of the detailed way for public opinion aggregation and for the reflection of the aggregated opinion, Korean public-hearing system is only a conceptual model. Therefore, some specific system for Korean Public-Hearing should be developed and applied. In this study, to share the right of decision making, which is an ultimate concept for public participation, decision making components and the characteristics of each phase are analyzed. The criteria weight for assessment and comparison with alternatives are founded as a valuation factor of the decision making components, which should be based on the social consensus. On these foundations, a system for aggregation and reflection of the public opinion was proposed. The system named 'CPDM' (Consensus based Participatory Decision Making) has three authority groups for decision making. At first, 'advisory experts group' play a role for the technical assessment and the serve utility value on the criteria for each alternatives. Next, 'participatory deliberation group' play a role for consensus building on the relative-importance (weight) between the criteria by feedback to promote degree of consensus. Lastly including gentlemen of the long robe, 'expert group for decision making' play a role to reflect the utility and weight and make a decision with agreement for performance of it. Also, in this study, a mathematical model for the quantification of the degree of consensus was conceptualized using Ordered Weighted Averaging (OWA) aggregation operator and fuzzy similarity theory, which is a comparison concept. Since this model enables influence of each

Consensus statement on panic disorder from the International Consensus Group on Depression and Anxiety.

Science.gov (United States)

Ballenger, J C; Davidson, J R; Lecrubier, Y; Nutt, D J; Baldwin, D S; den Boer, J A; Kasper, S; Shear, M K

1998-01-01

To provide primary care clinicians with a better understanding of management issues in panic disorder and guide clinical practice with recommendations for appropriate pharmacotherapy. The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Four faculty invited by the chairman also participated: David S. Baldwin, Johan A. den Boer, Siegfried Kasper, and M. Katherine Shear. The consensus statement is based on the 6 review papers that are published in this supplement and on the scientific literature relevant to these issues. There were group meetings held during a 2-day period. On day 1, the group discussed each review paper and the chairman and discussant (Dr. Kasper) identified key issues for further debate. On day 2, the group discussed these key issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chairman and approved by all attendees. The consensus statement provides standard definitions for response and remission and identifies appropriate strategy for the management of panic disorder in a primary care setting. Serotonin selective reuptake inhibitors are recommended as drugs of first choice with a treatment period of 12 to 24 months. Pharmacotherapy should be discontinued slowly over a period of 4 to 6 months.

US and territory telemedicine policies: identifying gaps in perinatal care

Science.gov (United States)

Okoroh, Ekwutosi M.; Kroelinger, Charlan D.; Smith, Alexander M.; Goodman, David A.; Barfield, Wanda D.

2016-01-01

BACKGROUND Perinatal regionalization is a system of maternal and neonatal risk-appropriate health care delivery in which resources are ideally allocated for mothers and newborns during pregnancy, labor and delivery, and postpartum, in order to deliver appropriate care. Typically, perinatal risk-appropriate care is provided in-person, but with the advancement of technologies, the opportunity to provide care remotely has emerged. Telemedicine provides distance-based care to patients by consultation, diagnosis, and treatment in rural or remote US jurisdictions (states and territories). OBJECTIVE We sought to summarize the telemedicine policies of states and territories and assess if maternal and neonatal risk-appropriate care is specified. STUDY DESIGN We conducted a 2014 systematic World Wide Web–based review of publicly available rules, statutes, regulations, laws, planning documents, and program descriptions among US jurisdictions (N=59) on telemedicine care. Policies including language on the topics of consultation, diagnosis, or treatment, and those specific to maternal and neonatal risk-appropriate care were categorized for analysis. RESULTS Overall, 36 jurisdictions (32 states; 3 territories; and District of Columbia) (61%) had telemedicine policies with language referencing consultation, diagnosis, or treatment; 29 (49%) referenced consultation, 30 (51%) referenced diagnosis, and 35 (59%) referenced treatment. In all, 26 jurisdictions (22 states; 3 territories; and District of Columbia) (44%), referenced all topics. Only 3 jurisdictions (3 states; 0 territories) (5%), had policy language specifically addressing perinatal care. CONCLUSION The majority of states have published telemedicine policies, but few specify policy language for perinatal risk-appropriate care. By ensuring that language specific to the perinatal population is included in telemedicine policies, access to maternal and neonatal care can be increased in rural, remote, and resource

Similar and yet so different: cash-for-care in six European countries' long-term care policies.

Science.gov (United States)

Da Roit, Barbara; Le Bihan, Blanche

2010-09-01

In response to increasing care needs, the reform or development of long-term care (LTC) systems has become a prominent policy issue in all European countries. Cash-for-care schemes-allowances instead of services provided to dependents-represent a key policy aimed at ensuring choice, fostering family care, developing care markets, and containing costs. A detailed analysis of policy documents and regulations, together with a systematic review of existing studies, was used to investigate the differences among six European countries (Austria, France, Germany, Italy, the Netherlands, and Sweden). The rationale and evolution of their various cash-for-care schemes within the framework of their LTC systems also were explored. While most of the literature present cash-for-care schemes as a common trend in the reforms that began in the 1990s and often treat them separately from the overarching LTC policies, this article argues that the policy context, timing, and specific regulation of the new schemes have created different visions of care and care work that in turn have given rise to distinct LTC configurations. A new typology of long-term care configurations is proposed based on the inclusiveness of the system, the role of cash-for-care schemes and their specific regulations, as well as the views of informal care and the care work that they require. © 2010 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

Family care work: a policy-relevant research agenda.

Science.gov (United States)

Moen, Phyllis; DePasquale, Nicole

2017-03-01

This article addresses the need for policy-relevant research agendas on family care in transaction with formal care and public as well as organisational norms and policies in light of the crisis in caregiving for older adults. We propose a combined institutional and life-course theoretical approach, suggesting seven ways of organising scholarly enquiry to promote understanding of the changing nature of family care in the 21st century, inform policymakers' efforts at supporting family caregivers and improve caregivers' and care recipients' quality of life. These include: (1) moving beyond snapshots of individuals; (2) conducting comparative cross-cultural and crosscohort analyses; (3) documenting social heterogeneity, vulnerability and inequality; (4) capturing individuals' and families' adaptive strategies and cycles of control during the caregiving process; (5) investigating policy innovations and natural experiments; (6) assessing third parties as mediating institutions between regulatory environments and caregiving families; and (7) attending to the subjective meanings of care.

Health Policy Training: A Review of the Literature.

Science.gov (United States)

Heiman, Harry J; Smith, L Lerissa; McKool, Marissa; Mitchell, Denise N; Roth Bayer, Carey

2015-12-23

The context within which health care and public health systems operate is framed by health policies. There is growing consensus about the need for increased health policy leadership and a health professional workforce prepared to assume these leadership roles. At the same time, there is strong evidence supporting the need for a broader policy lens and the need to intentionally target health disparities. We reviewed the published literature between 1983 and 2013 regarding health policy training. From 5124 articles identified, 33 met inclusion criteria. Articles varied across common themes including target audience, goal(s), health policy definition, and core curricular content. The majority of articles were directed to medical or nursing audiences. Most articles framed health policy as health care policy and only a small number adopted a broader health in all policies definition. Few articles specifically addressed vulnerable populations or health disparities. The need for more rigorous research and evaluation to inform health policy training is compelling. Providing health professionals with the knowledge and skills to engage and take leadership roles in health policy will require training programs to move beyond their limited health care-oriented health policy framework to adopt a broader health and health equity in all policies approach.

Health Policy Training: A Review of the Literature

Directory of Open Access Journals (Sweden)

Harry J. Heiman

2015-12-01

Full Text Available The context within which health care and public health systems operate is framed by health policies. There is growing consensus about the need for increased health policy leadership and a health professional workforce prepared to assume these leadership roles. At the same time, there is strong evidence supporting the need for a broader policy lens and the need to intentionally target health disparities. We reviewed the published literature between 1983 and 2013 regarding health policy training. From 5124 articles identified, 33 met inclusion criteria. Articles varied across common themes including target audience, goal(s, health policy definition, and core curricular content. The majority of articles were directed to medical or nursing audiences. Most articles framed health policy as health care policy and only a small number adopted a broader health in all policies definition. Few articles specifically addressed vulnerable populations or health disparities. The need for more rigorous research and evaluation to inform health policy training is compelling. Providing health professionals with the knowledge and skills to engage and take leadership roles in health policy will require training programs to move beyond their limited health care-oriented health policy framework to adopt a broader health and health equity in all policies approach.

Consensus principles for wound care research obtained using a Delphi process.

Science.gov (United States)

Serena, Thomas; Bates-Jensen, Barbara; Carter, Marissa J; Cordrey, Renee; Driver, Vickie; Fife, Caroline E; Haser, Paul B; Krasner, Diane; Nusgart, Marcia; Smith, Adrianne P S; Snyder, Robert J

2012-01-01

Too many wound care research studies are poorly designed, badly executed, and missing crucial data. The objective of this study is to create a series of principles for all stakeholders involved in clinical or comparative effectiveness research in wound healing. The Delphi approach was used to reach consensus, using a web-based survey for survey participants and face-to-face conferences for expert panel members. Expert panel (11 members) and 115 wound care researchers (respondents) drawn from 15 different organizations. Principles were rated for validity using 5-point Likert scales and comments. A 66% response rate was achieved in the first Delphi round from the 173 invited survey participants. The response rate for the second Delphi round was 46%. The most common wound care researcher profile was age 46-55 years, a wound care clinic setting, and >10 years' wound care research and clinical experience. Of the initial 17 principles created by the panel, only four principles were not endorsed in Delphi round 1 with another four not requiring revision. Of the 14 principles assessed by respondents in the second Delphi round, only one principle was not endorsed and it was revised; four other principles also needed revision based on the use of specific words or contextual use. Of the 19 final principles, three included detailed numbered lists. With the wide variation in design, conduct, and reporting of wound care research studies, it is hoped that these principles will improve the standard and practice of care in this field. © 2012 by the Wound Healing Society.

The International Glossary on Infertility and Fertility Care, 2017

DEFF Research Database (Denmark)

Zegers-Hochschild, Fernando; Adamson, G. David; Dyer, Silke

2017-01-01

STUDY QUESTION: Can a consensus and evidence-driven set of terms and definitions be generated to be used globally in order to ensure consistency when reporting on infertility issues and fertility care interventions, as well as to harmonize communication among the medical and scientific communities......, policy-makers, and lay public including individuals and couples experiencing fertility problems? SUMMARY ANSWER: A set of 283 consensus-based and evidence-driven terminologies used in infertility and fertility care has been generated through an inclusive consensus-based process with multiple stakeholders...... of the reproductive system, and increased standardization of fertility treatment terminology. Since 2009, limitations were identified in several areas and enhancements were suggested for the glossary, especially concerning male factor, demography, epidemiology and public health issues. STUDY DESIGN, SIZE, DURATION...

End-Of-Life Care for Persons with Advanced Chronic Obstructive Pulmonary Disease: Report of a National Interdisciplinary Consensus Meeting

Directory of Open Access Journals (Sweden)

DM Goodridge

2009-01-01

Full Text Available While systemic shortcomings in meeting the needs of individuals with progressive chronic illnesses at the end of life have been well documented, there is growing interest in improving both care and quality of life for persons with advanced chronic obstructive pulmonary disease (COPD. For instance, the American Thoracic Society has issued an official statement on palliative care for patients with respiratory diseases, affirming that the prevention, relief, reduction and soothing of symptoms “without affecting a cure” must become an integral component of standard care. A recent Medline search located 1015 articles related to palliative or end-of-life care for people with COPD published between 2001 and 2008, compared with only 336 articles published before 2001. To address the needs of Canadian patients, an interdisciplinary consensus meeting, funded by the Canadian Institutes of Health Research and supported by the Canadian Thoracic Society, the Canadian Respiratory Health Professionals and the Canadian Lung Association was convened in Toronto, Ontario, on November 22, 2008, to begin examining the quality of end-of-life care for individuals with COPD in Canada. The present report summarizes the background to and outcomes of this consensus meeting.

Care ‘going market’: Finnish elderly-care policies in transition

Directory of Open Access Journals (Sweden)

Anneli Anttonen

2011-06-01

-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} The article evaluates marketization and its effects on elderly-care policies in Finland, where the welfare state has been the most important mechanism in mitigating failures caused by the functioning of market. In addition, since the 1960s the public sector has been regarded as the guarantee for citizens' social rights and the common good. Therefore, marketization, denoting to market logics intervened with social-care practices that construct care as a commodity and the individual in need of care as a consumer, is a critical juncture for an evaluation of the underlying pattern change. To evaluate the change this article employs a framework of institutional policy analysis. By focusing on institutional framing of care policies, institutionalized responsibilities, policy discourses, and policy outcomes and by using textual and statistical data, this article aims to reach a detailed but comprehensive picture on marketization and its influence in the Finnish social-care regime. All institutional aspects analysed in the study show a clear transition from universal social policies based on public responsibility to market-friendly policies and the marketization of social care. However, they also imply that marketization is regulated by public authorities. On the basis of these results, we argue that Finnish elderly-care policies is going through a profound change, in magnitude similar to what occurred 30-40 years ago when the politics of universalism was breaking through. The new direction points to the market and a deep-going reform of social-care service provision is taking place, and the earlier state-centred welfare production mode is at least partly withering away. In this respect the pattern of social-care service

Developing an undergraduate curriculum in Special Care Dentistry - by consensus.

LENUS (Irish Health Repository)

Dougall, A

2013-02-01

It has been reported that healthcare providers often lack the skills set to provide care for people with disabilities, leading to inequalities in health and reduced access to health care. Newly graduating dentists are likely to see a significant number of patients with special healthcare needs in the course of their practicing lives. However, there is evidence of national and international variation in the availability of education and training at the undergraduate level in this important, emerging area. The quality and content of undergraduate education in Special Care Dentistry has been shown to correlate with students\\' confidence and their expressed willingness, towards providing care for patients with special healthcare needs in their future practice. The aim of this study was to use information from a three-round Delphi process, continued into a face-to-face meeting, to establish consensus on what constitutes the essential core knowledge, skills and attitudes required by a newly qualified dentist so that they are able to deliver patient care to diverse populations following graduation. A high level of agreement was established amongst an international panel of experts from 30 countries. The final core items identified by the panel showed a paradigm shift away from the traditional emphasis on medical diagnosis within a curriculum towards an approach based on the International Classification of Functioning (ICF) with patient-centred treatment planning for people with disabilities and special healthcare needs according to function or environment. Many of the core skills identified by the panel are transferable across a curriculum and should encourage a person-centred approach to treatment planning based on the function, needs and wishes of the patient rather than their specific diagnosis.

Best Practices for Chiropractic Care for Older Adults: A Systematic Review and Consensus Update.

Science.gov (United States)

Hawk, Cheryl; Schneider, Michael J; Haas, Mitchell; Katz, Paul; Dougherty, Paul; Gleberzon, Brian; Killinger, Lisa Z; Weeks, John

2017-05-01

The purpose of this study was to update evidence-based recommendations on the best practices for chiropractic care of older adults. The project consisted of a systematic literature review and a consensus process. The following were searched from October 2009 through January 2016: MEDLINE, Index to Chiropractic Literature, CINAHL (Cumulative Index to Nursing and Allied Health Literature), AMED (Allied and Complementary Medicine Database), Alt HealthWatch, Cochrane Database of Systematic Reviews, and Cochrane Registry of Controlled Trials. Search terms were: (manipulation, spinal OR manipulation, chiropractic OR chiropract*) AND (geriatric OR "older adult*"). Two reviewers independently screened articles and abstracts using inclusion and exclusion criteria. The systematic review informed the project steering committee, which revised the previous recommendations. A multidisciplinary panel of experts representing expertise in practice, research, and teaching in a variety of health professions serving older adults rated the revised recommendations. The RAND Corporation/University of California, Los Angeles methodology for a modified Delphi consensus process was used. A total of 199 articles were found; after exclusion criteria were applied, 6 articles about effectiveness or efficacy and 6 on safety were added. The Delphi process was conducted from April to June 2016. Of the 37 Delphi panelists, 31 were DCs and 6 were other health care professionals. Three Delphi rounds were conducted to reach consensus on all 45 statements. As a result, statements regarding the safety of manipulation were strengthened and additional statements were added recommending that DCs advise patients on exercise and that manipulation and mobilization contribute to general positive outcomes beyond pain reduction only. This document provides a summary of evidence-informed best practices for doctors of chiropractic for the evaluation, management, and manual treatment of older adult patients

Asian Consensus Report on Functional Dyspepsia

Science.gov (United States)

Miwa, Hiroto; Ghoshal, Uday C; Gonlachanvit, Sutep; Gwee, Kok-Ann; Ang, Tiing-Leong; Chang, Full-Young; Fock, Kwong Ming; Hongo, Michio; Hou, Xiaohua; Kachintorn, Udom; Ke, Meiyun; Lai, Kwok-Hung; Lee, Kwang Jae; Lu, Ching-Liang; Mahadeva, Sanjiv; Miura, Soichiro; Park, Hyojin; Rhee, Poong-Lyul; Sugano, Kentaro; Vilaichone, Ratha-korn; Wong, Benjamin CY

2012-01-01

Background/Aims Environmental factors such as food, lifestyle and prevalence of Helicobacter pylori infection are widely different in Asian countries compared to the West, and physiological functions and genetic factors of Asians may also be different from those of Westerners. Establishing an Asian consensus for functional dyspepsia is crucial in order to attract attention to such data from Asian countries, to articulate the experience and views of Asian experts, and to provide a relevant guide on management of functional dyspepsia for primary care physicians working in Asia. Methods Consensus team members were selected from Asian experts and consensus development was carried out using a modified Delphi method. Consensus teams collected published papers on functional dyspepsia especially from Asia and developed candidate consensus statements based on the generated clinical questions. At the first face-to-face meeting, each statement was reviewed and e-mail voting was done twice. At the second face-to-face meeting, final voting on each statement was done using keypad voting system. A grade of evidence and a strength of recommendation were applied to each statement according to the method of the GRADE Working Group. Results Twenty-nine consensus statements were finalized, including 7 for definition and diagnosis, 5 for epidemiology, 9 for pathophysiology and 8 for management. Algorithms for diagnosis and management of functional dyspepsia were added. Conclusions This consensus developed by Asian experts shows distinctive features of functional dyspepsia in Asia and will provide a guide to the diagnosis and management of functional dyspepsia for Asian primary care physicians. PMID:22523724

Pharmaceutical policy and the lay public

DEFF Research Database (Denmark)

Traulsen, Janine Marie; Almarsdóttir, Anna Birna

2005-01-01

Almost every national and supranational health policy document accords high importance to the need to listen to and 'empower' patients. The relationship between pharmaceutical policy and the lay public is not direct but mediated by several actors, including health care workers, patient organisati......Almost every national and supranational health policy document accords high importance to the need to listen to and 'empower' patients. The relationship between pharmaceutical policy and the lay public is not direct but mediated by several actors, including health care workers, patient...... organisations, industry and, most recently, the media. Although the overall aim of health and pharmaceutical policy is to address the needs of all citizens, there are only a few, well organised groups who are actually consulted and involved in the policymaking process, often with the support of the industry....... The reasons for this lack of citizen involvement in health and pharmaceutical policymaking are many, for example: there is no consensus about what public involvement means; there is a predominance of special interest groups with narrow, specific agendas; not all decision makers welcome lay participation...

Palliative care policy analysis in Iran: A conceptual model

Directory of Open Access Journals (Sweden)

Mojgan Ansari

2018-01-01

Full Text Available Background: Palliative care programs are rapidly evolving for patients with life-threatening illnesses. Increased and earlier access for facilities is a subject of growing importance in health services, policy, and research. Aim: This study was conducted to explain stakeholders' perceptions of the factors affecting the design of such a palliative care system and its policy analysis. Methodology: Semi-structured in-depth interviews conducted following purposive sampling of the participants. Twenty-two participants were included in the study. The interviews were analyzed using qualitative-directed content analysis based on "policy analysis triangle" framework. Results: The findings showed the impact of four categories, namely context (political, social, and structural feasibility, content (target setting, process (attracting stakeholder participation, the standardization of care, and education management, and actors (the Ministry of Health and Medical Education, health-care providers, and volunteers in the analysis of the palliative care policies of Iran. Conclusion: In the past 6 years, attention to palliative care has increased significantly as a result of the National Cancer Research Network with the support of the Ministry of Health. The success of health system plan requires great attention to its aspects of social, political, and executive feasibility. Careful management by policymakers of different stakeholders is vital to ensure support for any national plan, but this is challenging to achieve.

Policy choices in dementia care-An exploratory analysis of the Alberta continuing care system (ACCS) using system dynamics.

Science.gov (United States)

Cepoiu-Martin, Monica; Bischak, Diane P

2018-02-01

The increase in the incidence of dementia in the aging population and the decrease in the availability of informal caregivers put pressure on continuing care systems to care for a growing number of people with disabilities. Policy changes in the continuing care system need to address this shift in the population structure. One of the most effective tools for assessing policies in complex systems is system dynamics. Nevertheless, this method is underused in continuing care capacity planning. A system dynamics model of the Alberta Continuing Care System was developed using stylized data. Sensitivity analyses and policy evaluations were conducted to demonstrate the use of system dynamics modelling in this area of public health planning. We focused our policy exploration on introducing staff/resident benchmarks in both supportive living and long-term care (LTC). The sensitivity analyses presented in this paper help identify leverage points in the system that need to be acknowledged when policy decisions are made. Our policy explorations showed that the deficits of staff increase dramatically when benchmarks are introduced, as expected, but at the end of the simulation period, the difference in deficits of both nurses and health care aids are similar between the 2 scenarios tested. Modifying the benchmarks in LTC only versus in both supportive living and LTC has similar effects on staff deficits in long term, under the assumptions of this particular model. The continuing care system dynamics model can be used to test various policy scenarios, allowing decision makers to visualize the effect of a certain policy choice on different system variables and to compare different policy options. Our exploration illustrates the use of system dynamics models for policy making in complex health care systems. © 2017 John Wiley & Sons, Ltd.

"Who Cares for the Children?" Lessons from a Global Perspective of Child Care Policy

Science.gov (United States)

Lokteff, Maegan; Piercy, Kathleen W.

2012-01-01

We present the argument that the meaning of child care and the policies that address it are explicitly linked with national ideologies, work force participation, economic success, and child outcomes. The relationship between family and child care policies is cyclical in nature, with a nation's ideology and vision of family often driving child care…

Advance care planning for nursing home residents with dementia: policy vs. practice.

Science.gov (United States)

Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal

2016-03-01

The aims of this study were: to evaluate the advance care planning policy for people with dementia in nursing homes; to gain insight in the involvement of residents with dementia and their families in advance care planning, and in the relationship between the policy and the actual practice of advance care planning. Through advance care planning, nursing home residents with dementia are involved in care decisions, anticipating their reduced decision-making capacity. However, advance care planning is rarely realized for this group. Prevalence and outcomes have been researched, but hardly any research has focused on the involvement of residents/families in advance care planning. Observational cross-sectional study in 20 nursing homes. The ACP audit assessed the views of the nursing homes' staff on the advance care planning policy. In addition, individual conversations were analysed with 'ACP criteria' (realization of advance care planning) and the 'OPTION' instrument (involvement of residents/families). June 2013-September 2013. Nursing homes generally met three quarters of the pre-defined criteria for advance care planning policy. In almost half of the conversations, advance care planning was explained and discussed substantively. Generally, healthcare professionals only managed to involve residents/families on a baseline skill level. There were no statistically significant correlations between policy and practice. The evaluations of the policy were promising, but the actual practice needs improvement. Future assessment of both policy and practice is recommended. Further research should focus on communication interventions for implementing advance care planning in the daily practice. © 2015 John Wiley & Sons Ltd.

European Consensus on Primary Prevention of Coronary Heart Disease.

Science.gov (United States)

Assmann, G

1988-07-01

The European Consensus on Primary Prevention of Coronary Heart Disease has recommended that providing care for individuals at particular risk for coronary artery disease (CAD) requires case finding through medical examinations in primary care, hospital and employment health examination settings. Decisions concerning management of elevated lipid levels should be based on overall cardiovascular risk. The goal of reducing cholesterol levels through risk reduction can ultimately be accomplished only with the implementation of health education efforts directed toward all age groups and actions by government and supranational agencies, including adequate food labelling to identify fat content, selective taxation to encourage healthful habits and wider availability of exercise facilities. Only measures directed at the overall population can eventually reach the large proportion of individuals at mildly to moderately increased risk for CAD. The European Policy Statement on the Prevention of Coronary Heart Disease recognizes that the question of lipid elevation as a risk factor for CAD involves assessment, not only of cholesterol level alone, but also of triglycerides and the HDL cholesterol lipid fraction. Five specific categories of dyslipidemia have been identified, with individualized screening and treatment strategies advised for each. It is the consensus of the study group panel members that these procedures are both practical and feasible. They begin the necessary long term process to reduce the unacceptably high levels of morbidity and mortality due to CAD throughout the European community.

EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum.

Science.gov (United States)

van de Velde, Cornelis J H; Boelens, Petra G; Borras, Josep M; Coebergh, Jan-Willem; Cervantes, Andres; Blomqvist, Lennart; Beets-Tan, Regina G H; van den Broek, Colette B M; Brown, Gina; Van Cutsem, Eric; Espin, Eloy; Haustermans, Karin; Glimelius, Bengt; Iversen, Lene H; van Krieken, J Han; Marijnen, Corrie A M; Henning, Geoffrey; Gore-Booth, Jola; Meldolesi, Elisa; Mroczkowski, Pawel; Nagtegaal, Iris; Naredi, Peter; Ortiz, Hector; Påhlman, Lars; Quirke, Philip; Rödel, Claus; Roth, Arnaud; Rutten, Harm; Schmoll, Hans J; Smith, Jason J; Tanis, Pieter J; Taylor, Claire; Wibe, Arne; Wiggers, Theo; Gambacorta, Maria A; Aristei, Cynthia; Valentini, Vincenzo

2014-01-01

Care for patients with colon and rectal cancer has improved in the last 20years; however considerable variation still exists in cancer management and outcome between European countries. Large variation is also apparent between national guidelines and patterns of cancer care in Europe. Therefore, EURECCA, which is the acronym of European Registration of Cancer Care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012, the first multidisciplinary consensus conference about cancer of the colon and rectum was held. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries. The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Consensus was achieved using the Delphi method. For the Delphi process, multidisciplinary experts were invited to comment and vote three web-based online voting rounds and to lecture on the subjects during the meeting (13th-15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. This manuscript covers all sentences of the consensus document with the result of the voting. The consensus document represents sections on diagnostics, pathology, surgery, medical oncology, radiotherapy, and follow-up where

Protecting care home residents from mistreatment and abuse: on the need for policy

Directory of Open Access Journals (Sweden)

Phelan A

2015-11-01

Full Text Available Amanda Phelan School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland Abstract: With a rising older person population with increasing life expectancies, the demand for care homes will increase in the future. Older people in care homes are particularly vulnerable due to their dependencies related to cognitive and/or functional self-care challenges. Although many care homes provide good care, maltreatment and abuse of older people can and does occur. One major step in preventing and addressing maltreatment in care homes is having comprehensive and responsive policy, which delineates national expectations that are locally implemented. This paper examines the literature related to maltreatment in care homes and argues for policy based on a multisystems approach. Policy needs to firstly acknowledge and address general societal issues which tacitly impact on older person care delivery, underpin how care homes and related systems should be operationalized, and finally delineate expected standards and outcomes for individual experience of care. Such a policy demands attention at every level of the health care and societal system. Furthermore, contemporary issues central to policy evolution in care homes are discussed, such as safeguarding education and training and fostering organization whistle-blowing protection. Keywords: care homes, maltreatment, policy, older people

Practical recommendations for improvement of the physical health care of patients with severe mental illness

NARCIS (Netherlands)

van Hasselt, F. M.; Oud, M. J. T.; Loonen, A. J. M.

ObjectiveHealth care for the physical health of patients with severe mental illness (SMI) needs to be improved. Therefore, we aimed to develop policy recommendations to improve this physical health care in the Netherlands based on consensus (general agreement) between the major stakeholders. MethodA

The atomic policy consensus as legally binding contract; Der Atomkonsens als rechtsverbindlicher Vertrag. Gutachten im Rahmen des ICSID-Schiedsverfahrens Vattenfall v. Germany im Auftrag der Vattenfall AB

Energy Technology Data Exchange (ETDEWEB)

Kischel, Uwe

2017-07-01

The booklet on the atomic policy consensus as legally binding contract covers the following issues: legal prerequisites for legal binding, interpretation viewpoints, possible further aspect of the legal binding.

Reproductive health care strategy -- a gender-sensitive approach to family welfare.

Science.gov (United States)

Anita

1996-01-01

The author advocates a reproductive health care strategy to revitalize India's family welfare program. A major shift in focus is needed in population policy and programs to incorporate a gender-sensitive approach. That shift should help to clear the path toward improved health status for women and female children. Consensus reached at the UN's 1994 International Conference on Population and Development supported a change in population and development policies, affording women's empowerment, gender equality, and equity greater priority for a meaningful policy of human-centered sustainable development. Reproductive health care, reproductive health in practice, the quality of care in reproductive health, gender equality as a human right, and empowering women are discussed.

Universal Health Coverage in Francophone Sub-Saharan Africa: Assessment of Global Health Experts' Confidence in Policy Options.

Science.gov (United States)

Paul, Elisabeth; Fecher, Fabienne; Meloni, Remo; van Lerberghe, Wim

2018-05-29

Many countries rely on standard recipes for accelerating progress toward universal health coverage (UHC). With limited generalizable empirical evidence, expert confidence and consensus plays a major role in shaping country policy choices. This article presents an exploratory attempt conducted between April and September 2016 to measure confidence and consensus among a panel of global health experts in terms of the effectiveness and feasibility of a number of policy options commonly proposed for achieving UHC in low- and middle-income countries, such as fee exemptions for certain groups of people, ring-fenced domestic health budgets, and public-private partnerships. To ensure a relative homogeneity of contexts, we focused on French-speaking sub-Saharan Africa. We initially used the Delphi method to arrive at expert consensus, but since no consensus emerged after 2 rounds, we adjusted our approach to a statistical analysis of the results from our questionnaire by measuring the degree of consensus on each policy option through 100 (signifying total consensus) minus the size of the interquartile range of the individual scores. Seventeen global health experts from various backgrounds, but with at least 20 years' experience in the broad region, participated in the 2 rounds of the study. The results provide an initial "mapping" of the opinions of a group of experts and suggest interesting lessons. For the 18 policy options proposed, consensus emerged only on strengthening the supply of quality primary health care services (judged as being effective with a confidence score of 79 and consensus score of 90), and on fee exemptions for the poorest (judged as being fairly easy to implement with a confidence score of 66 and consensus score of 85). For none of the 18 common policy options was there consensus on both potential effectiveness and feasibility, with very diverging opinions concerning 5 policy options. The lack of confidence and consensus within the panel seems to

How can health care organisations make and justify decisions about risk reduction? Lessons from a cross-industry review and a health care stakeholder consensus development process

International Nuclear Information System (INIS)

Sujan, Mark A.; Habli, Ibrahim; Kelly, Tim P.; Gühnemann, Astrid; Pozzi, Simone; Johnson, Christopher W.

2017-01-01

Interventions to reduce risk often have an associated cost. In UK industries decisions about risk reduction are made and justified within a shared regulatory framework that requires that risk be reduced as low as reasonably practicable. In health care no such regulatory framework exists, and the practice of making decisions about risk reduction is varied and lacks transparency. Can health care organisations learn from relevant industry experiences about making and justifying risk reduction decisions? This paper presents lessons from a qualitative study undertaken with 21 participants from five industries about how such decisions are made and justified in UK industry. Recommendations were developed based on a consensus development exercise undertaken with 20 health care stakeholders. The paper argues that there is a need in health care to develop a regulatory framework and an agreed process for managing explicitly the trade-off between risk reduction and cost. The framework should include guidance about a health care specific notion of acceptable levels of risk, guidance about standardised risk reduction interventions, it should include regulatory incentives for health care organisations to reduce risk, and it should encourage the adoption of an approach for documenting explicitly an organisation's risk position. - Highlights: • Empirical description of industry perceptions on making risk reduction decisions. • Health care consensus development identified five recommendations. • Risk concept should be better integrated into safety management. • Education and awareness about risk concept are required. • Health systems need to start a dialogue about acceptable levels of risk.

Financing and funding health care: Optimal policy and political implementability.

Science.gov (United States)

Nuscheler, Robert; Roeder, Kerstin

2015-07-01

Health care financing and funding are usually analyzed in isolation. This paper combines the corresponding strands of the literature and thereby advances our understanding of the important interaction between them. We investigate the impact of three modes of health care financing, namely, optimal income taxation, proportional income taxation, and insurance premiums, on optimal provider payment and on the political implementability of optimal policies under majority voting. Considering a standard multi-task agency framework we show that optimal health care policies will generally differ across financing regimes when the health authority has redistributive concerns. We show that health care financing also has a bearing on the political implementability of optimal health care policies. Our results demonstrate that an isolated analysis of (optimal) provider payment rests on very strong assumptions regarding both the financing of health care and the redistributive preferences of the health authority. Copyright © 2015 Elsevier B.V. All rights reserved.

The labor impacts of policy change in health care: how federal policy transformed home health organizations and their labor practices.

Science.gov (United States)

Szasz, A

1990-01-01

Health care organizations are highly labor-intensive; policies designed to stimulate organizational change are likely to have labor impacts. This paper examines the labor effects of policy change in home health care. Major federal home care policy trends since 1980 have spurred the evolution of the typical home care provider toward greater organizational and market rationality. Greater managerial sophistication has introduced changes in management/labor relations. Survey data from the 1986 DRG Impact Study are used to show how the pressure of cost-containment policies has pushed agencies to cut labor costs by increasing workloads, managerial supervision, and control of the work process. Research on the effects of recent policy change in health care has to date focused primarily on potential client effects. Labor impacts are rarely examined and are poorly understood at the time that policy is made. Findings in this article suggest that these issues deserve greater, more systematic attention, because unanticipated labor impacts may prove to be significant impediments to the realization of intended policy goals.

Treatment of Osteoporosis in Australian Residential Aged Care Facilities: Update on Consensus Recommendations for Fracture Prevention

Science.gov (United States)

Duque, Gustavo; Lord, Stephen R.; Mak, Jenson; Ganda, Kirtan; Close, Jacqueline J.T.; Ebeling, Peter; Papaioannou, Alexandra; Inderjeeth, Charles A.

2016-01-01

Background Older people living in residential aged care facilities (RACFs) are at a higher risk of suffering fractures than the community-dwelling older population. The first Consensus Conference on Treatment of Osteoporosis in RACFs in Australia, held in Sydney in July 2009, aimed to address some of the issues relating to the treatment of older residents with osteoporosis in RACFs. Considering that the field of osteoporosis diagnosis and management has significantly advanced in the last 5 years and that new evidence has been generated from studies performed within RACFs, a Second Consensus Conference was held in Sydney in November 2014. Methods An expert panel met in November 2014 in Penrith, NSW, Australia in an attempt to reach a consensus on diverse issues related to the treatment of osteoporosis at RACFs. Participants were selected by the scientific committee on the basis of their practice in an RACF and/or major published articles. The co-chairs distributed topics randomly to all participants, who then had to propose a statement on each topic for approval by the conference after a short, evidence-based presentation, when possible. Results This article provides an update on the most relevant evidence on osteoporosis in older people living in RACFs graded according to its level, quality, and relevance. Conclusion As with the first consensus, it is hoped that this statement will constitute an important guide to aid physicians in their decision making while practicing at RACFs. PMID:27349626

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets.

Science.gov (United States)

Munns, Craig F; Shaw, Nick; Kiely, Mairead; Specker, Bonny L; Thacher, Tom D; Ozono, Keiichi; Michigami, Toshimi; Tiosano, Dov; Mughal, M Zulf; Mäkitie, Outi; Ramos-Abad, Lorna; Ward, Leanne; DiMeglio, Linda A; Atapattu, Navoda; Cassinelli, Hamilton; Braegger, Christian; Pettifor, John M; Seth, Anju; Idris, Hafsatu Wasagu; Bhatia, Vijayalakshmi; Fu, Junfen; Goldberg, Gail; Sävendahl, Lars; Khadgawat, Rajesh; Pludowski, Pawel; Maddock, Jane; Hyppönen, Elina; Oduwole, Abiola; Frew, Emma; Aguiar, Magda; Tulchinsky, Ted; Butler, Gary; Högler, Wolfgang

2016-02-01

Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describe the strength of the recommendation and the quality of supporting evidence. Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required.

Consensus-Based Palliative Care Competencies for Undergraduate Nurses and Physicians: A Demonstrative Process with Colombian Universities.

Science.gov (United States)

Pastrana, Tania; Wenk, Roberto; De Lima, Liliana

2016-01-01

A World Health Assembly (WHA) resolution adopted in 2014 strongly encourages member states to integrate palliative care (PC) in undergraduate training for health professionals. The study objective was to describe a consensus-based process workshop to develop PC competences for medical and nursing schools in Colombia and to present a summary of the findings. The workshop included 36 participants representing 16 medical and 6 nursing schools from 18 universities in Colombia. Participants were distributed in four thematic groups. Using the International Association for Hospice and Palliative Care (IAHPC) List of Essential Practices (LEP) as guidance, they were asked to discuss and define PC competencies at the undergraduate level. Participants provided feedback and approved each recommendation, and then were asked to complete an evaluation. The resulting competences were separated into six categories: (1) Definition and Principles of PC, (2) Identification and Control of Symptoms, (3) End-of-Life Care, (4) Ethical and Legal Issues, (5) Psychosocial and Spiritual Issues, and (6) Teamwork. A comparative analysis revealed that treatment of several symptoms in the IAHPC LEP (pain, dyspnea, constipation, nausea, vomit, diarrhea, delirium, and insomnia) were included in the competencies. All of the IAHPC LEP related to psychological/emotional/spiritual care was included. The evaluation rate of return was 80%. The assessment was very positive: total score of 4.7/5.0; SD = 0.426), with 89% considering the workshop to be helpful. The workshop provided an opportunity for individuals from different disciplines to discuss competencies and achieve consensus. The resulting competencies will be helpful in the development of PC curricula for physicians and nurses throughout schools in Colombia and other countries.

Day Care: A Program in Search of a Policy.

Science.gov (United States)

Bikales, Gerda

This report examines current issues relating to day care and challenges many of the policy assumptions that underlie a major public program of subsidized day care for children. A historical perspective of day care is presented and various types of day care are described. The costs and benefits of day care are examined and the relation of day care…

Approaches to the management of agents used for the treatment of multiple sclerosis: consensus statements from a panel of U.S. managed care pharmacists and physicians.

Science.gov (United States)

Miller, Ross M; Happe, Laura E; Meyer, Kellie L; Spear, Rachel J

2012-01-01

Multiple sclerosis (MS) is a chronic, disabling, and costly disease with several treatment options available; however, there is variability in evidence-based clinical guidelines. Therefore, payers are at a disadvantage when making management decisions without the benefit of definitive guidance from treatment guidelines. To outline approaches for the management of agents used to treat MS, as determined from a group of U.S. managed care pharmacists and physicians. A modified Delphi process was used to develop consensus statements regarding MS management approaches. The panel was composed of experts in managed care and included 8 pharmacy directors and 6 medical directors presently or previously involved in formulary decision making from 12 health plans, 1 specialty pharmacy, and 1 consulting company. These decision makers, who have experience designing health care benefits that include MS treatments, provided anonymous feedback through 2 rounds of web-based surveys and participated in 1 live panel meeting held in December 2010. Consensus was defined as a mean response of at least 3.3 or 100% of responses either "agree" or "strongly agree" (i.e., no panelist answered "disagree" or "strongly disagree") on a 4-item Likert scale (1=strongly disagree, 2=disagree, 3=agree, 4=strongly agree). After 3 phases, these managed care representatives reached consensus on 25 statements for management of patients with MS. Consistent with managed care principles, this group of managed care experts found that health plans should consider efficacy, effectiveness, and safety, as well as patient preference, when evaluating MS therapies for formulary placement. Cost and contracting should be considered if efficacy and safety are judged to be comparable between agents. The consensus statements developed by a panel of managed care representatives provide some insight into decision making in formulary and utilization management of MS therapies.

Employer Child Care Resources: A Guide to Developing Effective Child Care Programs and Policies.

Science.gov (United States)

Women's Bureau (DOL), Washington, DC.

Increasing numbers of employers are responding to employee child care needs by revising their benefit packages, work schedules, and recruitment plans to include child care options. This guide details ways to develop effective child care programs and policies. Section 1 of the guide describes employees' growing child care needs and employers'…

Aging, care and social policy. Continuities and changes in Argentina and Mexico

Directory of Open Access Journals (Sweden)

María Concepción ARROYO RUEDA

2015-12-01

Full Text Available This paper intends to show from a comparative perspective of social policy, the provision of care in old age in Argentina and Mexico. It will also show the experience of the national policy of care in Argentina. In this country we carried out interviews with coordinators, operational personnel and users of the national program of care. The participants identify in the policy a vision of rights and social inclusion of the elderly and effective support for family caregivers. Meanwhile, in the case of Mexico, we observe scarce and ambiguous legislation on the subject, which is predominated by the practice of informal care to older people, given mainly by the women in the families. Basic care is outside the aging policy and confined within the «familist model» according to an exalted social assessment of the moral obligation of family care.

A Nordic Perspective on Early Childhood Education and Care Policy

Science.gov (United States)

Karila, Kirsti

2012-01-01

The national policies and historical roots of early childhood education (ECE) vary from society to society. In the Nordic countries, early childhood education and care (ECEC) policies have been built in the context of the welfare state. As such, they are closely connected to other welfare policy areas such as social policy, family policy and…

Consensus statement on panic disorder from the International Consensus Group on Depression and Anxiety

NARCIS (Netherlands)

Ballenger, JC; Lecrubier, Y; Nutt, DJ; Baldwin, DS; den Boer, JA; Kasper, S; Shear, MK

1998-01-01

Objective: To provide primary care clinicians with a better understanding of management issues in panic disorder and guide clinical practice with recommendations for appropriate pharmacotherapy. Participants: The 4 members of the International Consensus Group on Depression and Anxiety were James C.

Health care policy and community pharmacy: implications for the New Zealand primary health care sector.

Science.gov (United States)

Scahill, Shane; Harrison, Jeff; Carswell, Peter; Shaw, John

2010-06-25

The aim of our paper is to expose the challenges primary health care reform is exerting on community pharmacy and other groups. Our paper is underpinned by the notion that a broad understanding of the issues facing pharmacy will help facilitate engagement by pharmacy and stakeholders in primary care. New models of remuneration are required to deliver policy expectations. Equally important is redefining the place of community pharmacy, outlining the roles that are mooted and contributions that can be made by community pharmacy. Consistent with international policy shifts, New Zealand primary health care policy outlines broad directives which community pharmacy must respond to. Policymakers are calling for greater integration and collaboration, a shift from product to patient-centred care; a greater population health focus and the provision of enhanced cognitive services. To successfully implement policy, community pharmacists must change the way they think and act. Community pharmacy must improve relationships with other primary care providers, District Health Boards (DHBs) and Primary Health Organisations (PHOs). There is a requirement for DHBs to realign funding models which increase integration and remove the requirement to sell products in pharmacy in order to deliver services. There needs to be a willingness for pharmacy to adopt a user pays policy. General practitioners (GPs) and practice nurses (PNs) need to be aware of the training and skills that pharmacists have, and to understand what pharmacists can offer that benefits their patients and ultimately general practice. There is also a need for GPs and PNs to realise the fiscal and professional challenges community pharmacy is facing in its attempt to improve pharmacy services and in working more collaboratively within primary care. Meanwhile, community pharmacists need to embrace new approaches to practice and drive a clearly defined agenda of renewal in order to meet the needs of health funders, patients

Health care models guiding mental health policy in Kenya 1965 - 1997

Directory of Open Access Journals (Sweden)

Jenkins Rachel

2010-04-01

Full Text Available Abstract Background Mental health policy is needed to set the strategy and direction for the provision of mental health services in a country. Policy formulation does not occur in a vacuum, however, but is influenced by local and international factors in the health sector and other sectors. Methods This study was carried out in 1997 to examine the evolution of mental health policy in Kenya between 1965 and 1997 in the context of changing international concepts of health and development. Qualitative content analysis of policy documents was combined with interviews of key policy makers. Results The study showed that during the period 1965-1997 the generic health policy in Kenya changed from one based on the Medical Model in the 1960s and 1970s to one based on the Primary Health Care Model in the late 1970s and the 1980s and finally to one based on the Market Model of health care in the 1990s. The mental health policy, on the other hand, evolved from one based on the Medical Model in the 1960s to one based on the Primary Health Care Model in the 1990s, but did not embrace the Market Model of health care. This resulted in a situation in the 1990s where the mental health policy was rooted in a different conceptual model from that of the generic health policy under which it was supposed to be implemented. This "Model Muddlement" may have impeded the implementation of the mental health policy in Kenya. Conclusions Integration of the national mental health policy with the general health policy and other sector policies would be appropriate and is now underway.

Interassociation Consensus Statement on Cardiovascular Care of College Student-Athletes.

Science.gov (United States)

Hainline, Brian; Drezner, Jonathan; Baggish, Aaron; Harmon, Kimberly G; Emery, Michael S; Myerburg, Robert J; Sanchez, Eduardo; Molossi, Silvana; Parsons, John T; Thompson, Paul D

2016-04-01

Cardiovascular evaluation and care of college student-athletes is gaining increasing attention from both the public and medical communities. Emerging strategies include screening of the general athlete population, recommendations of permissible levels of participation by athletes with identified cardiovascular conditions, and preparation for responding to unanticipated cardiac events in athletic venues. The primary focus has been sudden cardiac death and the utility of screening with or without advanced cardiac screening. The National Collegiate Athletic Association convened a multidisciplinary task force to address cardiovascular concerns in collegiate student-athletes and to develop consensus for an interassociation statement. This document summarizes the task force deliberations and follow-up discussions, and includes available evidence on cardiovascular risk, pre-participation evaluation, and the recognition of and response to cardiac arrest. Future recommendations for cardiac research initiatives, education, and collaboration are also provided. (J Am Coll Cardiol 2016;doi: 10.1016/j.jacc.2016.03.527.) ©2016 by the American College of Cardiology Foundation.

The use of a policy dialogue to facilitate evidence-informed policy development for improved access to care: the case of the Winnipeg Central Intake Service (WCIS).

Science.gov (United States)

Damani, Zaheed; MacKean, Gail; Bohm, Eric; DeMone, Brie; Wright, Brock; Noseworthy, Tom; Holroyd-Leduc, Jayna; Marshall, Deborah A

2016-10-18

meeting achieved its purpose (to engage stakeholders, elicit feedback, refine policy directions). Third, our decision-maker partners' expectations of the policy roundtable meeting were exceeded; they re-affirmed its value and described the refined policy directions as foundational to establishing the vocabulary, vision and framework for improving access to scheduled clinical services in Manitoba. Finally, our adaptation of key design elements was conducive to discussion of issues surrounding access to care. Our policy roundtable process was an effective tool for acquiring broad input from stakeholders, refining policy directions and forming the necessary consensus starting points to move towards evidence-informed policy.

The "common sense" of the nonprofit hospital tax exemption: a policy analysis.

Science.gov (United States)

Sanders, S M

1995-01-01

Although rarely discussed prior to the 1985 Utah Supreme Court ruling against Intermountain Health Care Inc., the question of whether to grant tax exemptions to nonprofit hospitals is currently being debated by federal, state, and local legislators, and by the courts. Changes to current policy seem likely. This policy analysis: (1) presents the historical and legal background; (2) examines the economic, political, and organizational implications of current tax-exemption policy; and (3) offers three alternatives to this current policy. The analysis indicates that the current policy provides little incentive for nonprofit hospitals to make contributions of charity care. Of the alternatives, eliminating the exemption is not politically feasible at this time; regulating hospital operations and outputs portends an implementation nightmare; and tying tax subsidy levels to output levels of charity care--perhaps the strongest and most efficient incentive--would require an unlikely political consensus on what constitute valid and reliable measures of charity care. If there is a movement toward subsidies, then linking subsidy amounts to levels of charity care will depend on whether policy analysts can design satisfactory empirical measures. With the advent of universal health coverage, the demand for charity care will decrease. The problem for tax-exempt hospitals will then become justifying the exemption by demonstrating the extent to which they generate community benefits at no or reduced cost to society.

Nursing shaping and influencing health and social care policy.

Science.gov (United States)

Fyffe, Theresa

2009-09-01

This paper seeks to consider how nursing as a profession in the United Kingdom is developing its role in shaping and influencing policy using lessons learnt from a policy study tour undertaken in the United States of America and extensive experience as a senior nurse within the government, the health service and more recently within a Professional Organization. The nursing profession faces major changes in health and health care and nurses need to be visible in the public debate about future models of health and health care. This paper critically reviews recent UK and USA literature and policy with relevance to nursing. Strategies that support nurses and nursing to influence policy are in place but more needs to be done to address all levels of nursing in order to find creative solutions that promote and increase the participation of nurses in the political process and health policy. There are lessons to be learnt in the UK from the US nursing experience. These need to be considered in the context of the UK and devolution. Although much has been achieved in positioning nurses and nursing as an influencer in the arena of policy and political decision-making, there is a need for greater co-ordination of action to ensure that nursing is actively supported in influencing and shaping health and health care policy. All leaders and other stakeholders require to play their part in considering how the actions set out in this article can be taken forward and how gaps such as education, fellowship experience and media engagement can be addressed in the future.

Health care policy at a crossroads?

DEFF Research Database (Denmark)

Lassen, Inger Marie; Strunck, Jeanne; Ottesen, Aase Marie

2018-01-01

analyse and discuss how political discourse moments (Rancière 1999; Gamson 1992; Carvalho 2008) influence the contents of the national health quality strategies and how variation in the construal of patient roles and agency indicate discursive struggle in Danish national health care policy. Underlying...

Consensus on the use of neurophysiological tests in the intensive care unit (ICU): electroencephalogram (EEG), evoked potentials (EP), and electroneuromyography (ENMG)

DEFF Research Database (Denmark)

Guørit, J.M.; Amantini, A.; Amodio, P.

2009-01-01

STUDY AIM: To provide a consensus of European leading authorities about the optimal use of clinical neurophysiological (CN) tests (electroencephalogram [EEG]; evoked potentials [EP]; electroneuromyography [ENMG]) in the intensive care unit (ICU) and, particularly, about the way to make these tests...... contribution to all other experts. A complete consensus has been reached when submitting the manuscript. RESULTS: What the group considered as the best classification systems for EEG and EP abnormalities in the ICU is first presented. CN tests are useful for diagnosis (epilepsy, brain death, and neuromuscular...

Consensus statement on transcultural issues in depression and anxiety from the International Consensus Group on Depression and Anxiety.

Science.gov (United States)

Ballenger, J C; Davidson, J R; Lecrubier, Y; Nutt, D J; Kirmayer, L J; Lépine, J P; Lin, K M; Tajima, O; Ono, Y

2001-01-01

To provide primary care physicians with a better understanding of transcultural issues in depression and anxiety. The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Five faculty invited by the chair also participated: Laurence J. Kirmayer, Jean-Pierre Lepine, Keh-Ming Lin, Osamu Tajima, and Yutaka Ono. The consensus statement is based on the 5 review articles that are published in this supplement and the scientific literature relevant to the issues reviewed in these articles. Group meetings were held over a 2-day period. On day 1, the group discussed the review articles, and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. The consensus statement underlines the prevalence of depression and anxiety disorders across all cultures and nations while recognizing that cultural differences exist in symptom presentation and prevalence estimates. In all countries, the recognition of depression by clinicians in the primary care setting is low (generally less than 50%), and the consensus group recommends a 2-step process to aid the recognition and diagnosis of depression. In line with the low recognition of depression and anxiety disorders is the finding that only a small proportion of patients with depression or anxiety are receiving appropriate treatments for their condition. Biological diversity across ethnic groups may account for the differential sensitivity of some groups to psychotropic medication, but this area requires further investigation.

Aging, care and social policy. Continuities and changes in Argentina and Mexico

OpenAIRE

Arroyo Rueda, María Concepción

2016-01-01

This paper intends to show from a comparative perspective of social policy, the provision of care in old age in Argentina and Mexico. It will also show the experience of the national policy of care in Argentina. In this country we carried out interviews with coordinators, operational personnel and users of the national program of care. The participants identify in the policy a vision of rights and social inclusion of the elderly and effective support for family caregivers. Meanwhile, in the c...

[The development of public policies for elderly care in Brazil].

Science.gov (United States)

Fernandes, Maria Teresinha de Oliveira; Soares, Sônia Maria

2012-12-01

The objective of this documental analysis is to discuss the legal aspects involved in the development of elderly care policies in Brazil, considering the socio-historical-political context, and in view of the aspects that outline the wellbeing of an aged individual. Data collection was performed between June and September of 2010 via governmental websites. Documents were included if they complied with the proposed objective; were connected with elderly care policies, and lay within the legal accomplishments regarding elderly care policies in 2006 and the Elói Chaves Law of 1923. This analysis indicated that elderly wellbeing depends significantly on resource allocation in sectors other than the healthcare area, with emphasis on the elderly in the labor market and the feminization of old age. It is expected that the community and administrators will discuss the needs of the elderly population and the integration of care networks that remain necessary for the heterogeneity of this population.

How do high cost-sharing policies for physician care affect total care costs among people with chronic disease?

Science.gov (United States)

Xin, Haichang; Harman, Jeffrey S; Yang, Zhou

2014-01-01

This study examines whether high cost-sharing in physician care is associated with a differential impact on total care costs by health status. Total care includes physician care, emergency room (ER) visits and inpatient care. Since high cost-sharing policies can reduce needed care as well as unneeded care use, it raises the concern whether these policies are a good strategy for controlling costs among chronically ill patients. This study used the 2007 Medical Expenditure Panel Survey data with a cross-sectional study design. Difference in difference (DID), instrumental variable technique, two-part model, and bootstrap technique were employed to analyze cost data. Chronically ill individuals' probability of reducing any overall care costs was significantly less than healthier individuals (beta = 2.18, p = 0.04), while the integrated DID estimator from split results indicated that going from low cost-sharing to high cost-sharing significantly reduced costs by $12,853.23 more for sick people than for healthy people (95% CI: -$17,582.86, -$8,123.60). This greater cost reduction in total care among sick people likely resulted from greater cost reduction in physician care, and may have come at the expense of jeopardizing health outcomes by depriving patients of needed care. Thus, these policies would be inappropriate in the short run, and unlikely in the long run to control health plans costs among chronically ill individuals. A generous benefit design with low cost-sharing policies in physician care or primary care is recommended for both health plans and chronically ill individuals, to save costs and protect these enrollees' health status.

Primary health care and public policy.

Science.gov (United States)

Mangelsdorf, K L; Luna, J; Smith, H L

1988-01-01

The health problems of Ecuador are similar to those in other developing countries where the standard of living is low, and housing and sanitation are inadequate. Women, children, and those living in rural areas are those most severely affected. National policy has been to attempt to increase access to health care in rural areas through the construction of new facilities and the appointment of highly paid medical staff. However, little attention was paid to sociocultural factors, which caused the peasantry to reject the medical care system, or to problems of internal efficiency which inhibited utilization. Since the 1970s various national and international organizations have attempted to implement primary health care (PHC) through the use of trained community health workers (CHWs). The primary problems faced by the CHWs were shortages of medicines and supplies, an almost total lack of supervision, and lack of transportation available to take staff to isolated villages. The poor supervision is blamed for the 17% drop out rate among CHWs since 1980. Independent PHC programs have also been established in Ecuador by voluntary organizations. These work best when coordinated with governmental programs, in order to allow monitoring and to avoid the duplication of services. Problems with the establishment of PHC programs in Ecuador will continue, as the government has no clear cut policy, and difficulties financing on a broad national scale. Other problems include the absence of effective supervision and logistical support for even small pilot programs, and inconsistencies in the training and role definition for CHWs. These problems need to be met in the implementation of a national PHC policy.

Understanding Parents' Child Care Decision-Making: A Foundation for Child Care Policy Making. Research-to-Policy, Research-to-Practice Brief. OPRE 2011-12

Science.gov (United States)

Weber, Roberta

2011-01-01

Policies such as those related to child care subsidies and quality rating and improvement systems are designed to increase the likelihood that child care and education arrangements meet developmental needs of children and employment needs of parents. Ultimately, parents select child care arrangements, and the quality and stability of these…

Consensus statement on generalized anxiety disorder from the International Consensus Group on Depression and Anxiety.

Science.gov (United States)

Ballenger, J C; Davidson, J R; Lecrubier, Y; Nutt, D J; Borkovec, T D; Rickels, K; Stein, D J; Wittchen, H U

2001-01-01

To provide primary care clinicians with a better understanding of management issues in generalized anxiety disorder (GAD) and guide clinical practice with recommendations on the appropriate treatment strategy. The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R.T. Davidson, Yves Lecrubier, and David J. Nutt. Four additional faculty members invited by the chair were Karl Rickels, Hans-Ulrich Wittchen, Dan J. Stein, and Thomas D. Borkovec. The consensus statement is based on the 6 review articles that are published in this supplement and the scientific literature relevant to the issues reviewed in these articles. Group meetings were held over a 2-day period. On day 1, the group discussed the review articles and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. GAD is the most common anxiety disorder in primary care and is highly debilitating. Furthermore, it is frequently comorbid with depression and other anxiety disorders, which exacerbates functional impairment. Antidepressants (serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and nonsedating tricyclic antidepressants) are generally the most appropriate first-line pharmacotherapy for GAD, since they are also effective against comorbid psychiatric disorders and are suitable for long-term use. Cognitive-behavioral therapy is the preferred form of psychotherapy for GAD, although when GAD is comorbid with depression, pharmacotherapy is increasingly indicated.

Two decades of maternity care fee exemption policies in Ghana: have they benefited the poor?

Science.gov (United States)

Johnson, Fiifi Amoako; Frempong-Ainguah, Faustina; Padmadas, Sabu S

2016-02-01

To investigate, the impact of maternity-related fee payment policies on the uptake of skilled birth care amongst the poor in Ghana. Population data representing 12 288 births between November 1990 and October 2008 from four consecutive rounds of the Ghana demographic and health surveys were used to examine the impact of four major maternity-related payment policies: the full-cost recovery 'cash and carry' scheme; 'antenatal care fee exemption'; 'delivery care fee exemption' and the 'National Health Insurance Scheme (NHIS)'. Concentration curves were used to analyse the rich-poor gap in the use of skilled birth care by the four policy interventions. Multilevel logistic regression was used to examine the effect of the policies on the uptake of skilled birth care, adjusting for relevant predictors and clustering within communities and districts. The uptake of skilled birth care over the policy periods for the poorest women was trivial when compared with their non-poor counterparts. The rich-poor gap in skilled birth care use was highly pronounced during the 'cash and carry' and 'free antenatal care' policies period. The benefits during the 'free delivery care' and ' NHIS' policy periods accrued more for the rich than the poor. There exist significant differences in skilled birth care use between and within communities and districts, even after adjusting for policy effects and other relevant predictors. The maternal care fee exemption policies specifically targeted towards the poorest women had limited impact on the uptake of skilled birth care. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Criteria required for an acceptable point-of-care test for UTI detection: Obtaining consensus using the Delphi technique.

Science.gov (United States)

Weir, Nichola-Jane M; Pattison, Sally H; Kearney, Paddy; Stafford, Bob; Gormley, Gerard J; Crockard, Martin A; Gilpin, Deirdre F; Tunney, Michael M; Hughes, Carmel M

2018-01-01

Urinary Tract Infections (UTIs) are common bacterial infections, second only to respiratory tract infections and particularly prevalent within primary care. Conventional detection of UTIs is culture, however, return of results can take between 24 and 72 hours. The introduction of a point of care (POC) test would allow for more timely identification of UTIs, facilitating improved, targeted treatment. This study aimed to obtain consensus on the criteria required for a POC UTI test, to meet patient need within primary care. Criteria for consideration were compiled by the research team. These criteria were validated through a two-round Delphi process, utilising an expert panel of healthcare professionals from across Europe and United States of America. Using web-based questionnaires, panellists recorded their level of agreement with each criterion based on a 5-point Likert Scale, with space for comments. Using median response, interquartile range and comments provided, criteria were accepted/rejected/revised depending on pre-agreed cut-off scores. The first round questionnaire presented thirty-three criteria to the panel, of which 22 were accepted. Consensus was not achieved for the remaining 11 criteria. Following response review, one criterion was removed, while after revision, the remaining 10 criteria entered the second round. Of these, four were subsequently accepted, resulting in 26 criteria considered appropriate for a POC test to detect urinary infections. This study generated an approved set of criteria for a POC test to detect urinary infections. Criteria acceptance and comments provided by the healthcare professionals also supports the development of a multiplex point of care UTI test.

Increasing Internal Stakeholder Consensus about a University Science Center's Outreach Policies and Procedures

Science.gov (United States)

Fisher, Richard D.

For decades the United States has tried to increase the number of students pursuing science, technology, engineering, and mathematics (STEM) education and careers. Educators and policy makers continue to seek strategies to increase the number of students in the STEM education pipeline. Public institutions of higher education are involved in this effort through education and public outreach (EPO) initiatives. Arizona State University opened its largest research facility, the new Interdisciplinary Science and Technology Building IV (ISTB4) in September, 2012. As the new home of the School of Earth & Space Exploration (SESE), ISTB4 was designed to serve the school's dedication to K-12 education and public outreach. This dissertation presents a menu of ideas for revamping the EPO program for SESE. Utilizing the Delphi method, I was able to clarify which ideas would be most supported, and those that would not, by a variety of important SESE stakeholders. The study revealed that consensus exists in areas related to staffing and expansion of free programming, whereas less consensus exist in the areas of fee-based programs. The following most promising ideas for improving the SESE's EPO effort were identified and will be presented to SESE's incoming director in July, 2013: (a) hire a full-time director, theater manager, and program coordinator; (b) establish a service-learning requirement obligating undergraduate SESE majors to serve as docent support for outreach programs; (c) obligate all EPO operations to advise, assist, and contribute to the development of curricula, activities, and exhibits; (d) perform a market and cost analysis of other informational education venues offering similar programming; (3) establish a schedule of fee-based planetarium and film offerings; and (f) create an ISTB4 centric, fee-based package of programs specifically correlated to K12 education standards that can be delivered as a fieldtrip experience.

BNFL and environmental care. An introduction to our policy

Energy Technology Data Exchange (ETDEWEB)

1992-12-31

British Nuclear Fuel plc (BNFL) acknowledge a duty of care for the environment and aims to reduce the effects of its activities on the environment to as low as reasonably practicable. Its environmental policy statement is presented and its approach, investment policies and activities to implement this policy are outlined. The activities include energy efficiency, recycling, surveillance and research, conservation and open information. (UK).

Enhancing the contribution of research to health care policy-making: a case study of the Dutch Health Care Performance Report.

Science.gov (United States)

Hegger, Ingrid; Marks, Lisanne K; Janssen, Susan W J; Schuit, Albertine J; van Oers, Hans A M

2016-01-01

The Dutch Health Care Performance Report, issued by the National Institute of Public Health and the Environment, aims to monitor health care performance in The Netherlands. Both the National Institute and the Ministry of Health wish to increase the contribution of the Report to health care policy-making. Our aim was to identify ways to achieve that. We used contribution mapping as a theoretical framework that recognizes alignment of research as crucial to managing contributions to policy-making. To investigate which areas need alignment efforts by researchers and/or policy-makers, we interviewed National Institute researchers and policy-makers from the Ministry of Health and assessed the process for developing the 2010 Report. We identified six areas where alignment is specifically relevant for enhancing the contributions of future versions of the Dutch Health Care Performance Report: well-balanced information for different ministerial directorates; backstage work; double role actors; reports of other knowledge institutes; data collection/generation and presentation forms. The contribution of health care performance reporting to policy-making is complex and requires continuous alignment efforts between researchers and policy-makers. These efforts should form an inseparable part of health care performance reporting and although this demands considerable resources, it is worth considering since it may pay back in better contributions to policy-making. © The Author(s) 2015.

Use of Convexity in Ostomy Care: Results of an International Consensus Meeting.

Science.gov (United States)

Hoeflok, Jo; Salvadalena, Ginger; Pridham, Sue; Droste, Werner; McNichol, Laurie; Gray, Mikel

Ostomy skin barriers that incorporate a convexity feature have been available in the marketplace for decades, but limited resources are available to guide clinicians in selection and use of convex products. Given the widespread use of convexity, and the need to provide practical guidelines for appropriate use of pouching systems with convex features, an international consensus panel was convened to provide consensus-based guidance for this aspect of ostomy practice. Panelists were provided with a summary of relevant literature in advance of the meeting; these articles were used to generate and reach consensus on 26 statements during a 1-day meeting. Consensus was achieved when 80% of panelists agreed on a statement using an anonymous electronic response system. The 26 statements provide guidance for convex product characteristics, patient assessment, convexity use, and outcomes.

Status of conversion of NE standards to national consensus standards

International Nuclear Information System (INIS)

Jennings, S.D.

1990-06-01

One major goal of the Nuclear Standards Program is to convert existing NE standards into national consensus standards (where possible). This means that an NE standard in the same subject area using the national consensus process. This report is a summary of the activities that have evolved to effect conversion of NE standards to national consensus standards, and the status of current conversion activities. In some cases, all requirements in an NE standard will not be incorporated into the published national consensus standard because these requirements may be considered too restrictive or too specific for broader application by the nuclear industry. If these requirements are considered necessary for nuclear reactor program applications, the program standard will be revised and issued as a supplement to the national consensus standard. The supplemental program standard will contain only those necessary requirements not reflected by the national consensus standard. Therefore, while complete conversion of program standards may not always be realized, the standards policy has been fully supported in attempting to make maximum use of the national consensus standard. 1 tab

Developing New Mexico Health Care Policy: An application of the Vital Issues Process

Energy Technology Data Exchange (ETDEWEB)

Engi, D. [Sandia National Labs., Albuquerque, NM (United States); Icerman, L. [Icerman & Associates, Santa Fe, NM (United States)

1995-06-01

The Vital Issues Process, developed by the Sandia National Laboratories Strategic Technologies Department, was utilized by the Health Care Task Force Advisory Group to apply structure to their policy deliberations. By convening three expert panels, an overarching goal for the New Mexico health care system, seven desired outcomes, nine policy options, and 17 action items were developed for the New Mexico health care system. Three broadly stated evaluation criteria were articulated and used to produce relative rankings of the desired outcomes and policy options for preventive care and information systems. Reports summarizing the policy deliberations were submitted for consideration by the Health Care Task Force, a Joint Interim Committee of the New Mexico Legislature, charged with facilitating the development and implementation of a comprehensive health care delivery system for New Mexico. The Task Force reported its findings and recommendations to the Second Session of the 41st New Mexico State Legislature in January 1994.

Consensus statement update on posttraumatic stress disorder from the international consensus group on depression and anxiety.

Science.gov (United States)

Ballenger, James C; Davidson, Jonathan R T; Lecrubier, Yves; Nutt, David J; Marshall, Randall D; Nemeroff, Charles B; Shalev, Arieh Y; Yehuda, Rachel

2004-01-01

To provide an update to the "Consensus Statement on Posttraumatic Stress Disorder From the International Consensus Group on Depression and Anxiety" that was published in a supplement to The Journal of Clinical Psychiatry (2000) by presenting important developments in the field, the latest recommendations for patient care, and suggestions for future research. The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Other faculty who were invited by the chair were Randall D. Marshall, Charles B. Nemeroff, Arieh Y. Shalev, and Rachel Yehuda. The consensus statement is based on the 7 review articles in this supplement and the related scientific literature. Group meetings were held over a 2-day period. On day 1, the group discussed topics to be represented by the 7 review articles in this supplement, and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all faculty. There have been advancements in the science and treatment of posttraumatic stress disorder. Attention to this disorder has increased with recent world events; however, continued efforts are needed to improve diagnosis, treatment, and prevention of posttraumatic stress disorder.

The SOS-framework (Systems of Sedentary behaviours): an international transdisciplinary consensus framework for the study of determinants, research priorities and policy on sedentary behaviour across the life course: a DEDIPAC-study.

Science.gov (United States)

Chastin, Sebastien F M; De Craemer, Marieke; Lien, Nanna; Bernaards, Claire; Buck, Christoph; Oppert, Jean-Michel; Nazare, Julie-Anne; Lakerveld, Jeroen; O'Donoghue, Grainne; Holdsworth, Michelle; Owen, Neville; Brug, Johannes; Cardon, Greet

2016-07-15

Ecological models are currently the most used approaches to classify and conceptualise determinants of sedentary behaviour, but these approaches are limited in their ability to capture the complexity of and interplay between determinants. The aim of the project described here was to develop a transdisciplinary dynamic framework, grounded in a system-based approach, for research on determinants of sedentary behaviour across the life span and intervention and policy planning and evaluation. A comprehensive concept mapping approach was used to develop the Systems Of Sedentary behaviours (SOS) framework, involving four main phases: (1) preparation, (2) generation of statements, (3) structuring (sorting and ranking), and (4) analysis and interpretation. The first two phases were undertaken between December 2013 and February 2015 by the DEDIPAC KH team (DEterminants of DIet and Physical Activity Knowledge Hub). The last two phases were completed during a two-day consensus meeting in June 2015. During the first phase, 550 factors regarding sedentary behaviour were listed across three age groups (i.e., youths, adults and older adults), which were reduced to a final list of 190 life course factors in phase 2 used during the consensus meeting. In total, 69 international delegates, seven invited experts and one concept mapping consultant attended the consensus meeting. The final framework obtained during that meeting consisted of six clusters of determinants: Physical Health and Wellbeing (71% consensus), Social and Cultural Context (59% consensus), Built and Natural Environment (65% consensus), Psychology and Behaviour (80% consensus), Politics and Economics (78% consensus), and Institutional and Home Settings (78% consensus). Conducting studies on Institutional Settings was ranked as the first research priority. The view that this framework captures a system-based map of determinants of sedentary behaviour was expressed by 89% of the participants. Through an international

Internal Medicine Point-of-Care Ultrasound Curriculum: Consensus Recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group.

Science.gov (United States)

Ma, Irene W Y; Arishenkoff, Shane; Wiseman, Jeffrey; Desy, Janeve; Ailon, Jonathan; Martin, Leslie; Otremba, Mirek; Halman, Samantha; Willemot, Patrick; Blouw, Marcus

2017-09-01

Bedside point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. At present, no consensus exists for what POCUS curriculum is appropriate for internal medicine residency training programs. This document details the consensus-based recommendations by the Canadian Internal Medicine Ultrasound (CIMUS) group, comprising 39 members, representing 14 institutions across Canada. Guiding principles for selecting curricular content were determined a priori. Consensus was defined as agreement by at least 80% of the members on POCUS applications deemed appropriate for teaching and assessment of trainees in the core (internal medicine postgraduate years [PGY] 1-3) and expanded (general internal medicine PGY 4-5) training programs. We recommend four POCUS applications for the core PGY 1-3 curriculum (inferior vena cava, lung B lines, pleural effusion, and abdominal free fluid) and three ultrasound-guided procedures (central venous catheterization, thoracentesis, and paracentesis). For the expanded PGY 4-5 curriculum, we recommend an additional seven applications (internal jugular vein, lung consolidation, pneumothorax, knee effusion, gross left ventricular systolic function, pericardial effusion, and right ventricular strain) and four ultrasound-guided procedures (knee arthrocentesis, arterial line insertion, arterial blood gas sampling, and peripheral venous catheterization). These recommendations will provide a framework for training programs at a national level.

Achieving Prudent Dementia Care (Palliare: An International Policy and Practice Imperative

Directory of Open Access Journals (Sweden)

Debbie Tolson

2016-12-01

Full Text Available This paper examines the provision of integrated advanced dementia care within seven European countries and critically reviews the potential contribution of the Prudent Healthcare perspective as a starting point for reform. Progressive efforts to innovate, promote quality and integrate care are tempered with the reality of resource constraints. Some policy makers in Europe and North America have turned their attention to the principles of Prudent Healthcare as a potential mechanism to maximise benefits for patients within available resources. As dementia progresses, living well requires increasing levels of support and care, people living with advanced dementia have complex health and social care needs, are highly dependent on others but are not yet at the terminal end stage of the condition. People with advanced dementia can benefit from a dementia specific palliative approach to care ('Palliare', that helps them to live the best life possible for the months and often years they live with advanced dementia. It is also highly desirable to align policy innovations with integrated palliative care practice models and the education of the dementia workforce to accelerate informed improvements in advanced dementia care. There may be some coherence, at least superficially between Prudent Healthcare and integrated palliative care models such as Palliare. It is argued that for successful implementation, both require practitioners to be equipped with knowledge and skills and be empowered to deliver high quality care often within impoverished care environments. Adoption of the prudent perspective will however require development of a repertoire of approaches to hear the voice or proxy voice of people living with advanced dementia and to commit to the development and implementation of new evidence for advanced dementia practice. Evidence informing this policy debate draws upon contemporary literature and policy and the findings from research activities

Engagement and education: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

Science.gov (United States)

Devereaux, Asha V; Tosh, Pritish K; Hick, John L; Hanfling, Dan; Geiling, James; Reed, Mary Jane; Uyeki, Timothy M; Shah, Umair A; Fagbuyi, Daniel B; Skippen, Peter; Dichter, Jeffrey R; Kissoon, Niranjan; Christian, Michael D; Upperman, Jeffrey S

2014-10-01

Engagement and education of ICU clinicians in disaster preparedness is fragmented by time constraints and institutional barriers and frequently occurs during a disaster. We reviewed the existing literature from 2007 to April 2013 and expert opinions about clinician engagement and education for critical care during a pandemic or disaster and offer suggestions for integrating ICU clinicians into planning and response. The suggestions in this article are important for all of those involved in a pandemic or large-scale disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. A systematic literature review was performed and suggestions formulated according to the American College of Chest Physicians (CHEST) Consensus Statement development methodology. We assessed articles, documents, reports, and gray literature reported since 2007. Following expert-informed sorting and review of the literature, key priority areas and questions were developed. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Twenty-three suggestions were formulated based on literature-informed consensus opinion. These suggestions are grouped according to the following thematic elements: (1) situational awareness, (2) clinician roles and responsibilities, (3) education, and (4) community engagement. Together, these four elements are considered to form the basis for effective ICU clinician engagement for mass critical care. The optimal engagement of the ICU clinical team in caring for large numbers of critically ill patients due to a pandemic or disaster will require a departure from the routine independent systems operating in hospitals. An effective response will require robust information systems; coordination among clinicians, hospitals, and governmental

The impact of managed care and current governmental policies on an urban academic health care center.

Science.gov (United States)

Rodriguez, J L; Peterson, D J; Muehlstedt, S G; Zera, R T; West, M A; Bubrick, M P

2001-10-01

Managed care and governmental policies have restructured hospital reimbursement. We examined reimbursement trends in trauma care to assess the impact of this market driven change on an urban academic health center. Patients injured between January 1997 and December 1999 were analyzed for Injury Severity Score (ISS), length of hospital stay, hospital cost, payer, and reimbursement. Between 1997 and 1999, the volume of patients with an ISS less than 9 increased and length of stay decreased. In addition, overall cost, payment, and profit margin increased. Commercially insured patients accounted for this margin increase, because the margins of managed care and government insured patients experienced double-digit decreases. Patients with ISS of 9 or greater also experienced a volume increase and a reduction in length of stay; however, costs within this group increased greater than payments, thereby reducing profit margin. Whereas commercially insured patients maintained their margin, managed care and government insured patients did not (double- and triple-digit decreases). Managed care and current governmental policies have a negative impact on urban academic health center reimbursement. Commercial insurers subsidize not only the uninsured but also the government insured and managed care patients as well. National awareness of this issue and policy action are paramount to urban academic health centers and may also benefit commercial insurers.

Disintegrated care: the Achilles heel of international health policies in low and middle-income countries

Directory of Open Access Journals (Sweden)

Jean-Pierre Unger

2006-09-01

Full Text Available Purpose: To review the evidence basis of international aid and health policy. Context of case: Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. We review this policy's responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries. Data sources: National policies, international programmes and pilot experiments are examined in both scientific and grey literature. Conclusions and discussion: We document how health care privatisation has led to the pool of patients being cut off from public disease control interventions—causing health care disintegration—which in turn resulted in substandard performance of disease control. Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored. We conclude by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middle-income countries justifies an alternative aid policy to improve both disease control and health care.

Involving patients in patient safety programmes: A scoping review and consensus procedure by the LINNEAUS collaboration on patient safety in primary care

NARCIS (Netherlands)

Trier, H.; Valderas, J.M.; Wensing, M.; Martin, H.M.; Egebart, J.

2015-01-01

BACKGROUND: Patient involvement has only recently received attention as a potentially useful approach to patient safety in primary care. OBJECTIVE: To summarize work conducted on a scoping review of interventions focussing on patient involvement for patient safety; to develop consensus-based

Automation of the consensus guidelines in diabetes care: potential impact on clinical inertia.

Science.gov (United States)

Albisser, A Michael; Inhaber, Francine

2010-01-01

To propose that automation of the consensus guidelines and mandated targets (CG&MT) in glycemia, hemoglobin A1c, and body weight will facilitate optimal clinical management of patients with diabetes. (1) A simplified method for capturing diabetes outcomes at home was devised, (2) relevant portions of the CG&MT were translated into computer code and automated, and (3) algorithms were applied to transform data from self-monitoring of blood glucose into circadian profiles and hemoglobin A1c levels. (4) The resulting procedures were integrated into a USB memory drive for use by health-care providers at the point of care. For input from patients, a simple form is used to capture data on diabetes outcomes, including blood glucose measurements before and after meals and at bedtime, medication, and lifestyle events in a structured fashion. At each encounter with a health-care provider, the patient's data are transferred into the device and become available to assist in identifying deviations from mandated targets, potential risks of hypoglycemia, and necessary prescription changes. Preliminary observations during a 2 1/2-year period from a community support group dedicated to glycemic control on 20 unselected patients (10 with and 10 without use of the device) are summarized. With use of the automated information, the health professional is supported at the point of care to achieve better, safer outcomes and practice evidence-based medicine entirely in lockstep with the CG&MT. This automation helps to overcome clinical inertia.

Toward a New Era of Policy: Health Care Service Delivery to First Nations

Directory of Open Access Journals (Sweden)

Miranda D. Kelly

2011-05-01

Full Text Available The disproportionate burdens of ill health experienced by First Nations have been attributed to an uncoordinated, fragmented health care system. This system is rooted in public policies that have created jurisdictional gaps and a long-standing debate between federal, provincial and First Nations governments as to who is responsible for First Nations health care. This article examines: (1 the policies that shape First Nations health care in Canada and in the province of British Columbia (BC specifically; (2 the interests of the actors involved in First Nations health policy; and (3 recent developments in BC that present an opportunity for change to First Nations health policy development and have broader implications for Indigenous health policy across Canada and worldwide.

A Mysterious European Threesome: Work-care Regimes, Policies and Gender

Directory of Open Access Journals (Sweden)

Anália Torres

2012-07-01

Full Text Available Arguing that European family lives are affected by many societal factors, this article discusses the interplay between three sets of phenomena: the management of work and care responsibilities, workcarepolicies and regimes, and gender order within the family context. Based on discussions about orientations to work and care, we compare European countries and analyze regularities and singularities among them. Identifying and assessing the interplay between structural, institutional and cultural determinants of orientations we try to explain country diversity mobilizing data from the European Social Survey (rounds 2002, 2004 and 2006 and data from Eurobarometer 2003.The paper is organized around three analytical axes. First, we nalyze how work and family orientations are perceived by the Europeans. Secondly, we assess different European political policies regarding work and care arrangements, the outcome being a proposal for a workcare political typology. And finally we discuss the connectionsbetween those policies and the production or reproduction of gender order within the family. We conclude that in countries with more egalitarian gender values and policies targeted at workcarearrangements, individuals experience less workfamily conflict. Conversely, in countries with more traditional gender values and restricted or disadvantaged policies we found more familyworkconflict. But institutional constraints don’t act alone: orientations to work and care differ according to age, education, family forms and employment status.

Genomic sequencing: assessing the health care system, policy, and big-data implications.

Science.gov (United States)

Phillips, Kathryn A; Trosman, Julia R; Kelley, Robin K; Pletcher, Mark J; Douglas, Michael P; Weldon, Christine B

2014-07-01

New genomic sequencing technologies enable the high-speed analysis of multiple genes simultaneously, including all of those in a person's genome. Sequencing is a prominent example of a "big data" technology because of the massive amount of information it produces and its complexity, diversity, and timeliness. Our objective in this article is to provide a policy primer on sequencing and illustrate how it can affect health care system and policy issues. Toward this end, we developed an easily applied classification of sequencing based on inputs, methods, and outputs. We used it to examine the implications of sequencing for three health care system and policy issues: making care more patient-centered, developing coverage and reimbursement policies, and assessing economic value. We conclude that sequencing has great promise but that policy challenges include how to optimize patient engagement as well as privacy, develop coverage policies that distinguish research from clinical uses and account for bioinformatics costs, and determine the economic value of sequencing through complex economic models that take into account multiple findings and downstream costs. Project HOPE—The People-to-People Health Foundation, Inc.

International policies toward parental leave and child care.

Science.gov (United States)

Waldfogel, J

2001-01-01

The pleasures and pressures of parenting a newborn are universal, but the supports surrounding parents vary widely from country to country. In many nations, decades of attention to benefits and services for new parents offer lessons worthy of attention in this country. This article describes policies regarding parental leave, child care, and early childhood benefits here and in 10 industrial nations in North America and Europe. The sharpest contrast separates the United States from the other countries, although differences among the others also are instructive: The right to parental leave is new to American workers; it covers one-half of the private-sector workforce and is relatively short and unpaid. By contrast, other nations offer universal, paid leaves of 10 months or more. Child care assistance in Europe is usually provided through publicly funded programs, whereas the United States relies more on subsidies and tax credits to reimburse parents for part of their child care expenses. Nations vary in the emphasis they place on parental leave versus child care supports for families with children under age three. Each approach creates incentives that influence parents' decisions about employment and child care. Several European nations, seeking flexible solutions for parents, are testing "early childhood benefits" that can be used to supplement income or pay for private child care. Based on this review, the author urges that the United States adopt universal, paid parental leave of at least 10 months; help parents cover more child care costs; and improve the quality of child care. She finds policy packages that support different parental choices promising, because the right mix of leave and care will vary from family to family, and child to child.

A New Health Care Prevention Agenda: Sustainable Food Procurement and Agricultural Policy.

Science.gov (United States)

Harvie, Jamie; Mikkelsen, Leslie; Shak, Linda

2009-07-01

Health care leaders are broadening their awareness to include the need to address the food system as a means to individual, public, and global health, above and beyond basic nutritional factors. Key voices from the health care sector have begun to engage in market transformation and are aggregating to articulate the urgency for engagement in food and agricultural policy. Systemic transformation requires a range of policies that complement one another and address various aspects of the food system. Health care involvement in policy and advocacy is vital to solve the expanding ecological health crises facing our nation and globe and will require an urgency that may be unprecedented.

Sustainability of Long-term Care: Puzzling Tasks Ahead for Policy-Makers

Directory of Open Access Journals (Sweden)

Ilaria Mosca

2017-04-01

Full Text Available Background The sustainability of long-term care (LTC is a prominent policy priority in many Western countries. LTC is one of the most pressing fiscal issues for the growing population of elderly people in the European Union (EU Member States. Country recommendations regarding LTC are prominent under the EU’s European Semester. Methods This paper examines challenges related to the financial- and organizational sustainability of LTC systems in the EU. We combined a targeted literature review and a descriptive selected country analysis of: (1 public- and private funding; (2 informal care and externalities; and (3 the possible role of technology in increasing productivity. Countries were selected via purposive sampling to establish a cohort of country cases covering the spectrum of differences in LTC systems: public spending, private funding, informal care use, informal care support, and cash benefits. Results The aging of the population, the increasing gap between availability of informal care and demand for LTC, substantial market failures of private funding for LTC, and fiscal imbalances in some countries, have led to structural reforms and enduring pressures for LTC policy-makers across the EU. Our exploration of national policies illustrates different solutions that attempt to promote fairness while stimulating efficient delivery of services. Important steps must be taken to address the sustainability of LTC. First, countries should look deeper into the possibilities of complementing public- and private funding, as well as at addressing market failures of private funding. Second, informal care externalities with spill-over into neighboring policy areas, the labor force, and formal LTC workers, should be properly addressed. Thirdly, innovations in LTC services should be stimulated to increase productivity through technology and process innovations, and to reduce costs. Conclusion The analysis shows why it is difficult for EU Member State

Consensus statement on social anxiety disorder from the International Consensus Group on Depression and Anxiety.

Science.gov (United States)

Ballenger, J C; Davidson, J R; Lecrubier, Y; Nutt, D J; Bobes, J; Beidel, D C; Ono, Y; Westenberg, H G

1998-01-01

The goal of this consensus statement is to provide primary care clinicians with a better understanding of management issues in social anxiety disorder (social phobia) and guide clinical practice with recommendations for appropriate pharmacotherapy. The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Other faculty invited by the chair were Julio Bobes, Deborah C. Beidel, Yukata Ono, and Herman G. M. Westenberg. The consensus statement is based on the 7 review papers published in this supplement and on the scientific literature relevant to the issues reviewed in these papers. The group met over a 2-day period. On day 1, the group discussed each review paper, and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. The consensus statement underlines the importance of recognizing social anxiety disorder and provides recommendations on how it may be distinguished from other anxiety disorders. It proposes definitions for response and remission and considers appropriate management strategies. Selective serotonin reuptake inhibitors are recommended as first-line therapy, and effective treatment should be continued for at least 12 months. Long-term treatment is indicated if symptoms are unresolved, the patient has a comorbid condition or a history of relapse, or there was an early onset of the disorder.

Protection of Children in Malaysia through Foster Care Legislation and Policy

Directory of Open Access Journals (Sweden)

Azizah Mohd

2012-01-01

Full Text Available Children are immature, naive and unable to care for themselves. Due to this verynature of children, they are in need of among others, care, attention andsupervision from adults. Care, attention and supervision are among the means ofcare and protection of children, which can only be acquired in a familyenvironment. One of the ways to achieve family environment is through FosterCare where a child who is in need of care and protection will be placed with afamily permanently or temporarily or until they are able to care for themselves.Foster care will at least provide for a family life experience especially for childrenwithout family or who have problems in their family life. This paper is to examinethe Concept of Foster care in Malaysia and the law relating to it as to provideprotection to children in need of care and protection. Examination will focus onrelevant legislations and policy relating to Foster Care. Discussion will extend toanalysis on whether the available laws and policies are adequate to sustainchildren protection in Malaysia through Foster Care.

Implementing care policy in developing countries

International Nuclear Information System (INIS)

Tattum, L.; Phishner, E.S.

1992-01-01

How do chief executives of Western companies, from their plush offices, keep tabs on what happens at chemical plants in developing countries? Many point out that it is difficult to operate a Responsible Care policy in countries where industry associations have not yet started a coordinated initiative. 'Responsible Care is a program that has primarily a geographic dimension and is organized country by country by the industry associations,' note Kaspar Eigenmann, head of corporate unit safety and environment at Ciba (Basel). Where there is a campaign, the local Ciba company participates, he says. 'It's obvious that the industrialized countries are taking the lead,' adds Eigenmann

How to Choose? Using the Delphi Method to Develop Consensus Triggers and Indicators for Disaster Response.

Science.gov (United States)

Lis, Rebecca; Sakata, Vicki; Lien, Onora

2017-08-01

To identify key decisions along the continuum of care (conventional, contingency, and crisis) and the critical triggers and data elements used to inform those decisions concerning public health and health care response during an emergency. A classic Delphi method, a consensus-building survey technique, was used with clinicians around Washington State to identify regional triggers and indicators. Additionally, using a modified Delphi method, we combined a workshop and single-round survey with panelists from public health (state and local) and health care coalitions to identify consensus state-level triggers and indicators. In the clinical survey, 122 of 223 proposed triggers or indicators (43.7%) reached consensus and were deemed important in regional decision-making during a disaster. In the state-level survey, 110 of 140 proposed triggers or indicators (78.6%) reached consensus and were deemed important in state-level decision-making during a disaster. The identification of consensus triggers and indicators for health care emergency response is crucial in supporting a comprehensive health care situational awareness process. This can inform the creation of standardized questions to ask health care, public health, and other partners to support decision-making during a response. (Disaster Med Public Health Preparedness. 2017;11:467-472).

Consensus on consensus: a synthesis of consensus estimates on human-caused global warming

Science.gov (United States)

Cook, John; Oreskes, Naomi; Doran, Peter T.; Anderegg, William R. L.; Verheggen, Bart; Maibach, Ed W.; Carlton, J. Stuart; Lewandowsky, Stephan; Skuce, Andrew G.; Green, Sarah A.; Nuccitelli, Dana; Jacobs, Peter; Richardson, Mark; Winkler, Bärbel; Painting, Rob; Rice, Ken

2016-04-01

The consensus that humans are causing recent global warming is shared by 90%-100% of publishing climate scientists according to six independent studies by co-authors of this paper. Those results are consistent with the 97% consensus reported by Cook et al (Environ. Res. Lett. 8 024024) based on 11 944 abstracts of research papers, of which 4014 took a position on the cause of recent global warming. A survey of authors of those papers (N = 2412 papers) also supported a 97% consensus. Tol (2016 Environ. Res. Lett. 11 048001) comes to a different conclusion using results from surveys of non-experts such as economic geologists and a self-selected group of those who reject the consensus. We demonstrate that this outcome is not unexpected because the level of consensus correlates with expertise in climate science. At one point, Tol also reduces the apparent consensus by assuming that abstracts that do not explicitly state the cause of global warming (‘no position’) represent non-endorsement, an approach that if applied elsewhere would reject consensus on well-established theories such as plate tectonics. We examine the available studies and conclude that the finding of 97% consensus in published climate research is robust and consistent with other surveys of climate scientists and peer-reviewed studies.

Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study.

Science.gov (United States)

Plenge, U; Nortje, M B; Marais, L C; Jordaan, J D; Parker, R; van der Westhuizen, N; van der Merwe, J F; Marais, J; September, W V; Davies, G L; Pretorius, T; Solomon, C; Ryan, P; Torborg, A M; Farina, Z; Smit, R; Cairns, C; Shanahan, H; Sombili, S; Mazibuko, A; Hobbs, H R; Porrill, O S; Timothy, N E; Siebritz, R E; van der Westhuizen, C; Troskie, A J; Blake, C A; Gray, L A; Munting, T W; Steinhaus, H K S; Rowe, P; van der Walt, J G; Isaacs Noordien, R; Theron, A; Biccard, B M

2018-05-09

A structured approach to perioperative patient management based on an enhanced recovery pathway protocol facilitates early recovery and reduces morbidity in high income countries. However, in low- and middle-income countries (LMICs), the feasibility of implementing enhanced recovery pathways and its influence on patient outcomes is scarcely investigated. To inform similar practice in LMICs for total hip and knee arthroplasty, it is necessary to identify potential factors for inclusion in such a programme, appropriate for LMICs. Applying a Delphi method, 33 stakeholders (13 arthroplasty surgeons, 12 anaesthetists and 8 physiotherapists) from 10 state hospitals representing 4 South African provinces identified and prioritised i) risk factors associated with poor outcomes, ii) perioperative interventions to improve outcomes and iii) patient and clinical outcomes necessary to benchmark practice for patients scheduled for primary elective unilateral total hip and knee arthroplasty. Thirty of the thirty-three stakeholders completed the 3 months Delphi study. The first round yielded i) 36 suggestions to preoperative risk factors, ii) 14 (preoperative), 18 (intraoperative) and 23 (postoperative) suggestions to best practices for perioperative interventions to improve outcomes and iii) 25 suggestions to important postsurgical outcomes. These items were prioritised by the group in the consecutive rounds and consensus was reached for the top ten priorities for each category. The consensus derived risk factors, perioperative interventions and important outcomes will inform the development of a structured, perioperative multidisciplinary enhanced patient care protocol for total hip and knee arthroplasty. It is anticipated that this study will provide the construct necessary for developing pragmatic enhanced care pathways aimed at improving patient outcomes after arthroplasty in LMICs.

Effect of delivery care user fee exemption policy on institutional ...

African Journals Online (AJOL)

Background: To improve access to skilled attendance at delivery and thereby reduce maternal mortality, the Government of Ghana introduced a policy exempting all women attending health facilities from paying delivery care fees. Objective: To examine the effect of the exemption policy on delivery-related maternal mortality.

Public policy and medical tourism: ethical implications for the Egyptian health care system.

Science.gov (United States)

Haley, Bob

2011-01-01

Egypt's medical tourism industry has been experiencing tremendous growth. However, Egypt continues to lack the necessary investment in its public health system to effectively care for its population. Current policy and the emergence of medical tourism have led to unequal health care access, resulting in high a prevalence of infectious diseases and lack of resources for its most vulnerable populations. As a new Egyptian government emerges, it is important for policymakers to understand the critical issues and ethical concerns of existing health policy. This understanding may be used to propose new policy that more effectively allocates to care for Egypt's population.

Is There a Consensus on Consensus Methodology? Descriptions and Recommendations for Future Consensus Research.

Science.gov (United States)

Waggoner, Jane; Carline, Jan D; Durning, Steven J

2016-05-01

The authors of this article reviewed the methodology of three common consensus methods: nominal group process, consensus development panels, and the Delphi technique. The authors set out to determine how a majority of researchers are conducting these studies, how they are analyzing results, and subsequently the manner in which they are reporting their findings. The authors conclude with a set of guidelines and suggestions designed to aid researchers who choose to use the consensus methodology in their work.Overall, researchers need to describe their inclusion criteria. In addition to this, on the basis of the current literature the authors found that a panel size of 5 to 11 members was most beneficial across all consensus methods described. Lastly, the authors agreed that the statistical analyses done in consensus method studies should be as rigorous as possible and that the predetermined definition of consensus must be included in the ultimate manuscript. More specific recommendations are given for each of the three consensus methods described in the article.

Competition policy for health care provision in Norway.

Science.gov (United States)

Brekke, Kurt R; Straume, Odd Rune

2017-02-01

Competition policy has played a very limited role for health care provision in Norway. The main reason is that Norway has a National Health Service (NHS) with extensive public provision and a wide set of sector-specific regulations that limit the scope for competition. However, the last two decades, several reforms have deregulated health care provision and opened up for provider competition along some dimensions. For specialised care, the government has introduced patient choice and (partly) activity (DRG) based funding, but also corporatised public hospitals and allowed for more private provision. For primary care, a reform changed the payment scheme to capitation and (a higher share of) fee-for-service, inducing almost all GPs on fixed salary contracts to become self-employed. While these reforms have the potential for generating competition in the Norwegian NHS, the empirical evidence is quite limited and the findings are mixed. We identify a set of possible caveats that may weaken the incentives for provider competition - such as the partial implementation of DRG pricing, the dual purchaser-provider role of regional health authorities, and the extensive consolidation of public hospitals - and argue that there is great scope for competition policy measures that could stimulate provider competition within the Norwegian NHS. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Sustainability of Long-term Care: Puzzling Tasks Ahead for Policy-Makers.

Science.gov (United States)

Mosca, Ilaria; van der Wees, Philip J; Mot, Esther S; Wammes, Joost J G; Jeurissen, Patrick P T

2016-08-17

The sustainability of long-term care (LTC) is a prominent policy priority in many Western countries. LTC is one of the most pressing fiscal issues for the growing population of elderly people in the European Union (EU) Member States. Country recommendations regarding LTC are prominent under the EU's European Semester. This paper examines challenges related to the financial- and organizational sustainability of LTC systems in the EU. We combined a targeted literature review and a descriptive selected country analysis of: (1) public- and private funding; (2) informal care and externalities; and (3) the possible role of technology in increasing productivity. Countries were selected via purposive sampling to establish a cohort of country cases covering the spectrum of differences in LTC systems: public spending, private funding, informal care use, informal care support, and cash benefits. The aging of the population, the increasing gap between availability of informal care and demand for LTC, substantial market failures of private funding for LTC, and fiscal imbalances in some countries, have led to structural reforms and enduring pressures for LTC policy-makers across the EU. Our exploration of national policies illustrates different solutions that attempt to promote fairness while stimulating efficient delivery of services. Important steps must be taken to address the sustainability of LTC. First, countries should look deeper into the possibilities of complementing public- and private funding, as well as at addressing market failures of private funding. Second, informal care externalities with spill-over into neighboring policy areas, the labor force, and formal LTC workers, should be properly addressed. Thirdly, innovations in LTC services should be stimulated to increase productivity through technology and process innovations, and to reduce costs. The analysis shows why it is difficult for EU Member State governments to meet all their goals for sustainable LTC

Combating a two-decade campaign attacking the scientific consensus on climate change

International Nuclear Information System (INIS)

Cook, J.

2013-01-01

New research published this year found that among peer-reviewed climate papers stating a position on anthropogenic global warning, over 97% endorsed the scientific consensus that humans were causing climate change. Meanwhile, the public think there is a 50/50 consensus among climate scientists. The article analyses how such a wide consensus gap has developed. At the beginning there was a misinformation campaign originated from opponents of climate action who rather than propose alternative policy solutions to climate change instead opted to attack the science. A key strategy was (and still is) creating the illusion of ongoing debate by magnifying the voices of a few dissenting scientists. Another common technique is the promotion of 'fake experts', using spokespeople unqualified in climate research. It is not easy to close the consensus gap because public perception of consensus is strongly associated with political ideology: the more conservative you are, the lower the consensus you perceive. Closing the consensus gap is absolutely necessary because when people perceive that scientists agree on an issue, they are more likely to support that issue. An intense information campaign focusing on the 97% consensus might be efficient to topple the fifty/fifty consensus. (A.C.)

Consensus statement: Supporting Safer Conception and Pregnancy For Men And Women Living with and Affected by HIV.

Science.gov (United States)

Matthews, Lynn T; Beyeza-Kashesya, Jolly; Cooke, Ian; Davies, Natasha; Heffron, Renee; Kaida, Angela; Kinuthia, John; Mmeje, Okeoma; Semprini, Augusto E; Weber, Shannon

2017-05-13

Safer conception interventions reduce HIV incidence while supporting the reproductive goals of people living with or affected by HIV. We developed a consensus statement to address demand, summarize science, identify information gaps, outline research and policy priorities, and advocate for safer conception services. This statement emerged from a process incorporating consultation from meetings, literature, and key stakeholders. Three co-authors developed an outline which was discussed and modified with co-authors, working group members, and additional clinical, policy, and community experts in safer conception, HIV, and fertility. Co-authors and working group members developed and approved the final manuscript. Consensus across themes of demand, safer conception strategies, and implementation were identified. There is demand for safer conception services. Access is limited by stigma towards PLWH having children and limits to provider knowledge. Efficacy, effectiveness, safety, and acceptability data support a range of safer conception strategies including ART, PrEP, limiting condomless sex to peak fertility, home insemination, male circumcision, STI treatment, couples-based HIV testing, semen processing, and fertility care. Lack of guidelines and training limit implementation. Key outstanding questions within each theme are identified. Consumer demand, scientific data, and global goals to reduce HIV incidence support safer conception service implementation. We recommend that providers offer services to HIV-affected men and women, and program administrators integrate safer conception care into HIV and reproductive health programs. Answers to outstanding questions will refine services but should not hinder steps to empower people to adopt safer conception strategies to meet reproductive goals.

Obesity Prevention Practices and Policies in Child Care Settings Enrolled and Not Enrolled in the Child and Adult Care Food Program.

Science.gov (United States)

Liu, Sherry T; Graffagino, Cheryl L; Leser, Kendall A; Trombetta, Autumn L; Pirie, Phyllis L

2016-09-01

Objectives The United States Department of Agriculture's Child and Adult Care Food Program (CACFP) provides meals and snacks to low-income children in child care. This study compared nutrition and physical activity practices and policies as well as the overall nutrition and physical activity environments in a sample of CACFP and non-CACFP child care settings. Methods A random stratified sample of 350 child care settings in a large Midwestern city and its suburbs, was mailed a survey on obesity prevention practices and policies concerning menu offerings, feeding practices, nutrition and physical activity education, activity levels, training, and screen time. Completed surveys were obtained from 229 of 309 eligible child care settings (74.1 % response rate). Chi square tests were used to compare practices and policies in CACFP and non-CACFP sites. Poisson and negative binomial regression were used to examine associations between CACFP and total number of practices and policies. Results Sixty-nine percent of child care settings reported CACFP participation. A significantly higher proportion of CACFP sites reported offering whole grain foods daily and that providers always eat the same foods that are offered to the children. CACFP sites had 1.1 times as many supportive nutrition practices as non-CACFP sites. CACFP participation was not associated with written policies or physical activity practices. Conclusions for Practice There is room for improvement across nutrition and physical activity practices and policies. In addition to food reimbursement, CACFP participation may help promote child care environments that support healthy nutrition; however, additional training and education outreach activities may be needed.

Advancing team-based primary health care: a comparative analysis of policies in western Canada.

Science.gov (United States)

Suter, Esther; Mallinson, Sara; Misfeldt, Renee; Boakye, Omenaa; Nasmith, Louise; Wong, Sabrina T

2017-07-17

We analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada. We conducted comparative case studies (n = 3). The policy analysis included: Context review: We reviewed relevant information (2007 to 2014) from databases and websites. Policy review and comparative analysis: We compared and contrasted publically available PHC policies. Key informant interviews: Key informants (n = 30) validated narratives prepared from the comparative analysis by offering contextual information on potential policy imperatives. Advisory group and roundtable: An expert advisory group guided this work and a key stakeholder roundtable event guided prioritization of policy imperatives. The concept of team-based PHC varies widely across and within the three provinces. We noted policy gaps related to team configuration, leadership, scope of practice, role clarity and financing of team-based care; few policies speak explicitly to monitoring and evaluation of team-based PHC. We prioritized four policy imperatives: (1) alignment of goals and policies at different system levels; (2) investment of resources for system change; (3) compensation models for all members of the team; and (4) accountability through collaborative practice metrics. Policies supporting team-based PHC have been slow to emerge, lacking a systematic and coordinated approach. Greater alignment with specific consideration of financing, reimbursement, implementation mechanisms and performance monitoring could accelerate systemic transformation by removing some well-known barriers to team-based care.

[Consensus report for the clinical care of smoking cessation in Spain. Comité Nacional para la Prevención del Tabaquismo].

Science.gov (United States)

Camarelles Guillem, Francisco; Dalmau González-Gallarza, Regina; Clemente Jiménez, Lourdes; Díaz-Maroto Muñoz, José Luis; Lozano Polo, Adelaida; Pinet Ogué, María Cristina

2013-03-16

Tobacco use presents an odd confluence of circumstances: it is a significant and high threat to health, and there is a lack of motivation among health workers to act accordingly. Yet we have effective interventions. It is really hard to identify any other determinant of health presenting this mixture of lethality, prevalence, and lack of care, despite having effective treatments readily available. On the other hand, smoking cessation interventions are considered as the gold standard of preventive interventions, far above other preventive measures commonly used. This has prompted the National Committee for Smoking Prevention to develop a consensus document for the Clinical Care of Smoking Cessation in Spain. The purpose of this technical and scientific document is to agree on a basic proposal of quality of care to tackle smokers to quit. This document would serve as a guideline in the clinical practice in our country. The aims of this agreement are to review the effectiveness of the existing therapies for smoking cessation, to synthesize their available evidence, and to set the basic minimum standards of care in the clinical practice of patients who smoke. The consensus sets the strategies, and the evidences that support them, in order to assist both the smokers who want to quit, and the smokers who do not, setting out the steps to intervene in the most adequate. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Outcome Criteria for Discharging the Patient With a New Ostomy From Home Health Care: A WOCN Society Consensus Conference.

Science.gov (United States)

Colwell, Janice C; Kupsick, Phyllis T; McNichol, Laurie L

2016-01-01

The Wound, Ostomy and Continence Nurses Society hosted a consensus panel of expert ostomy clinicians who were tasked with identifying minimal discharge criteria for home care patients with a new fecal or urinary diversion. Shortened hospital inpatient stays, higher patient acuity, and limited access to ostomy specialists send patients with new ostomies home with multiple educational and adjustment needs related to a new stoma. The Society recognized the lack of evidence-based ostomy practice and supported the work of the panel to develop statements that defined elements of the care plan for the patient or caregiver in home care who is adapting to living with a stoma. Eighteen statements were developed that provide minimum discharge criteria for the patient with a new ostomy in the home care setting. Support based upon current evidence as well as expert opinion with implementation strategies are offered for each statement.

Development of an Internet Security Policy for health care establishments.

Science.gov (United States)

Ilioudis, C; Pangalos, G

2000-01-01

The Internet provides unprecedented opportunities for interaction and data sharing among health care providers, patients and researchers. However, the advantages provided by the Internet come with a significantly greater element of risk to the confidentiality and integrity of information. This paper defines the basic security requirements that must be addressed in order to use the Internet to safely transmit patient and/or other sensitive Health Care information. It describes a suitable Internet Security Policy for Health Care Establishments and provides the set of technical measures that are needed for its implementation. The proposed security policy and technical approaches have been based on an extensive study of the related recommendations from the security and standard groups both in EU amid USA and our related work and experience. The results have been utilized in the framework of the Intranet Health Clinic project, where the use of the Internet for the transmission of sensitive Health Care information is of vital importance.

Distributed Optimal Consensus Control for Multiagent Systems With Input Delay.

Science.gov (United States)

Zhang, Huaipin; Yue, Dong; Zhao, Wei; Hu, Songlin; Dou, Chunxia; Huaipin Zhang; Dong Yue; Wei Zhao; Songlin Hu; Chunxia Dou; Hu, Songlin; Zhang, Huaipin; Dou, Chunxia; Yue, Dong; Zhao, Wei

2018-06-01

This paper addresses the problem of distributed optimal consensus control for a continuous-time heterogeneous linear multiagent system subject to time varying input delays. First, by discretization and model transformation, the continuous-time input-delayed system is converted into a discrete-time delay-free system. Two delicate performance index functions are defined for these two systems. It is shown that the performance index functions are equivalent and the optimal consensus control problem of the input-delayed system can be cast into that of the delay-free system. Second, by virtue of the Hamilton-Jacobi-Bellman (HJB) equations, an optimal control policy for each agent is designed based on the delay-free system and a novel value iteration algorithm is proposed to learn the solutions to the HJB equations online. The proposed adaptive dynamic programming algorithm is implemented on the basis of a critic-action neural network (NN) structure. Third, it is proved that local consensus errors of the two systems and weight estimation errors of the critic-action NNs are uniformly ultimately bounded while the approximated control policies converge to their target values. Finally, two simulation examples are presented to illustrate the effectiveness of the developed method.

Orphanhood, Poverty and the Care Dilemma: Review of Global Policy Trends

Directory of Open Access Journals (Sweden)

Abebe, Tatek

2009-07-01

Full Text Available The care and protection of children experiencing orphanhood presents a major child-care policy challenge. This paper draws on a review of the literature to document divergent conceptualizations of orphanhood, how the hurdles for the care of orphans reflect wider issues of poverty and inequality, as well as the ways in which different care interventions (familial, institutional, community-based and rights-based might be appropriated for children in need. It is argued that the map of contemporary orphanhood overlaps with the contours of global poverty, inequality, age-based deprivations and marginalization. An example of a ‘globalised’ model of orphan care, namely SOS Children’s Villages, is presented and its implications for policy are examined. The paper highlights the significance of fighting poverty and enhancing the care-giving capabilities of extended families in the care and protection of children from a rights-based perspective. It suggests that external interventions should primarily address the structural causes of poverty and marginality, rather than amplifying inequalities through the selective support of orphans in economically vulnerable communities.

Developing and implementing an oral care policy and assessment tool.

LENUS (Irish Health Repository)

Stout, Michelle

2012-01-09

Oral hygiene is an essential aspect of nursing care. Poor oral care results in patients experiencing pain and discomfort, puts individuals at risk of nutritional deficiency and infection, and has an adverse effect on quality of life. This article describes how an oral care policy and assessment tool were updated to ensure the implementation of evidence-based practice at one hospital in the Republic of Ireland.

Evidence-informed primary health care workforce policy: are we asking the right questions?

Science.gov (United States)

Naccarella, Lucio; Buchan, Jim; Brooks, Peter

2010-01-01

Australia is facing a primary health care workforce shortage. To inform primary health care (PHC) workforce policy reforms, reflection is required on ways to strengthen the evidence base and its uptake into policy making. In 2008 the Australian Primary Health Care Research Institute funded the Australian Health Workforce Institute to host Professor James Buchan, Queen Margaret University, UK, an expert in health services policy research and health workforce planning. Professor Buchan's visit enabled over forty Australian PHC workforce mid-career and senior researchers and policy stakeholders to be involved in roundtable policy dialogue on issues influencing PHC workforce policy making. Six key thematic questions emerged. (1) What makes PHC workforce planning different? (2) Why does the PHC workforce need to be viewed in a global context? (3) What is the capacity of PHC workforce research? (4) What policy levers exist for PHC workforce planning? (5) What principles can guide PHC workforce planning? (6) What incentives exist to optimise the use of evidence in policy making? The emerging themes need to be discussed within the context of current PHC workforce policy reforms, which are focussed on increasing workforce supply (via education/training programs), changing the skill mix and extending the roles of health workers to meet patient needs. With the Australian government seeking to reform and strengthen the PHC workforce, key questions remain about ways to strengthen the PHC workforce evidence base and its uptake into PHC workforce policy making.

Alignment between chronic disease policy and practice: case study at a primary care facility.

Science.gov (United States)

Draper, Claire A; Draper, Catherine E; Bresick, Graham F

2014-01-01

Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape (PGWC) has prioritized the management of chronic diseases and has developed a policy and framework (Adult Chronic Disease Management Policy 2009) to guide and improve the prevention and management of chronic diseases at a primary care level. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy. One comprehensive primary care facility in a Cape Town health district was used as a case study. Data was collected via semi-structured interviews (n = 10), focus groups (n = 8) and document review. Participants in this study included clinical staff involved in chronic disease management at the facility and at a provincial level. Data previously collected using the Integrated Audit Tool for Chronic Disease Management (part of the PGWC Adult Chronic Disease Management policy) formed the basis of the guide questions used in focus groups and interviews. The results of this research indicate a significant gap between policy and its implementation to improve and support chronic disease management at this primary care facility. A major factor seems to be poor policy knowledge by clinicians, which contributes to an individual rather than a team approach in the management of chronic disease patients. Poor interaction between facility- and community-based services also emerged. A number of factors were identified that seemed to contribute to poor policy implementation, the majority of which were staff related and ultimately resulted in a decrease in the quality of patient care. Chronic disease policy implementation needs to be improved in order to support chronic disease management at this facility. It is possible that similar

The Global Spine Care Initiative: a consensus process to develop and validate a stratification scheme for surgical care of spinal disorders as a guide for improved resource utilization in low- and middle-income communities.

Science.gov (United States)

Acaroğlu, Emre; Mmopelwa, Tiro; Yüksel, Selcen; Ayhan, Selim; Nordin, Margareta; Randhawa, Kristi; Haldeman, Scott

2017-10-16

The purpose of this study was to develop a stratification scheme for surgical spinal care to serve as a framework for referrals and distribution of patients with spinal disorders. We used a modified Delphi process. A literature search identified experts for the consensus panel and the panel was expanded by inviting spine surgeons known to be global opinion leaders. After creating a seed document of five hierarchical levels of surgical care, a four-step modified Delphi process (question validation, collection of factors, evaluation of factors, re-evaluation of factors) was performed. Of 78 invited experts, 19 participated in round 1, and of the 19, 14 participated in 2, and 12 in 3 and 4. Consensus was fairly heterogeneous for levels of care 2-4 (moderate resources). Only simple assessment methods based on the clinical skills of the medical personnel were considered feasible and safe in low-resource settings. Diagnosis, staging, and treatment were deemed feasible and safe in a specialized spine center. Accurate diagnostic workup was deemed feasible and safe for lower levels of care complexity (from level 3 upwards) compared to non-invasive procedures (level 4) and the full range of invasive procedures (level 5). This study introduces a five-level stratification scheme for the surgical care of spinal disorders. This stratification may provide input into the Global Spine Care Initiative care pathway that will be applied in medically underserved areas and low- and middle-income countries. These slides can be retrieved under Electronic Supplementary Material.

Bridging the gap in ageing: Translating policies into practice in Malaysian Primary Care

Directory of Open Access Journals (Sweden)

Ambigga Krishnapillai S

2011-03-01

Full Text Available Abstract Population ageing is poised to become a major challenge to the health system as Malaysia progresses to becoming a developed nation by 2020. This article aims to review the various ageing policy frameworks available globally; compare aged care policies and health services in Malaysia with Australia; and discuss various issues and challenges in translating these policies into practice in the Malaysian primary care system. Fundamental solutions identified to bridge the gap include restructuring of the health care system, development of comprehensive benefit packages for older people under the national health financing scheme, training of the primary care workforce, effective use of electronic medical records and clinical guidelines; and empowering older people and their caregivers with knowledge, skills and positive attitudes to ageing and self care. Ultimately, family medicine specialists must become the agents for change to lead multidisciplinary teams and work with various agencies to ensure that better coordination, continuity and quality of care are eventually delivered to older patients across time and settings.

The role of ethical banks in health care policy and financing in Spain.

Science.gov (United States)

Salvador-Carulla, Luis; Solans, Josep; Duaigues, Mónica; Balot, Jordi; García-Gutierrez, Juan Carlos

2009-01-01

Ethical, social, or civic banks, constitute a secondary source of financing, which is particularly relevant in Southern and Central Europe. However there is no information on the scientific literature on this source of health care financing. We review the characteristics of saving banks in Spain and illustrate the contribution of one institution "Obra Social Caixa Catalunya" (OS-CC) to the health care financing in Spain. Savings bank health care funding was equivalent to 3 percent of the public health expenditure for 2008. The programs developed by OS-CC illustrate the complex role of savings banks in health financing, provision, training, and policy, particularly in the fields of integrated care and innovation. Financing is a basic tool for health policy. However, the role of social banking in the development of integrated care networks has been largely disregarded, in spite of its significant contribution to complementary health and social care in Southern and Central Europe. Decision makers both at the public health agencies and at the social welfare departments of savings banks should become aware of the policy implications and impact of savings bank activities in the long-term care system.

Consensus statement on posttraumatic stress disorder from the International Consensus Group on Depression and Anxiety.

Science.gov (United States)

Ballenger, J C; Davidson, J R; Lecrubier, Y; Nutt, D J; Foa, E B; Kessler, R C; McFarlane, A C; Shalev, A Y

2000-01-01

To provide primary care clinicians with a better understanding of management issues in posttraumatic stress disorder (PTSD) and guide clinical practice with recommendations on the appropriate management strategy. The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Other faculty invited by the chair were Edna B. Foa, Ronald C. Kessler, Alexander C. McFarlane, and Arieh Y. Shalev. The consensus statement is based on the 6 review articles that are published in this supplement and the scientific literature relevant to the issues reviewed in these articles. Group meetings were held over a 2-day period. On day 1, the group discussed the review articles and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. PTSD is often a chronic and recurring condition associated with an increased risk of developing secondary comorbid disorders, such as depression. Selective serotonin reuptake inhibitors are generally the most appropriate choice of first-line medication for PTSD, and effective therapy should be continued for 12 months or longer. The most appropriate psychotherapy is exposure therapy, and it should be continued for 6 months, with follow-up therapy as needed.

Perceptions of a fluid consensus: uniqueness bias, false consensus, false polarization, and pluralistic ignorance in a water conservation crisis.

Science.gov (United States)

Monin, Benoît; Norton, Michael I

2003-05-01

A 5-day field study (N = 415) during and right after a shower ban demonstrated multifaceted social projection and the tendency to draw personality inferences from simple behavior in a time of drastic consensus change. Bathers thought showering was more prevalent than did non-bathers (false consensus) and respondents consistently underestimated the prevalence of the desirable and common behavior--be it not showering during the shower ban or showering after the ban (uniqueness bias). Participants thought that bathers and non-bathers during the ban differed greatly in their general concern for the community, but self-reports demonstrated that this gap was illusory (false polarization). Finally, bathers thought other bathers cared less than they did, whereas non-bathers thought other non-bathers cared more than they did (pluralistic ignorance). The study captures the many biases at work in social perception in a time of social change.

Elderly and long-term care trends and policy in Taiwan: Challenges and opportunities for health care professionals

Directory of Open Access Journals (Sweden)

Hsiu-Hung Wang

2012-09-01

Full Text Available The purpose of this article is to address the trends and policy of elderly and long-term care in Taiwan. In response to the increasing demand of an aging society, healthcare professionals play crucial roles in elderly and long-term care and quality assurance of services. This article focuses on the current situation of elderly health care, demands of long-term care, long-term care policy in Taiwan, draft of the Long-term Care Services Act, and draft of the Long-term Care Insurance Act. After the 10-year long-term care project was proposed by the Taiwan government, the supply of health care services and demand for long-term care have created many challenges and opportunities for innovative health professional development. Challenges consist of low old dependency ratio caused by low birth rate, lack of elderly and long-term care related manpower, services and education reform related to long-term care for the future society, and interprofessional collaboration and team work of long-term care. Opportunities include expanding the roles and the career pathways of healthcare professionals, promoting the concepts of active aging and good quality of life, and developing industrial cooperation related to long-term care services. Under these circumstances, healthcare professonals are actively involved in practice, education and research of long-term care services that ensure elderly and disabled people can live a healthier and better life.

Education and Health Care Policies in Ghana

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Ziblim Abukari

2015-10-01

Full Text Available Education and health care policies in Ghana since independence have been universalist in approach providing free universal health care and free basic and tertiary education until the early 1980s. Precipitated primarily by a severe drought, stagnant economic growth, mismanagement, and political instability, Ghana undertook major economic reforms with prodding from the World Bank and International Monetary Fund in a bid to salvage the economy. These economic measures included cost recovery and cutback spending in education and health sectors. However, in recent years, purposive targeted interventions have been pursued to address inequalities in education and health care. These new programs include the Education Capitation Grant, school feeding program, and the National Health Insurance Scheme (NHIS, which are propelling Ghana toward the achievement of the Millennium Development Goals. The prospects of these programs in addressing disparities in access to education and health care in the country and recommendations for improved delivery are discussed.

Child protection and out of home care: Policy, practice, and research connectionsAustralia and New Zealand

Directory of Open Access Journals (Sweden)

2014-03-01

Full Text Available This article provides an outline of the early development of care and protection in Australia and New Zealand as a backdrop to an overview of child protection systems and policies and the current childprotection profile in both countries. Key issues that have become the focus of policy reform are canvassed and legislative and policy initiatives to promote child safety as well as strengthen families are elaborated. An overview of trends in relation to out of home care, including routes into care, care arrangements and permanency policies is provided. The article profiles selected research studies from Australia focusing on outcomes of care: stability of care, mental health and educational outcomes of looked after children, abuse in care, and routes out of care through reunification and aging out. Other issues treated are the overrepresentation of indigenous children in care systems in both countries and the challenges of maintaining cultural connections. The article concludes with a brief comparative analysis identifying similarities and differences in child welfare systems in both countries.

Preferences on policy options for ensuring the financial sustainability of health care services in the future: results of a stakeholder survey.

Science.gov (United States)

Tordrup, David; Angelis, Aris; Kanavos, Panos

2013-12-01

highest preference was for policies to modify lifestyle and implement more extensive screening within risk groups for high burden illnesses. There was a broad consensus not to reallocate resources from social security/education. Between stakeholders, there were differences of opinion between industry/advisory and a range of other groups, with industry being generally more in favour of market-based interventions and an increased role for the private sector in health care financing/delivery. Conversely, stakeholders from academia, government, national health services and insurance were relatively more in favour of more restrictive purchasing of new and expensive technologies, and (to varying extent) of higher income/corporate taxes. Taxes on cigarettes/alcohol were by far considered the most politically feasible option. According to this study, policy options that are broadly acceptable across stakeholder groups with different inherent interests exist but are limited to lifestyle modification, screening interventions and excise taxes on harmful products. Representatives from the private sector tend to view solutions rooted in the private sector as both effective and politically feasible options, while stakeholders from academia and the public sector seem to place more emphasis on solutions that do not disproportionately impact certain population groups.

Antibiotic Policies in the Intensive Care Unit

Directory of Open Access Journals (Sweden)

Nese Saltoglu

2003-08-01

Full Text Available The antimicrobial management of patients in the Intensive Care Units are complex. Antimicrobial resistance is an increasing problem. Effective strategies for the prevention of antimicrobial resistance in ICUs have focused on limiting the unnecessary use of antibiotics and increasing compliance with infection control practices. Antibiotic policies have been implemented to modify antibiotic use, including national or regional formulary manipulations, antibiotic restriction forms, care plans, antibiotic cycling and computer assigned antimicrobial therapy. Moreover, infectious diseases consultation is a simple way to limit antibiotic use in ICU units. To improve rational antimicrobial using a multidisiplinary approach is suggested. [Archives Medical Review Journal 2003; 12(4.000: 299-309

Standardised neonatal parenteral nutrition formulations – an Australasian group consensus 2012

Science.gov (United States)

2014-01-01

Standardised parenteral nutrition formulations are routinely used in the neonatal intensive care units in Australia and New Zealand. In 2010, a multidisciplinary group was formed to achieve a consensus on the formulations acceptable to majority of the neonatal intensive care units. Literature review was undertaken for each nutrient and recommendations were developed in a series of meetings held between November 2010 and April 2011. Three standard and 2 optional amino acid/dextrose formulations and one lipid emulsion were agreed by majority participants in the consensus. This has a potential to standardise neonatal parenteral nutrition guidelines, reduce costs and prescription errors. PMID:24548745

76 FR 21894 - Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations...

Science.gov (United States)

2011-04-19

... contractual clauses or provisions 2. Tying sales (either explicitly or implicitly through pricing policies) of... Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings... (the ``Agencies'') are proposing an enforcement policy regarding the application of the antitrust laws...

Implementation of Fee-Free Maternal Health-Care Policy in Ghana: Perspectives of Users of Antenatal and Delivery Care Services From Public Health-Care Facilities in Accra.

Science.gov (United States)

Anafi, Patricia; Mprah, Wisdom K; Jackson, Allen M; Jacobson, Janelle J; Torres, Christopher M; Crow, Brent M; O'Rourke, Kathleen M

2018-01-01

In 2008, the government of Ghana implemented a national user fee maternal care exemption policy through the National Health Insurance Scheme to improve financial access to maternal health services and reduce maternal as well as perinatal deaths. Although evidence shows that there has been some success with this initiative, there are still issues relating to cost of care to beneficiaries of the initiative. A qualitative study, comprising 12 focus group discussions and 6 interviews, was conducted with 90 women in six selected urban neighborhoods in Accra, Ghana, to examine users' perspectives regarding the implementation of this policy initiative. Findings showed that direct cost of delivery care services was entirely free, but costs related to antenatal care services and indirect costs related to delivery care still limit the use of hospital-based midwifery and obstetric care. There was also misunderstanding about the initiative due to misinformation created by the government through the media.We recommend that issues related to both direct and indirect costs of antenatal and delivery care provided in public health-care facilities must be addressed to eliminate some of the lingering barriers relating to cost hindering the smooth operation and sustainability of the maternal care fee exemption policy.

[Intercultural health care policy from the perspective of health care providers and Mapuche clients].

Science.gov (United States)

Alarcón, Ana María; Astudillo, Paula; Barrios, Sara; Rivas, Edith

2004-09-01

Intercultural health is becoming an emergent topic in the design of health care programs for Mapuche people of Chile. This process faces important challenges such as the scarce theoretical support about the meaning of intercultural health and their practical consequences for providers and clients. To explore the perception in providers and Mapuche clients about intercultural health. A survey performed in 11 counties with the highest concentration of Mapuche people, of the IX region of Chile. The perception about the development of a new health policy specially designed for Mapuche patients was surveyed in 399 Mapuche patients and 64 providers of primary health care centers. Mapuche clients considered, as the main regional challenges, the indifference and discrimination of health care teams towards Mapuche patients, aggravated by the indifference of authorities. Providers considered that the main problem was a lack of knowledge about Mapuche culture and skills to deal with this ethnic group. Patients and providers agreed on the need to use Mapuche dialect in health care attentions, to coordinate actions with traditional healers and to accept ethnical therapeutic practices. There is scarce agreement between providers and Mapuche clients about the need for an special intercultural health policy, its contents, and the regional conditions for its implementation and development.

Caring: Implications for Child Care and for Family Policy

Directory of Open Access Journals (Sweden)

Roderic Beaujot

2009-12-01

Full Text Available Canadian families have changed, in part due to an economy that provides more work opportunities for women, and a cultural orientation that values equal opportunity and diversity in families. In spite of the change, both quantitative and qualitative evidence suggest a continued preference for mothers to spend considerable time with children, especially in the infant and toddler years. Thus, in an average couple, the presence of young children in the home brings wives to reduce their paid work and husbands to increase their paid work. Our reading of parental preferences suggests an interest in more services for young children in the form of early childhood education and child care, but also an interest in policies that would allow parents to spend more time with children through parental leaves, part-time work with good benefits, and subsidies that supplement market income. Many options available to two-parent families are often less feasible for lone parents, giving a higher priority to child care.

Special populations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

Science.gov (United States)

Dries, David; Reed, Mary Jane; Kissoon, Niranjan; Christian, Michael D; Dichter, Jeffrey R; Devereaux, Asha V; Upperman, Jeffrey S

2014-10-01

Past disasters have highlighted the need to prepare for subsets of critically ill, medically fragile patients. These special patient populations require focused disaster planning that will address their medical needs throughout the event to prevent clinical deterioration. The suggestions in this article are important for all who are involved in large-scale disasters or pandemics with multiple critically ill or injured patients, including frontline clinicians, hospital administrators, and public health or government officials. Key questions regarding the care of critically ill or injured special populations during disasters or pandemics were identified, and a systematic literature review (1985-2013) was performed. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. The panel did not include pediatrics as a separate special population because pediatrics issues are embedded in each consensus document. Fourteen suggestions were formulated regarding the care of critically ill and injured patients from special populations during pandemics and disasters. The suggestions cover the following areas: defining special populations for mass critical care, special population planning, planning for access to regionalized service for special populations, triage and resource allocation of special populations, therapeutic considerations, and crisis standards of care for special populations. Chronically ill, technologically dependent, and complex critically ill patients present a unique challenge to preparing and implementing mass critical care. There are, however, unique opportunities to engage patients, primary physicians, advocacy groups, and professional organizations to lessen the impact of disaster on these special populations.

Methodology: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

Science.gov (United States)

Ornelas, Joe; Dichter, Jeffrey R; Devereaux, Asha V; Kissoon, Niranjan; Livinski, Alicia; Christian, Michael D

2014-10-01

Natural disasters, industrial accidents, terrorism attacks, and pandemics all have the capacity to result in large numbers of critically ill or injured patients. This supplement provides suggestions for all those involved in a disaster or pandemic with multiple critically ill patients, including front-line clinicians, hospital administrators, professional societies, and public health or government officials. The field of disaster medicine does not have the required body of evidence needed to undergo a traditional guideline development process. In result, consensus statement-development methodology was used to capture the highest-caliber expert opinion in a structured, scientific approach. Task Force Executive Committee members identified core topic areas regarding the provision of care to critically ill or injured patients from pandemics or disasters and subsequently assembled an international panel for each identified area. International disaster medicine experts were brought together to identify key questions (in a population, intervention, comparator, outcome [PICO]-based format) within each of the core topic areas. Comprehensive literature searches were then conducted to identify studies upon which evidence-based recommendations could be made. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions that are presented in this supplement using a modified Delphi process. A total of 315 suggestions were drafted across all topic groups. After two rounds of a Delphi consensus-development process, 267 suggestions were chosen by the panel to include in the document and published in a total of 12 manuscripts composing the core chapters of this supplement. Draft manuscripts were prepared by the topic editor and members of the working groups for each of the topics, producing a total of 11 papers. Once the preliminary drafts were received, the Executive Committee (Writing Committee) then met to review, edit, and

Preventive care utilization: Association with individual- and workgroup-level policy and practice perceptions.

Science.gov (United States)

Sabbath, Erika L; Sparer, Emily H; Boden, Leslie I; Wagner, Gregory R; Hashimoto, Dean M; Hopcia, Karen; Sorensen, Glorian

2018-06-01

Preventive medical care may reduce downstream medical costs and reduce population burden of disease. However, although social, demographic, and geographic determinants of preventive care have been studied, there is little information about how the workplace affects preventive care utilization. This study examines how four types of organizational policies and practices (OPPs) are associated with individual workers' preventive care utilization. We used data collected in 2012 from 838 hospital patient care workers, grouped in 84 patient care units at two hospitals in Boston. Via survey, we assessed individuals' perceptions of four types of OPPs on their work units. We linked the survey data to a database containing detailed information on medical expenditures. Using multilevel models, we tested whether individual-level perceptions, workgroup-average perceptions, and their combination were associated with individual workers' preventive care utilization (measured by number of preventive care encounters over a two-year period). Adjusting for worker characteristics, higher individual-level perceptions of workplace flexibility were associated with greater preventive care utilization. Higher average unit-level perceptions of people-oriented culture, ergonomic practices, and flexibility were associated with greater preventive care utilization. Overall, we find that workplace policies and practices supporting flexibility, ergonomics, and people-oriented culture are associated with positive preventive care-seeking behavior among workers, with some policies and practices operating at the individual level and some at the group level. Improving the work environment could impact employers' health-related expenditures and improve workers' health-related quality of life. Copyright © 2018 Elsevier Inc. All rights reserved.

Gaining consensus on family carer needs when caring for someone dying at home to develop the Carers' Alert Thermometer (CAT): a modified Delphi study.

Science.gov (United States)

Knighting, Katherine; O'Brien, Mary R; Roe, Brenda; Gandy, Rob; Lloyd-Williams, Mari; Nolan, Mike; Jack, Barbara A

2016-01-01

To report a multi-phase modified Delphi study conducted with carers and professionals to identify the priority areas for inclusion in an alert screening tool for carers providing support to someone dying at home. Internationally, there is a growing emphasis on increasing choice for patients who wish to die at home which relies heavily on care provided by the unpaid family carers. Family carers can have high levels of unmet needs comprising their psychological and physical health and their ability to provide effective care and support. Development of an alert tool to identify carers' needs in everyday practice required identification and consensus of the priority areas of need for inclusion. Multi-phase modified Delphi study and instrument development. Qualitative and quantitative data collection took place between 2011-2013 with 111 carers and 93 professionals to identify carers' needs and gain consensus on the priority areas for inclusion in the alert tool. An expert panel stage and final evidence review post-Delphi were used. The Delphi panels had high levels of agreement and consensus. Ten areas of carer need across two themes of 'the current caring situation' and 'the carer's own health and well-being' were prioritized for inclusion in the alert tool. An optional end-of-life planning question was included following the final stages. The results provide evidence of carers' needs to be assessed, areas for consideration in the education of those who support carers and someone dying at home and targeting of services, while demonstrating the usefulness and adaptability of the Delphi method. © 2015 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

Development of a national health care waste management policy for South Africa

CSIR Research Space (South Africa)

Molefe, GS

2006-09-01

Full Text Available A Policy for Health Care Risk Waste (HCRW) Management is being developed by the Department of Environmental Affairs and Tourism in collaboration with the national Department of Health. The HCRW Management Policy aims at: i) Setting of standards...

Canadian Association of Gastroenterology consensus guidelines on safety and quality indicators in endoscopy.

Science.gov (United States)

Armstrong, David; Barkun, Alan; Bridges, Ron; Carter, Rose; de Gara, Chris; Dube, Catherine; Enns, Robert; Hollingworth, Roger; Macintosh, Donald; Borgaonkar, Mark; Forget, Sylviane; Leontiadis, Grigorios; Meddings, Jonathan; Cotton, Peter; Kuipers, Ernst J

2012-01-01

Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality, highlight the need for clearly defined, evidence-based processes to support quality improvement in endoscopy. To identify processes and indicators of quality and safety relevant to high-quality endoscopy service delivery. A multidisciplinary group of 35 voting participants developed recommendation statements and performance indicators. Systematic literature searches generated 50 initial statements that were revised iteratively following a modified Delphi approach using a web-based evaluation and voting tool. Statement development and evidence evaluation followed the AGREE (Appraisal of Guidelines, REsearch and Evaluation) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidelines. At the consensus conference, participants voted anonymously on all statements using a 6-point scale. Subsequent web-based voting evaluated recommendations for specific, individual quality indicators, safety indicators and mandatory endoscopy reporting fields. Consensus was defined a priori as agreement by 80% of participants. Consensus was reached on 23 recommendation statements addressing the following: ethics (statement 1: agreement 100%), facility standards and policies (statements 2 to 9: 90% to 100%), quality assurance (statements 10 to 13: 94% to 100%), training, education, competency and privileges (statements 14 to 19: 97% to 100%), endoscopy reporting standards (statements 20 and 21: 97% to 100%) and patient perceptions (statements 22 and 23: 100%). Additionally, 18 quality indicators (agreement 83% to 100%), 20 safety indicators (agreement 77% to 100%) and 23 recommended endoscopy-reporting elements (agreement 91% to 100%) were identified. The consensus process identified a clear need for high-quality clinical and outcomes research to support quality improvement in the delivery of endoscopy services. The

Dementia care in public health in Brazil and the world: A systematic review

Directory of Open Access Journals (Sweden)

Bianca Bolzan Cieto

Full Text Available ABSTRACT OBJECTIVE: This study aimed to identify in the recent scientific literature, information on health care provided to people with dementia, dementia costs and its resource implications for public health. METHODS: This was a systematic review of the literature in which the articles were consulted from the databases PubMed/MEDLINE, LILACS and SciELO. The review sample consisted of 45 articles. RESULTS: Examination of the studies identified the current scenario of dementia in relation to public health and public policy in Brazil and the world. The analyzed studies revealed key information on aspects of dementia in the world. There was consensus on the high prevalence of the syndrome and on the significant cost of health care and public policy for assisting the elderly with dementia. CONCLUSION: The importance of planning and implementing new public policies was recognized, since these are essential for the organization and management of health services and directly influence the country's ability to provide health care for people with dementia.

Mixed methods research in the development and evaluation of complex interventions in palliative and end-of-life care: report on the MORECare consensus exercise.

Science.gov (United States)

Farquhar, Morag; Preston, Nancy; Evans, Catherine J; Grande, Gunn; Short, Vicky; Benalia, Hamid; Higginson, Irene J; Todd, Chris

2013-12-01

Complex interventions are common in palliative and end-of-life care. Mixed methods approaches sit well within the multiphase model of complex intervention development and evaluation. Generic mixed methods guidance is useful but additional challenges in the research design and operationalization within palliative and end-of-life care may have an impact on the use of mixed methods. The objective of the study was to develop guidance on the best methods for combining quantitative and qualitative methods for health and social care intervention development and evaluation in palliative and end-of-life care. A one-day workshop was held where experts participated in facilitated groups using Transparent Expert Consultation to generate items for potential recommendations. Agreement and consensus were then sought on nine draft recommendations (DRs) in a follow-up exercise. There was at least moderate agreement with most of the DRs, although consensus was low. Strongest agreement was with DR1 (usefulness of mixed methods to palliative and end-of-life care) and DR5 (importance of attention to respondent burden), and least agreement was with DR2 (use of theoretical perspectives) and DR6 (therapeutic effects of research interviews). Narrative comments enabled recommendation refinement. Two fully endorsed, five partially endorsed, and two refined DRs emerged. The relationship of these nine to six key challenges of palliative and end-of-life care research was analyzed. There is a need for further discussion of these recommendations and their contribution to methodology. The recommendations should be considered when designing and operationalizing mixed methods studies of complex interventions in palliative care, and because they may have wider relevance, should be considered for other applications.

Late presentation of chronic viral hepatitis for medical care

DEFF Research Database (Denmark)

Mauss, Stefan; Pol, Stanislas; Buti, Maria

2017-01-01

, and relevant stakeholders including patient advocacy groups, health policy-makers, international health organisations and surveillance experts, met in 2014 and 2015 to develop a draft consensus definition of late presentation with viral hepatitis for medical care. This was refined through subsequent...... consultations among the group. RESULTS: Two definitions were agreed upon. Presentation with advanced liver disease caused by chronic viral hepatitis for medical care is defined as a patient with chronic hepatitis B and C and significant fibrosis (≥ F3 assessed by either APRI score > 1.5, FIB-4 > 3.25, Fibrotest...

Consensus on the back end of the fuel cycle urgently needed; Entsorgungskonsens dringend geboten

Energy Technology Data Exchange (ETDEWEB)

Strassburg, W. [RWE Energie AG, Essen (Germany). Zentralbereich Ausland - Politikanalysen

1996-05-01

The lack of harmonization among the fields of environmental policy, energy policy, and economic policy in Germany is obvious. Returning to a basic consensus in energy policy, with an unbiased evaluation of all energy resources, is an indispensable step for all those to whom ecology is a truly serious concept. The positions of all energy resources must be assessed with a view to national and international developments. No source of primary energy must be excluded from that review. Nuclear power remains one of the important options in the energy mix especially from the points of view of CO{sub 2} avoidance and preventive protection of the climate. A leading industrialized nation, such as the Federal Republic of Germany, ought to be able, in the more and more important discussion about globally sustainable development, to return to a consensus across all political parties at least about the back end of the nuclear fuel cycle. Or should the philosopher, Sir Karl Popper, finally be proven right in his statement that those wanting to establish a paradise on earth must be careful not to create hell? (orig.) [Deutsch] Der Abstimmungsmangel zwischen Umwelt-, Energie- und Wirtschaftspolitik in Deutschland ist unuebersehbar. Die Rueckkehr zum energiepolitischen Grundkonsens mit einer vorurteilsfreien Bewertung aller Energietraeger ist fuer solche, die es mit der Oekologie wirklich ernst meinen, unverzichtbar. Der Stellenwert aller Energietraeger muss im Hinblick auf nationale und internationale Entwicklungen ueberdacht werden; eine Tabuisierung einzelner Primaerenergietraeger darf es nicht geben. Insbesondere unter dem Aspekt der CO{sub 2}-Vermeidung und des vorsorgenden Klimaschutzes ist und bleibt die Kernenergie eine bedeutende Option im Energie-Mix. Im Rahmen der allgemein an Bedeutung gewinnenden Diskussion ueber eine global nachhaltige Entwicklung sollte es einer fuehrenden Industrienation wie der Bundesrepublik Deutschland eigentlich gelingen, zumindest hinsichtlich

Implementation as transfer between policy, research and practice in care.

OpenAIRE

Heiligers, P.J.M.; Niet, A. van der

2010-01-01

Background: Health Services Research is policy related and results have an impact on practices. Implementation of research output into practices is performed with a variety of strategies. Type of policy intentions and research output create a specific context for implementation. The main question here is: what combinations of background factors and implementation strategies lead to successful implementations in health care? Methods: Sources for this study are evaluations of 72 completed imple...

Expert surgical consensus for prenatal counseling using the Delphi method.

Science.gov (United States)

Berman, Loren; Jackson, Jordan; Miller, Kristen; Kowalski, Rebecca; Kolm, Paul; Luks, Francois I

2017-11-28

Pediatric surgeons frequently offer prenatal consultation for congenital pulmonary airway malformation (CPAM) and congenital diaphragmatic hernia (CDH); however, there is no evidence-based consensus to guide prenatal decision making and counseling for these conditions. Eliciting feedback from experts is integral to defining best practice regarding prenatal counseling and intervention. A Delphi consensus process was undertaken using a panel of pediatric surgeons identified as experts in fetal therapy to address current limitations. Areas of discrepancy in the literature on CPAM and CDH were identified and used to generate a list of content and intervention questions. Experts were invited to participate in an online Delphi survey. Items that did not reach first-round consensus were broken down into additional questions, and consensus was achieved in the second round. Fifty-four surgeons (69%) responded to at least one of the two survey rounds. During round one, consensus was reached on 54 of 89 survey questions (61%), and 45 new questions were developed. During round two, consensus was reached on 53 of 60 survey questions (88%). We determined expert consensus to establish guidelines regarding perinatal management of CPAM and CDH. Our results can help educate pediatric surgeons participating in perinatal care of these patients. V. Copyright © 2017 Elsevier Inc. All rights reserved.

Sustaining critical care: using evidence-based simulation to evaluate ICU management policies.

Science.gov (United States)

Mahmoudian-Dehkordi, Amin; Sadat, Somayeh

2017-12-01

Intensive Care Units (ICU) are costly yet critical hospital departments that should be available to care for patients needing highly specialized critical care. Shortage of ICU beds in many regions of the world and the constant fire-fighting to make these beds available through various ICU management policies motivated this study. The paper discusses the application of a generic system dynamics model of emergency patient flow in a typical hospital, populated with empirical evidence found in the medical and hospital administration literature, to explore the dynamics of intended and unintended consequences of such ICU management policies under a natural disaster crisis scenario. ICU management policies that can be implemented by a single hospital on short notice, namely premature transfer from ICU, boarding in ward, and general ward admission control, along with their possible combinations, are modeled and their impact on managerial and health outcome measures are investigated. The main insight out of the study is that the general ward admission control policy outperforms the rest of ICU management policies under such crisis scenarios with regards to reducing total mortality, which is counter intuitive for hospital administrators as this policy is not very effective at alleviating the symptoms of the problem, namely high ED and ICU occupancy rates that are closely monitored by hospital management particularly in times of crisis. A multivariate sensitivity analysis on parameters with diverse range of values in the literature found the superiority of the general ward admission control to hold true in every scenario.

[National Policy of Humanization and education of health care professionals: integrative review].

Science.gov (United States)

Barbosa, Guilherme Correa; Meneguim, Silmara; Lima, Silvana Andréa Molina; Moreno, Vania

2013-01-01

The National Policy of Humanization aims at innovations in health production, management and care with emphasis on permanent education for workers in the Unified Public Health System and training of university students in the health care field. This study aimed to know, through an integrative review of the literature, the scientific production about the National Policy of Humanization and education of health care professionals, from 2002 to 2010. Ten articles were analyzed in thematic strand through three axes: humanization and users caring, humanization and the work process, humanization and training. The articles point to the need to overcome the biological conception, valuing cultural aspects of users. The work process is marked by the devaluation of workers and by users deprived of their rights. The training of health professionals is grounded in health services where the prevailing standards are practices that hinder innovative attitudes.

Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

Science.gov (United States)

Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R

2017-01-01

Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

Diagnosis and treatments of Prader-Willi syndrome: a review of current consensuses

Directory of Open Access Journals (Sweden)

2014-05-01

Full Text Available We analyzed international consensuses of experts and clinical recommendations on diagnosis and treatment of Prader-Willi syndrome (PWS: PWS consensus diagnostic criteria (1993; US PWS Association (PWSA-USA consensus statements on evaluating of breathing abnormalities (2007, osteoporosis (2008, growth hormone treatment in PWS (2000 and 2009; Endocrine society clinical practice guideline on Prevention and treatment of pediatric obesity (2008; the Second Expert Meeting of the Comprehensive Care of Patients with PWS Consensus published as Recommendations for the diagnosis and management of PWS (2008. Historical analysis and comparison of recommendations are presented in this review article. Absence of Russian clinical practice guidelines on PWS patients management makes necessary the detailed study of listed documents.

The One-Child Policy, Elder Care, and LGB Chinese: A Social Policy Explanation for Family Pressure.

Science.gov (United States)

Hildebrandt, Timothy

2018-01-03

Lesbian, gay, and bisexual (LGB) people in China consistently report family pressure as the greatest challenge they face in their daily lives. This problem has been explained primarily by highlighting sociocultural factors. While such explanations are important to understanding family pressure, they do not easily lead to actionable policy interventions to relieve it. This article suggests a new way of looking at family pressure by positing a social policy explanation. In particular, it reveals how both the one-child policy and elder care reforms have strong heteronormative biases that negatively and disproportionately affect LGB people, and it explores social policy interventions that may help address them. Beyond the China case, the article seeks to open up new avenues for research into how sexuality could be better accounted for in analyses of social policies and considered in broader discussions on defamilization and welfare state reform.

Local variability in long-term care services: local autonomy, exogenous influences and policy spillovers.

Science.gov (United States)

Fernandez, José-Luis; Forder, Julien

2015-03-01

In many countries, public responsibility over the funding and provision of long-term care services is held at the local level. In such systems, long-term care provision is often characterised by significant local variability. Using a panel dataset of local authorities over the period 2002-2012, the paper investigates the underlying causes of variation in gross social care expenditure for older people in England. The analysis distinguishes between factors outside the direct control of policy makers, local preferences and local policy spillovers. The results indicate that local demand and supply factors, and to a much lesser extent local political preferences and spatial policy spillovers, explain a large majority of the observed variation in expenditure. Copyright © 2015 John Wiley & Sons, Ltd.

[A Delphi Method Survey of the Core Competences of Post-Acute-Care Nurses in Caring for Acute Stroke Patients].

Science.gov (United States)

Chi, Shu-Ching; Yeh, Lily; Lu, Meei-Shiow; Lin, Pei-Yu

2015-12-01

Post-acute care (PAC) service is becoming increasingly important in Taiwan as a core focus of government policies that are designed to ensure continuity of care. In order to improve PAC nursing education and quality of care, the present study applies a modified Delphi method to identify the core competences of nurses who provide PAC services to acute stroke patients. We surveyed 18 experts in post-acute care and long-term care anonymously using a 29-question questionnaire in order to identify the essential professional skills that are required to perform PAC effectively. The results of this survey indicate that the core competences of PAC may be divided into two categories: Case Management and Care Management. Case Management includes Direct Care, Communication, Health Care Education, Nursing Consulting, and Family Assessment & Health Care. Care Management includes Interdisciplinary Teamwork, Patient Care Management, and Resource Integration. The importance and practicality of each item was evaluated using a 7-point Likert scale. The experts required 2 rounds to reach a consensus about the importance and 3 rounds to determine the practicality of PAC core competences. This process highlighted the differing points of view that are held by professionals in the realms of nursing, medicine, and national health policy. The PAC in-job training program in its current form inadequately cul-tivates core competence in Care Management. The results of the present study may be used to inform the development of PAC nurse orientation training programs and continuing education courses.

Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015 – short version

Directory of Open Access Journals (Sweden)

DAS-Taskforce 2015

2015-11-01

Full Text Available In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine, twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM in conjunction with Society of Critical Care Medicine (SCCM and American Society of Health-System Pharmacists (ASHP from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade “A” (strong recommendation, Grade “B” (recommendation and Grade “0” (open recommendation. The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine.

Youth transitioning out of foster care: an evaluation of a Supplemental Security Income policy change.

Science.gov (United States)

King, Laura; Rukh-Kamaa, Aneer

2013-01-01

Youths with disabilities face numerous challenges when they transition to adulthood. Those who are aging out of foster care face the additional challenge of losing their foster care benefits, although some will be eligible for Supplemental Security Income (SSI) payments after foster care ceases. However, the time needed to process SSI applications exposes those youths to a potential gap in the receipt of benefits as they move between foster care and SSI. We evaluate the effects of a 2010 Social Security Administration policy change that allows such youths to apply for SSI payments 60 days earlier than the previous policy allowed. The change provides additional time for processing claims before the applicant ages out of the foster care system. We examine administrative records on SSI applications from before and after the policy change to determine if the change has decreased the gap between benefits for the target population.

Intersectional policy analysis of self-directed mental health care in Canada.

Science.gov (United States)

Cook, Judith A; Morrow, Marina; Battersby, Lupin

2017-06-01

Recovery from mental illness is influenced by one's social location along multiple dimensions of identity, such as race, class, gender, age, and ability, and by how these social locations are expressed through structural and institutional barriers. This project was developed using an intersectional policy analysis framework designed to promote equity across identity locations-called the multistrand method-to examine the potential use of self-directed care financing approaches in the Canadian mental health system. A panel of 16 diverse stakeholders came together 4 times at structured 6-hr meetings to examine the evidence for self-directed care and explore its application in the Canadian context. Telephone interviews with evidence panel members were conducted to assess their perceptions of the group process and outcomes. Our analysis revealed ways that intersecting strand locations might differentially influence the degree of choice and recovery experienced by self-directed care participants. Individualized resource allocation, draining financial resources from ethnically specific services, unevenness in acceptance of the recovery orientation, and paucity of service options in different geographical regions were identified as contexts in which self-directed care policies could promote inequity. However, greater peer involvement in the model's implementation, use of indigenous community supports, purchase of material goods by economically disenfranchised persons, and access to services from ethnically diverse clinicians in the private sector were identified as equity-promoting model features. By couching their analysis at the level of unique socially-situated perspectives, the group developed detailed policy recommendations and insights into both the potential and limitations of self-directed care. The knowledge gained from our project can be used to develop uniquely Canadian self-directed care models tailored to promote recovery through empowerment and self

Health care in Canada: a citizen's guide to policy and politics

National Research Council Canada - National Science Library

Fierlbeck, Katherine

2011-01-01

... outlines the basic framework of the health care system with reference to speci fi c areas such as administration and governance, public health, human resources, drugs and drug policy, and mental health. She also discusses alternative models in other countries such as Britain, the United States, and France. As health care becomes increasingly complex...

Obstacles and facilitators of open visiting policy in Intensive Care Units:A qualitative study

Directory of Open Access Journals (Sweden)

Shiva Khaleghparast

2016-07-01

Full Text Available Open visiting policy in intensive care units is proposed as an essential requirement for patients and their families, so this study is aimed to explain open visiting policy obstacles and facilitators from patients, families and health team members’ viewpoint. This qualitative study implemented in intensive care units of a hospital specialized in cardiology in Tehran-Iran. Patients’, families’, nurses’, doctors’ and guards’ viewpoint was determined regarding open visiting policy obstacles and facilitators by semi-structured interviews. Data analysis method was conventional approach of qualitative content analysis with thematic technique. Data analysis was performed using Max QDA10 software. Two main categories of data regarding open visiting obstacles and facilitators were extracted. Factors related to service systems and visitors derived from open visiting obstacles, and factors related to management system and personnel derived from open visiting facilitators. One of the most important obstacles of open visiting policy implementation is shortage of staff and personnel negative attitude. Regarding open visiting policy facilitators, designing visiting cards for close family and observing specific rules, modification of intensive care unit structure and facilities for families are useful. Finally, what is important as an open visiting policy implementation facilitator is presence of nursing profession as a humanitarian and ethical profession.

The Importance of Consensus Information in Acceptance of Climate Change (Invited)

Science.gov (United States)

Cook, J.; Lewandowsky, S.

2013-12-01

In recent years, public perception of the scientific consensus on human-caused global warming has been disturbingly low, in contrast to the overwhelming level of agreement among climate scientists and in peer-reviewed research. The misperception is partly cultural, with a significant link between perceived consensus and political ideology, and partly informational with all cultural groups exhibiting the misperception to varying degrees. This universal 'consensus gap' is in large part due to a persistent and focused misinformation campaign casting doubt on the consensus, dating back as early as the 1980s. Opponents of climate action have long recognized that perception of scientific consensus is linked to support for climate policy, a link only acknowledged by social scientists in the last few years. How do we counter the all-too-effective misinformation campaign? Psychological research tells us that a crucial aspect of effective refutations is an alternative narrative. In this case, an important counter-narrative to the consensus story is the strategy to perpetuate the impression of ongoing scientific debate. I will also present recent research into the effect that consensus information has on climate beliefs of Australians and Americans. For both groups, the consensus message significantly increased beliefs about human-caused global warming and outperformed interventions that feature evidence or scientists' expertise. For the Australian sample, consensus information partially neutralised the biasing influence of ideology. However, for Americans, a backfire effect (reduced climate belief) was observed for a small minority holding strong conservative views. A psychological model employing Bayesian Networks indicates that a key element to the backfire effect is conspiratorial thinking, consistent with other research finding a link between rejection of climate science and conspiratorial ideation. Thus when presented to a general audience, consensus information has an

State CCDBG Plans to Promote Opportunities for Babies and Toddlers in Child Care. Policy Brief

Science.gov (United States)

Lim, Teresa; Schumacher, Rachel

2009-01-01

State child care policies--including licensing, subsidy, and quality enhancement strategies--can promote the quality and continuity of early childhood experiences and foster the healthy growth and development of babies and toddlers in child care settings, especially if they are informed by research. One of the policy levers states may use to…

Policies and procedures in the workplace: how health care organizations compare.

Science.gov (United States)

Loo, R

1993-01-01

Many organizations are implementing programs and services to manage the human and economic costs of stress. A mail survey was conducted of 500 randomly selected Canadian organizations having at least 500 employees. The survey tapped four major areas: organizational policies and procedures for managing stress; programs and services offered; perceived benefits and constraints for the organization; and projected future directions in this area. Analyses of returns from 210 organizations-43 health and 167 non-health-revealed various findings. For example, over half of health care organizations have policies and procedures as opposed to less than half of non-health care organizations. Also, health care organizations place greater emphasis on smoking cessation, weight control programs and on stress management training. Although some Canadian organizations are addressing stress, much more could and should be done, especially by organizations that do not yet recognize the impact of stress on employees and their work performance.

Policy Capacity for Health Reform: Necessary but Insufficient: Comment on "Health Reform Requires Policy Capacity".

Science.gov (United States)

Adams, Owen

2015-09-04

Forest and colleagues have persuasively made the case that policy capacity is a fundamental prerequisite to health reform. They offer a comprehensive life-cycle definition of policy capacity and stress that it involves much more than problem identification and option development. I would like to offer a Canadian perspective. If we define health reform as re-orienting the health system from acute care to prevention and chronic disease management the consensus is that Canada has been unsuccessful in achieving a major transformation of our 14 health systems (one for each province and territory plus the federal government). I argue that 3 additional things are essential to build health policy capacity in a healthcare federation such as Canada: (a) A means of "policy governance" that would promote an approach to cooperative federalism in the health arena; (b) The ability to overcome the "policy inertia" resulting from how Canadian Medicare was implemented and subsequently interpreted; and (c) The ability to entertain a long-range thinking and planning horizon. My assessment indicates that Canada falls short on each of these items, and the prospects for achieving them are not bright. However, hope springs eternal and it will be interesting to see if the July, 2015 report of the Advisory Panel on Healthcare Innovation manages to galvanize national attention and stimulate concerted action. © 2016 by Kerman University of Medical Sciences.

Standard operating procedures for female orgasmic disorder: consensus of the International Society for Sexual Medicine

NARCIS (Netherlands)

Laan, Ellen; Rellini, Alessandra H.; Barnes, Tricia

2013-01-01

As the field of sexual medicine evolves, it is important to continually improve patient care by developing contemporary "standard operating procedures" (SOPs), reflecting the consensus view of experts in sexual medicine. Few, if any, consensus SOPs have been developed for the diagnosis and treatment

The Influence of a Policy Document in the Practice of Intersectorial Collaboration in Danish Health Care

DEFF Research Database (Denmark)

Andersen, Anne Bendix; Beedholm, Kirsten; Kolbæk, Raymond

. The linguistic analysis of grammatical features present in the document enabled us to demonstrate how the authors of Health Agreements apply governing technologies to control the delivery of intersectorial health care in Denmark. Furthermore, the findings showed how this policy document, through its use......Background Policy documents are powerful actors in health care, and they play a significant role because they produce certain discursive and non-discursive conditions for intersectorial collaboration. Central documents in Denmark are the Health Agreements. These policy documents set out...... assess a policy document. Method A critical discourse analysis based on a three-dimensional model. Findings Our analysis showed how wordings and grammatical features create and maintain certain perceptions or common-sense understandings of actors, responsibilities, and tasks in health care...

Using consensus building to improve utility regulation

International Nuclear Information System (INIS)

Raab, J.

1994-01-01

The utility industry and its regulatory environment are at a crossroads. Utilities, intervenors and even public utility commissions are no longer able to initiate and sustain changes unilaterally. Traditional approaches to regulation are often contentious and costly, producing results that are not perceived as legitimate or practical. Consensus building and alternative dispute resolution have the potential to help utilities, intervenors and regulators resolve a host of regulatory issues. This book traces the decline of consensus in utility regulation and delineates current controversies. It presents the theory and practice of alternative dispute resolution in utility regulation and offers a framework for evaluating the successes and failures of attempts to employ these processes. Four regulatory cases are analyzed in detail: the Pilgrim nuclear power plant outage settlement, the use of DSM collaboratives, the New Jersey resource bidding policy and the formation of integrated resource management rules in Massachusetts

Legislative and Policy Developments and Imperatives for Advancing the Primary Care Behavioral Health (PCBH) Model.

Science.gov (United States)

Freeman, Dennis S; Hudgins, Cathy; Hornberger, Joel

2018-03-05

The Primary Care Behavioral Health (PCBH) practice model continues to gain converts among primary care and behavioral health professionals as the evidence supporting its effectiveness continues to accumulate. Despite a growing number of practices and organizations using the model effectively, widespread implementation has been hampered by outmoded policies and regulatory barriers. As policymakers and legislators begin to recognize the contributions that PCBH model services make to the care of complex patients and the expansion of access to those in need of behavioral health interventions, some encouraging policy initiatives are emerging and the policy environment is becoming more favorable to implementation of the PCBH model. This article outlines the necessity for policy change, exposing the policy issues and barriers that serve to limit the practice of the PCBH model; highlights innovative approaches some states are taking to foster integrated practice; and discusses the compatibility of the PCBH model with the nation's health care reform agenda. Psychologists have emerged as leaders in the design and implementation of PCBH model integration and are encouraged to continue to advance the model through the demonstration of efficient and effective clinical practice, participation in the expansion of an appropriately trained workforce, and advocacy for the inclusion of this practice model in emerging healthcare systems and value-based payment methodologies.

Evaluating the 2008 consensus conference on genetically modified foods in Taiwan.

Science.gov (United States)

Fan, Mei-Fang

2015-07-01

Genetically modified foods have become one of the most popular topics for deliberative exercises involving ordinary citizens worldwide. This paper examines the Taiwanese consensus conference on GM foods held in June 2008, and the implications and limitations of the public deliberations. The consensus conference facilitated multiparty dialogues and enhanced citizens' knowledge, and affected their attitudes. This study demonstrates the ways contextual factors have influenced the outcome of the citizens' deliberative practices, including the government's conventional technocratic decision-making style, the strong influence of the U.S. government, the political and technological culture, the government's framing of economic development concerns, and a lack of pressure from civil society to compel the government to formally respond to their concerns. The consensus conference had a limited effect on policy decision-making, and seemed to serve as a socio-political experiment. © The Author(s) 2013.

Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France-The EPIPAGE-2 Cohort Study.

Science.gov (United States)

Pierrat, Veronique; Coquelin, Anaëlle; Cuttini, Marina; Khoshnood, Babak; Glorieux, Isabelle; Claris, Olivier; Durox, Mélanie; Kaminski, Monique; Ancel, Pierre-Yves; Arnaud, Catherine

2016-10-01

To describe the implementation of neurodevelopmental care for newborn preterm infants in neonatal ICUs in France in 2011, analyze changes since 2004, and investigate factors associated with practice. Prospective national cohort study of all births before 32 weeks of gestation. Twenty-five French regions. All neonatal ICUs (n = 66); neonates surviving at discharge (n = 3,005). None. Neurodevelopmental care policies and practices were assessed by structured questionnaires. Proportions of neonates initiating kangaroo care during the first week of life and those whose mothers expressed breast milk were measured as neurodevelopmental care practices. Multilevel logistic regression analyses were used to investigate relationships between kangaroo care or breast-feeding practices and unit policies, taking into account potential confounders. Free visiting policies, bed availability for parents, and kangaroo care encouragement significantly improved between 2004 and 2011 but with large variabilities between units. Kangaroo care initiation varied from 39% for neonates in the most restrictive units to 68% in less restrictive ones (p neurodevelopmental care significantly influenced kangaroo care initiation (odds ratio, 3.5; 95% CI, 1.8-7.0 for Newborn Individualized Developmental Care and Assessment Program implementation compared with no training). Breast milk expression by mothers was greater in units with full-time availability professionals trained for breast-feeding support (60% vs 73%; p neurodevelopmental practices occurred between 2004 and 2011, but large variabilities between units persist. Practices increased in units with supportive policies. Specific neurodevelopmental care training with multifaceted interventions strengthened the implementation of policies.

Home health nursing care agenda based on health policy in Korea.

Science.gov (United States)

Ryu, Hosihn; An, Jiyoung; Koabyashi, Mia

2005-06-01

Home health nursing care (HHNC) in Korea has taken on an important role under the mandate of the national health care system since 2000. This program was developed to verify the possibility of early discharge of hospitalized patients and cost containment through a research and development project that was conducted with the government from 1994 to 1999. The process of development of HHNC provided an opportunity to realize the advancement and changes in the system into a consumer-focused structure. This is an important turning point for the Korean health care system that suggests certain possibilities for building a foundation for further changes in the service delivery structure. The structure, which had been limited to a supplier-oriented model, is moving to a consumer-oriented structure. Accordingly, the major function and role of nursing policy makers in Korea is to develop an agenda and alternatives for policy-making in a systematic manner and to present implementation strategies clearly.

Surge capacity principles: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

Science.gov (United States)

Hick, John L; Einav, Sharon; Hanfling, Dan; Kissoon, Niranjan; Dichter, Jeffrey R; Devereaux, Asha V; Christian, Michael D

2014-10-01

This article provides consensus suggestions for expanding critical care surge capacity and extension of critical care service capabilities in disasters or pandemics. It focuses on the principles and frameworks for expansion of intensive care services in hospitals in the developed world. A companion article addresses surge logistics, those elements that provide the capability to deliver mass critical care in disaster events. The suggestions in this article are important for all who are involved in large-scale disasters or pandemics with injured or critically ill multiple patients, including front-line clinicians, hospital administrators, and public health or government officials. The Surge Capacity topic panel developed 23 key questions focused on the following domains: systems issues; equipment, supplies, and pharmaceuticals; staffing; and informatics. Literature searches were conducted to identify evidence on which to base key suggestions. Most reports were small scale, were observational, or used flawed modeling; hence, the level of evidence on which to base recommendations was poor and did not permit the development of evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Suggestions from the previous task force were also included for validation by the expert panel. This article presents 10 suggestions pertaining to the principles that should guide surge capacity and capability planning for mass critical care, including the role of critical care in disaster planning; the surge continuum; targets of surge response; situational awareness and information sharing; mitigating the impact on critical care; planning for the care of special populations; and service deescalation/cessation (also considered as engineered failure). Future reports on critical care surge should emphasize population-based outcomes as well as logistical details. Planning should be based on the projected number of

Nursing physical assessment for patient safety in general wards: reaching consensus on core skills.

Science.gov (United States)

Douglas, Clint; Booker, Catriona; Fox, Robyn; Windsor, Carol; Osborne, Sonya; Gardner, Glenn

2016-07-01

To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards. Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach. A modified Delphi study. Focus group interviews with 150 acute care registered nurses at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care registered nurses following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas. Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements. Among a large and diverse group of experienced acute care registered nurses consensus was achieved on a structured core physical assessment to detect early changes in patient status. Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside. © 2016 John Wiley & Sons Ltd.

Comparative federal health care policy: evidence of collaborative federalism in Pakistan and Venezuela.

Science.gov (United States)

Baracskay, Daniel

2013-01-01

Collaborative federalism has provided an effective analytical foundation for understanding how complex public policies are implemented in federal systems through intergovernmental and intersectoral alignments. This has particularly been the case in issue areas like public health policy where diseases are detected and treated at the local level. While past studies on collaborative federalism and health care policy have focused on federal systems that are largely democratic, little research has been conducted to examine the extent of collaboration in authoritarian structures. This article applies the collaborative federalism approach to the Islamic Republic of Pakistan and the Bolivarian Republic of Venezuela. Evidence suggests that while both nations have exhibited authoritarian governing structures, there have been discernible policy areas where collaborative federalism is embraced to facilitate the implementation process. Further, while not an innate aspect of their federal structures, Pakistan and Venezuela can potentially expand their use of the collaborative approach to successfully implement health care policy and the epidemiological surveillance and intervention functions. Yet, as argued, this would necessitate further development of their structures on a sustained basis to create an environment conducive for collaborative federalism to flourish, and possibly expand to other policy areas as well.

Health care workers' influenza vaccination: motivations and mandatory mask policy.

Science.gov (United States)

Dorribo, V; Lazor-Blanchet, C; Hugli, O; Zanetti, G

2015-12-01

Vaccination of health care workers (HCW) against seasonal influenza (SI) is recommended but vaccination rate rarely reach >30%. Vaccination coverage against 2009 pandemic influenza (PI) was 52% in our hospital, whilst a new policy requiring unvaccinated HCW to wear a mask during patient care duties was enforced. To investigate the determinants of this higher vaccination acceptance for PI and to look for an association with the new mask-wearing policy. A retrospective cohort study, involving HCW of three critical departments of a 1023-bed, tertiary-care university hospital in Switzerland. Self-reported 2009-10 SI and 2009 PI vaccination statuses, reasons and demographic data were collected through a literature-based questionnaire. Descriptive statistics, uni- and multivariate analyses were then performed. There were 472 respondents with a response rate of 54%. Self-reported vaccination acceptance was 64% for PI and 53% for SI. PI vaccination acceptance was associated with being vaccinated against SI (OR 9.5; 95% CI 5.5-16.4), being a physician (OR 7.7; 95% CI 3.1-19.1) and feeling uncomfortable wearing a mask (OR 1.7; 95% CI 1.0-2.8). Main motives for refusing vaccination were: preference for wearing a surgical mask (80% for PI, not applicable for SI) and concerns about vaccine safety (64%, 50%) and efficacy (44%, 35%). The new mask-wearing policy was a motivation for vaccination but also offered an alternative to non-compliant HCW. Concerns about vaccine safety and efficiency and self-interest of health care workers are still main determinants for influenza vaccination acceptance. Better incentives are needed to encourage vaccination amongst non-physician HCW. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

JERM model of care: an in-principle model for dental health policy.

Science.gov (United States)

Lam, Raymond; Kruger, Estie; Tennant, Marc

2014-01-01

Oral diseases are the most prevalent conditions in the community. Their economic burden is high and their impact on quality of life is profound. There is an increasing body of evidence indicating that oral diseases have wider implications beyond the confines of the mouth. The importance of oral health has not been unnoticed by the government. The Commonwealth (Federal) government under the Howard-led Coalition in 2004 had broken tradition by placing dentistry in its universal health insurance scheme, Medicare. Known as the Chronic Disease Dental Scheme (CDDS), the program aimed to manage patients with chronic conditions as part of the Enhanced Primary Care initiative. This scheme was a landmark policy for several reasons. Besides being the first major dental policy under Medicare, the program proved to be the most expensive and controversial. Unfortunately, cost containment and problems with service provision led to its cessation in 2012 by the Gillard Labor Government. Despite being seen as a failure, the CDDS provided a unique opportunity to assess national policy in practice. By analysing the policy-relevant effects of the CDDS, important lessons can be learnt for policy development. This paper discusses these lessons and has formulated a set of principles recommended for effective oral health policy. The JERM model represents the principles of a justified, economical and research-based model of care.

Policy Capacity for Health Reform: Necessary but Insufficient; Comment on “Health Reform Requires Policy Capacity”

Directory of Open Access Journals (Sweden)

Owen Adams

2016-01-01

Full Text Available Forest and colleagues have persuasively made the case that policy capacity is a fundamental prerequisite to health reform. They offer a comprehensive life-cycle definition of policy capacity and stress that it involves much more than problem identification and option development. I would like to offer a Canadian perspective. If we define health reform as re-orienting the health system from acute care to prevention and chronic disease management the consensus is that Canada has been unsuccessful in achieving a major transformation of our 14 health systems (one for each province and territory plus the federal government. I argue that 3 additional things are essential to build health policy capacity in a healthcare federation such as Canada: (a A means of “policy governance” that would promote an approach to cooperative federalism in the health arena; (b The ability to overcome the ”policy inertia” resulting from how Canadian Medicare was implemented and subsequently interpreted; and (c The ability to entertain a long-range thinking and planning horizon. My assessment indicates that Canada falls short on each of these items, and the prospects for achieving them are not bright. However, hope springs eternal and it will be interesting to see if the July, 2015 report of the Advisory Panel on Healthcare Innovation manages to galvanize national attention and stimulate concerted action.

Suicide Prevention Training: Policies for Health Care Professionals Across the United States as of October 2017.

Science.gov (United States)

Graves, Janessa M; Mackelprang, Jessica L; Van Natta, Sara E; Holliday, Carrie

2018-06-01

To identify and compare state policies for suicide prevention training among health care professionals across the United States and benchmark state plan updates against national recommendations set by the surgeon general and the National Action Alliance for Suicide Prevention in 2012. We searched state legislation databases to identify policies, which we described and characterized by date of adoption, target audience, and duration and frequency of the training. We used descriptive statistics to summarize state-by-state variation in suicide education policies. In the United States, as of October 9, 2017, 10 (20%) states had passed legislation mandating health care professionals complete suicide prevention training, and 7 (14%) had policies encouraging training. The content and scope of policies varied substantially. Most states (n = 43) had a state suicide prevention plan that had been revised since 2012, but 7 lacked an updated plan. Considerable variation in suicide prevention training for health care professionals exists across the United States. There is a need for consistent polices in suicide prevention training across the nation to better equip health care providers to address the needs of patients who may be at risk for suicide.

Demand-driven care and hospital choice. Dutch health policy toward demand-driven care: results from a survey into hospital choice.

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Lako, Christiaan J; Rosenau, Pauline

2009-03-01

In the Netherlands, current policy opinion emphasizes demand-driven health care. Central to this model is the view, advocated by some Dutch health policy makers, that patients should be encouraged to be aware of and make use of health quality and health outcomes information in making personal health care provider choices. The success of the new health care system in the Netherlands is premised on this being the case. After a literature review and description of the new Dutch health care system, the adequacy of this demand-driven health policy is tested. The data from a July 2005, self-administered questionnaire survey of 409 patients (response rate of 94%) as to how they choose a hospital are presented. Results indicate that most patients did not choose by actively employing available quality and outcome information. They were, rather, referred by their general practitioner. Hospital choice is highly related to the importance a patient attaches to his or her physician's opinion about a hospital. Some patients indicated that their hospital choice was affected by the reputation of the hospital, by the distance they lived from the hospital, etc. but physician's advice was, by far, the most important factor. Policy consequences are important; the assumptions underlying the demand-driven model of patient health provider choice are inadequate to explain the pattern of observed responses. An alternative, more adequate model is required, one that takes into account the patient's confidence in physician referral and advice.

Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France—The EPIPAGE-2 Cohort Study

Science.gov (United States)

Coquelin, Anaëlle; Cuttini, Marina; Khoshnood, Babak; Glorieux, Isabelle; Claris, Olivier; Durox, Mélanie; Kaminski, Monique; Ancel, Pierre-Yves; Arnaud, Catherine

2016-01-01

Objectives: To describe the implementation of neurodevelopmental care for newborn preterm infants in neonatal ICUs in France in 2011, analyze changes since 2004, and investigate factors associated with practice. Design: Prospective national cohort study of all births before 32 weeks of gestation. Setting: Twenty-five French regions. Participants: All neonatal ICUs (n = 66); neonates surviving at discharge (n = 3,005). Interventions: None. Measurements and Main Results: Neurodevelopmental care policies and practices were assessed by structured questionnaires. Proportions of neonates initiating kangaroo care during the first week of life and those whose mothers expressed breast milk were measured as neurodevelopmental care practices. Multilevel logistic regression analyses were used to investigate relationships between kangaroo care or breast-feeding practices and unit policies, taking into account potential confounders. Free visiting policies, bed availability for parents, and kangaroo care encouragement significantly improved between 2004 and 2011 but with large variabilities between units. Kangaroo care initiation varied from 39% for neonates in the most restrictive units to 68% in less restrictive ones (p neurodevelopmental care significantly influenced kangaroo care initiation (odds ratio, 3.5; 95% CI, 1.8–7.0 for Newborn Individualized Developmental Care and Assessment Program implementation compared with no training). Breast milk expression by mothers was greater in units with full-time availability professionals trained for breast-feeding support (60% vs 73%; p neurodevelopmental practices occurred between 2004 and 2011, but large variabilities between units persist. Practices increased in units with supportive policies. Specific neurodevelopmental care training with multifaceted interventions strengthened the implementation of policies. PMID:27518584

Consensus, Polarization, and Alignment in the Economics Profession

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Tod S. Van Gunten

2016-12-01

Full Text Available Scholars interested in the political influence of the economics profession debate whether the discipline is unified by policy consensus or divided among competing schools or factions. We address this question by reanalyzing a unique recent survey of elite economists. We present a theoretical framework based on a formal sociological approach to the structure of belief systems and propose alignment, rather than consensus or polarization, as a model for the structure of belief in the economics profession. Moreover, we argue that social clustering in a heterogeneous network topology is a better model for disciplinary social structure than discrete factionalization. Results show that there is a robust latent ideological dimension related to economists’ departmental affiliations and political partisanship. Furthermore, we show that economists closer to one another in informal social networks also share more similar ideologies.

Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices.

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Elshaug, Adam G; Hiller, Janet E; Tunis, Sean R; Moss, John R

2007-10-31

Internationally, many health care interventions were diffused prior to the standard use of assessments of safety, effectiveness and cost-effectiveness. Disinvestment from ineffective or inappropriately applied practices is a growing priority for health care systems for reasons of improved quality of care and sustainability of resource allocation. In this paper we examine key challenges for disinvestment from these interventions and explore potential policy-related avenues to advance a disinvestment agenda. We examine five key challenges in the area of policy driven disinvestment: 1) lack of resources to support disinvestment policy mechanisms; 2) lack of reliable administrative mechanisms to identify and prioritise technologies and/or practices with uncertain clinical and cost-effectiveness; 3) political, clinical and social challenges to removing an established technology or practice; 4) lack of published studies with evidence demonstrating that existing technologies/practices provide little or no benefit (highlighting complexity of design) and; 5) inadequate resources to support a research agenda to advance disinvestment methods. Partnerships are required to involve government, professional colleges and relevant stakeholder groups to put disinvestment on the agenda. Such partnerships could foster awareness raising, collaboration and improved health outcome data generation and reporting. Dedicated funds and distinct processes could be established within the Medical Services Advisory Committee and Pharmaceutical Benefits Advisory Committee to, a) identify technologies and practices for which there is relative uncertainty that could be the basis for disinvestment analysis, and b) conduct disinvestment assessments of selected item(s) to address existing practices in an analogous manner to the current focus on new and emerging technology. Finally, dedicated funding and cross-disciplinary collaboration is necessary to build health services and policy research capacity

Consenso brasileiro sobre políticas públicas do álcool Brazilian consensus on public policies on alcohol

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Ronaldo Laranjeira

2004-05-01

Full Text Available Esse é um resumo de uma reunião na qual vários especialistas, representando diversas organizações médicas e universitárias brasileiras, criaram um consenso sobre as principais políticas que deveriam ser implementadas pelos diferentes níveis de governo no Brasil. Há mais de 30 anos a OMS vem buscando um consenso internacional sobre as ações com maior potencial de trazer benefícios sociais. Essa busca trouxe duas conclusões importantes: 1 A pesquisa estabelece, sem margem à dúvida, que existem medidas de eficácia comprovada para reduzir os custos e os danos relacionados ao uso de álcool, visando ao bem comum; 2 É possível desenvolver estratégias que influenciam tanto a quantidade de álcool consumida por uma comunidade quanto os comportamentos de consumo e os contextos de alto risco causadores dos problemas relacionados ao consumo de álcool. Os objetivos deste Consenso são: 1 Tornar as evidências científicas mais acessíveis para os que elaboram políticas públicas; 2 Facilitar a avaliação das diversas estratégias disponíveis segundo critérios de efetividade, suporte científico, custo e viabilidade de transposição cultural; 3 Familiarizar o profissional de saúde, e em especial os que trabalham em saúde mental, sobre as prioridades da política do álcool.This is the summary of a meeting where a group of experts, representing several health organizations and academic departements from different parts of Brazil, created a consensus about the main alcohol policies which should be implemented by different levels of the brazilian government. The World Health Organization has been suggesting for 30 years the actions that should be implemented for the public good. Two important conclusions were reached: 1 The research establishes beyond doubt that public health measures of proven effectiveness are available to serve the public good by reducing the widespread costs and pain related to alcohol use; 2 To that end, it is

Delay-Induced Consensus and Quasi-Consensus in Multi-Agent Dynamical Systems

NARCIS (Netherlands)

Yu, Wenwu; Chen, Guanrong; Cao, Ming; Ren, Wei

2013-01-01

This paper studies consensus and quasi-consensus in multi-agent dynamical systems. A linear consensus protocol in the second-order dynamics is designed where both the current and delayed position information is utilized. Time delay, in a common perspective, can induce periodic oscillations or even

Establishing research priorities relating to the long-term impact of TIA and minor stroke through stakeholder-centred consensus.

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Turner, Grace M; Backman, Ruth; McMullan, Christel; Mathers, Jonathan; Marshall, Tom; Calvert, Melanie

2018-01-01

; and education/training for health care professionals. Conclusions Eleven different research priorities were established through stakeholder-centred consensus. These research questions could usefully inform the research agenda and policy decisions for TIA and minor stroke. Inclusion of stakeholders in setting research priorities is important to increase the relevance of research and reduce research waste.

Top management leadership style and quality of care in nursing homes.

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Castle, Nicholas G; Decker, Frederic H

2011-10-01

The purpose of this study was to examine the association of Nursing Home Administrator (NHA) leadership style and Director of Nursing (DON) leadership style with quality of care. Leaders were categorized into 4 groups: consensus managers, consultative autocrats, shareholder managers, or autocrats. This leadership style assessment came from primary data collected from approximately 4,000 NHAs and DONs that was linked to quality information (i.e., Nursing Home Compare Quality Measures and 5-Star rating scores) and nursing home information (i.e., Online Survey, Certification, And Reporting data). A consensus manager leadership style has a strong association with better quality. Top managers using this style solicit and act upon input from their employees. For NHAs exhibiting this leadership style, the coefficients on 5 of the 7 quality indicators are statistically significant, and all 7 are significant when the DON exhibits this style. When the NHA and DON both have a consensus manager leadership style, 6 of the 7 quality indicator coefficients are significantly associated with better quality. The findings indicate that NHA and DON leadership style is associated with quality of care. Leadership strategies are amenable to change; thus, the findings of this study may be used to develop policies for promoting more effective leadership in nursing homes.

Unravelling the concept of consumer preference: implications for health policy and optimal planning in primary care.

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Foster, Michele M; Earl, Peter E; Haines, Terry P; Mitchell, Geoffrey K

2010-10-01

Accounting for consumer preference in health policy and delivery system design makes good economic sense since this is linked to outcomes, quality of care and cost control. Probability trade-off methods are commonly used in policy evaluation, marketing and economics. Increasingly applied to health matters, the trade-off preference model has indicated that consumers of health care discriminate between different attributes of care. However, the complexities of the health decision-making environment raise questions about the inherent assumptions concerning choice and decision-making behavior which frame this view of consumer preference. In this article, we use the example of primary care in Australia as a vehicle to examine the concept of 'consumer preference' from different perspectives within economics and discuss the significance of how we model preferences for health policy makers. In doing so, we question whether mainstream thinking, namely that consumers are capable of deliberating between rival strategies and are willing to make trade-offs, is a reliable way of thinking about preferences given the complexities of the health decision-making environment. Alternative perspectives on preference can assist health policy makers and health providers by generating more precise information about the important attributes of care that are likely to enhance consumer engagement and optimise acceptability of health care. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

A Policy Analysis of Child Care Subsidies: Increasing Quality, Access, and Affordability

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Moodie-Dyer, Amber

2011-01-01

Changing family dynamics over the past four decades, including rises in the numbers of working mothers and single-parent families, have created an increased need for affordable child care. Government response to this need has involved a number of stop-and-start policy approaches, which have led to a fractured child care system that makes it…

Medication management policy, practice and research in Australian residential aged care: Current and future directions.

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Sluggett, Janet K; Ilomäki, Jenni; Seaman, Karla L; Corlis, Megan; Bell, J Simon

2017-02-01

Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

Implications of DSM-5 for Health Care Organizations and Mental Health Policy.

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Castillo, Richard J; Guo, Kristina L

2016-01-01

The American Psychiatric Association (APA) has made major changes in the way mental illness is conceptualized, assessed, and diagnosed in its new diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published in 2013, and has far reaching implications for health care organizations and mental health policy. This paper reviews the four new principles in DSM-5: 1) A spectrum (also called "dimensional") approach to the definition of mental illness; 2) recognition of the role played by environmental risk factors related to stress and trauma in predisposing, precipitating, and perpetuating mental illness; 3) cultural relativism in diagnosis and treatment of mental illness; and 4) recognizing the adverse effects of psychiatric medications on patients. Each of these four principles will be addressed in detail. In addition, four major implications for health care organizations and mental health policy are identified as: 1) prevention; 2) client-centered psychiatry; 3) mental health workers retraining; and 4) medical insurance reform. We conclude that DSM- 5's new approach to diagnosis and treatment of mental illness will have profound implications for health care organizations and mental health policy, indicating a greater emphasis on prevention and cure rather than long-term management of symptoms.

Core competencies for pain management: results of an interprofessional consensus summit.

Science.gov (United States)

Fishman, Scott M; Young, Heather M; Lucas Arwood, Ellyn; Chou, Roger; Herr, Keela; Murinson, Beth B; Watt-Watson, Judy; Carr, Daniel B; Gordon, Debra B; Stevens, Bonnie J; Bakerjian, Debra; Ballantyne, Jane C; Courtenay, Molly; Djukic, Maja; Koebner, Ian J; Mongoven, Jennifer M; Paice, Judith A; Prasad, Ravi; Singh, Naileshni; Sluka, Kathleen A; St Marie, Barbara; Strassels, Scott A

2013-07-01

The objective of this project was to develop core competencies in pain assessment and management for prelicensure health professional education. Such core pain competencies common to all prelicensure health professionals have not been previously reported. An interprofessional executive committee led a consensus-building process to develop the core competencies. An in-depth literature review was conducted followed by engagement of an interprofessional Competency Advisory Committee to critique competencies through an iterative process. A 2-day summit was held so that consensus could be reached. The consensus-derived competencies were categorized within four domains: multidimensional nature of pain, pain assessment and measurement, management of pain, and context of pain management. These domains address the fundamental concepts and complexity of pain; how pain is observed and assessed; collaborative approaches to treatment options; and application of competencies across the life span in the context of various settings, populations, and care team models. A set of values and guiding principles are embedded within each domain. These competencies can serve as a foundation for developing, defining, and revising curricula and as a resource for the creation of learning activities across health professions designed to advance care that effectively responds to pain. Wiley Periodicals, Inc.

Caring for Children and Older People - A Comparison of European Policies and Practices

DEFF Research Database (Denmark)

Rostgaard, Tine; Fridberg, Torben

systems for children and older people of seven countries, Denmark, Finland, Sweden, England, the Netherlands, France, and Germany. The book provides an overview of the historical development of the care policies, and the organisation, financing and provision of care for each country, as well as presenting...

Nursing home policies regarding advance care planning in Flanders, Belgium

NARCIS (Netherlands)

de Gendt, C.; Bilsen, J.; van der Stichele, R.; Deliens, L.

2010-01-01

Background: The aim of this study is to discover how many nursing homes (NHs) in Flanders (Belgium) have policies on advance care planning (ACP) and their content regarding different medical end-of-life decisions. Methods: A structured mail questionnaire was sent to the NH administrators of all 594

A Policy Guide on Integrated Care (PGIC: Lessons Learned from EU Project INTEGRATE and Beyond

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Liesbeth Borgermans

2017-09-01

Full Text Available Efforts are underway in many European countries to channel efforts into creating improved integrated health and social care services. But most countries lack a strategic plan that is sustainable over time, and that reflects a comprehensive systems perspective. The Policy Guide on Integrated Care (PGIC as presented in this paper resulted from experiences with the EU Project INTEGRATE and our own work with healthcare reform for patients with chronic conditions at the national and international level. This project is one of the largest EU funded projects on Integrated Care, conducted over a four-year period (2012–2016 and included partners from nine European countries. Project Integrate aimed to gain insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term conditions. The objective of this paper is to describe the PGIC as both a tool and a reasoning flow that aims at supporting policy makers at the national and international level with the development and implementation of integrated care. Any Policy Guide on Integrated should build upon three building blocks, being a mission, vision and a strategy that aim at capturing the large amount of factors that directly or indirectly influence the successful development of integrated care.

A Policy Guide on Integrated Care (PGIC): Lessons Learned from EU Project INTEGRATE and Beyond.

Science.gov (United States)

Borgermans, Liesbeth; Devroey, Dirk

2017-09-25

Efforts are underway in many European countries to channel efforts into creating improved integrated health and social care services. But most countries lack a strategic plan that is sustainable over time, and that reflects a comprehensive systems perspective. The Policy Guide on Integrated Care (PGIC) as presented in this paper resulted from experiences with the EU Project INTEGRATE and our own work with healthcare reform for patients with chronic conditions at the national and international level. This project is one of the largest EU funded projects on Integrated Care, conducted over a four-year period (2012-2016) and included partners from nine European countries. Project Integrate aimed to gain insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term conditions. The objective of this paper is to describe the PGIC as both a tool and a reasoning flow that aims at supporting policy makers at the national and international level with the development and implementation of integrated care. Any Policy Guide on Integrated should build upon three building blocks, being a mission, vision and a strategy that aim at capturing the large amount of factors that directly or indirectly influence the successful development of integrated care.

WSES consensus conference: Guidelines for first-line management of intra-abdominal infections

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Leppaniemi Ari

2011-01-01

Full Text Available Abstract Intra-abdominal infections are still associated with high rate of morbidity and mortality. A multidisciplinary approach to the management of patients with intra-abdominal infections may be an important factor in the quality of care. The presence of a team of health professionals from various disciplines, working in concert, may improve efficiency, outcome, and the cost of care. A World Society of Emergency Surgery (WSES Consensus Conference was held in Bologna on July 2010, during the 1st congress of the WSES, involving surgeons, infectious disease specialists, pharmacologists, radiologists and intensivists with the goal of defining recommendations for the early management of intra-abdominal infections. This document represents the executive summary of the final guidelines approved by the consensus conference.

Governance beyond the European Consensus on Development: What Drives EU Aid Selectivity?

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W. Hout (Wil)

2013-01-01

textabstractThis paper focuses on the ‘governance turn’ in the development policies of the European Union, represented in particular by the adoption of the ‘European Consensus on Development’ in 2005. The main assumption inherent in the EU approach to development is that the quality of governance in

Health Care Market Concentration Trends In The United States: Evidence And Policy Responses.

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Fulton, Brent D

2017-09-01

Policy makers and analysts have been voicing concerns about the increasing concentration of health care providers and health insurers in markets nationwide, including the potential adverse effect on the cost and quality of health care. The Council of Economic Advisers recently expressed its concern about the lack of estimates of market concentration in many sectors of the US economy. To address this gap in health care, this study analyzed market concentration trends in the United States from 2010 to 2016 for hospitals, physician organizations, and health insurers. Hospital and physician organization markets became increasingly concentrated over this time period. Concentration among primary care physicians increased the most, partially because hospitals and health care systems acquired primary care physician organizations. In 2016, 90 percent of Metropolitan Statistical Areas (MSAs) were highly concentrated for hospitals, 65 percent for specialist physicians, 39 percent for primary care physicians, and 57 percent for insurers. Ninety-one percent of the 346 MSAs analyzed may have warranted concern and scrutiny because of their concentration levels in 2016 and changes in their concentrations since 2010. Public policies that enhance competition are needed, such as stricter enforcement of antitrust laws, reducing barriers to entry, and restricting anticompetitive behaviors. Project HOPE—The People-to-People Health Foundation, Inc.

Time for a neonatal-specific consensus definition for sepsis.

Science.gov (United States)

Wynn, James L; Wong, Hector R; Shanley, Thomas P; Bizzarro, Matthew J; Saiman, Lisa; Polin, Richard A

2014-07-01

To review the accuracy of the pediatric consensus definition of sepsis in term neonates and to determine the definition of neonatal sepsis used. The review focused primarily on pediatric literature relevant to the topic of interest. Neonatal sepsis is variably defined based on a number of clinical and laboratory criteria that make the study of this common and devastating condition very difficult. Diagnostic challenges and uncertain disease epidemiology necessarily result from a variable definition of disease. In 2005, intensivists caring for children recognized that as new drugs became available, children would be increasingly studied and thus, pediatric-specific consensus definitions were needed. Pediatric sepsis criteria are not accurate for term neonates and have not been examined in preterm neonates for whom the developmental stage influences aberrations associated with host immune response. Thus, specific consensus definitions for both term and preterm neonates are needed. Such definitions are critical for the interpretation of observational studies, future training of scientists and practitioners, and implementation of clinical trials in neonates.

Parental involvement and kangaroo care in European neonatal intensive care units: a policy survey in eight countries.

Science.gov (United States)

Pallás-Alonso, Carmen R; Losacco, Valentina; Maraschini, Alice; Greisen, Gorm; Pierrat, Veronique; Warren, Inga; Haumont, Dominique; Westrup, Björn; Smit, Bert J; Sizun, Jacques; Cuttini, Marina

2012-09-01

To compare, in a large representative sample of European neonatal intensive care units, the policies and practices regarding parental involvement and holding babies in the kangaroo care position as well as differences in the tasks mothers and fathers are allowed to carry out. Prospective multicenter survey. Neonatal intensive care units in eight European countries (Belgium, Denmark, France, Italy, The Netherlands, Spain, Sweden, and the United Kingdom). Patients were not involved in this study. None. A structured questionnaire was mailed to 362 units (response rate 78%); only units with ≥50 very-low-birth-weight annual admissions were considered for this study. Facilities for parents such as reclining chairs near the babies' cots, beds, and a dedicated room were common, but less so in Italy and Spain. All units in Sweden, Denmark, the United Kingdom, and Belgium reported encouraging parental participation in the care of the babies, whereas policies were more restrictive in Italy (80% of units), France (73%), and Spain (41%). Holding babies in the kangaroo care position was widespread. However, in the United Kingdom, France, Italy, and Spain, many units applied restrictions regarding its frequency (sometimes or on parents request only, rather than routinely), method (conventional rather than skin-to-skin), and clinical conditions (especially mechanical ventilation and presence of umbilical lines) that would prevent its practice. In these countries, fathers were routinely offered kangaroo care less frequently than mothers (p involvement as well as the role played by mothers and fathers varied within and between countries.

Exploring areas of consensus and conflict around values underpinning public involvement in health and social care research: a modified Delphi study

Science.gov (United States)

Snape, D; Kirkham, J; Preston, J; Popay, J; Britten, N; Collins, M; Froggatt, K; Gibson, A; Lobban, F; Wyatt, K; Jacoby, A

2014-01-01

Objective There is growing interest in the potential benefits of public involvement (PI) in health and social care research. However, there has been little examination of values underpinning PI or how these values might differ for different groups with an interest in PI in the research process. We aimed to explore areas of consensus and conflict around normative, substantive and process-related values underpinning PI. Design Mixed method, three-phase, modified Delphi study, conducted as part of a larger multiphase project. Setting The UK health and social care research community. Participants Stakeholders in PI in research, defined as: clinical and non-clinical academics, members of the public, research managers, commissioners and funders; identified via research networks, online searches and a literature review. Results We identified high levels of consensus for many normative, substantive and process-related issues. However, there were also areas of conflict in relation to issues of bias and representativeness, and around whether the purpose of PI in health and social care research is to bring about service change or generate new knowledge. There were large differences by group in the percentages endorsing the ethical justification for PI and the argument that PI equalises power imbalances. With regard to practical implementation of PI, research support infrastructures were reported as lacking. Participants reported shortcomings in the uptake and practice of PI. Embedding PI practice and evaluation in research study designs was seen as fundamental to strengthening the evidence base. Conclusions Our findings highlight the extent to which PI is already embedded in research. However, they also highlight a need for ‘best practice’ standards to assist research teams to understand, implement and evaluate PI. These findings have been used in developing a Public Involvement Impact Assessment Framework (PiiAF), which offers guidance to researchers and members of the

Pediatricians Transitioning Practices, Youth With Special Health Care Needs in New York State.

Science.gov (United States)

Davidson, Lynn F; Chhabra, Rosy; Cohen, Hillel W; Lechuga, Claudia; Diaz, Patricia; Racine, Andrew

2015-10-01

To assess current practices of New York State pediatricians as they transition youth with special health care needs to adult-oriented medical care. A survey of New York State pediatricians included 6 critical steps from 2002 consensus statement, 11 essential steps adapted from recent literature, and questions targeting age of starting transition and availability of transition policy. Of 181 respondents, only 11% have a transition policy. Most assist patients in transition process; identify an adult provider (92%); and create portable medical summary (57%). Only 3% start planning process at recommended age. No respondents are compliant with all 6 critical steps; subspecialists were more likely to report compliance to more than 4 steps. Participating pediatricians are making gains, yet effort is needed, to incorporate the essential steps into practice for transitioning youth with special health care needs. Recognition of barriers, use of electronic tools, and clarifying subspecialist's approach, may improve compliance with transition recommendations. © The Author(s) 2015.

A Multistep, Consensus-Based Approach to Organ Allocation in Liver Transplantation: Toward a "Blended Principle Model".

Science.gov (United States)

Cillo, U; Burra, P; Mazzaferro, V; Belli, L; Pinna, A D; Spada, M; Nanni Costa, A; Toniutto, P

2015-10-01

Since Italian liver allocation policy was last revised (in 2012), relevant critical issues and conceptual advances have emerged, calling for significant improvements. We report the results of a national consensus conference process, promoted by the Italian College of Liver Transplant Surgeons (for the Italian Society for Organ Transplantation) and the Italian Association for the Study of the Liver, to review the best indicators for orienting organ allocation policies based on principles of urgency, utility, and transplant benefit in the light of current scientific evidence. MELD exceptions and hepatocellular carcinoma were analyzed to construct a transplantation priority algorithm, given the inequity of a purely MELD-based system for governing organ allocation. Working groups of transplant surgeons and hepatologists prepared a list of statements for each topic, scoring their quality of evidence and strength of recommendation using the Centers for Disease Control grading system. A jury of Italian transplant surgeons, hepatologists, intensivists, infectious disease specialists, epidemiologists, representatives of patients' associations and organ-sharing organizations, transplant coordinators, and ethicists voted on and validated the proposed statements. After carefully reviewing the statements, a critical proposal for revising Italy's current liver allocation policy was prepared jointly by transplant surgeons and hepatologists. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

Domestic violence against women, public policies and community health workers in Brazilian Primary Health Care.

Science.gov (United States)

Signorelli, Marcos Claudio; Taft, Angela; Pereira, Pedro Paulo Gomes

2018-01-01

Domestic violence creates multiple harms for women's health and is a 'wicked problem' for health professionals and public health systems. Brazil recently approved public policies to manage and care for women victims of domestic violence. Facing these policies, this study aimed to explore how domestic violence against women is usually managed in Brazilian primary health care, by investigating a basic health unit and its family health strategy. We adopted qualitative ethnographic research methods with thematic analysis of emergent categories, interrogating data with gender theory and emergent Brazilian collective health theory. Field research was conducted in a local basic health unit and the territory for which it is responsible, in Southern Brazil. The study revealed: 1) a yawning gap between public health policies for domestic violence against women at the federal level and its practical application at local/decentralized levels, which can leave both professionals and women unsafe; 2) the key role of local community health workers, paraprofessional health promotion agents, who aim to promote dialogue between women experiencing violence, health care professionals and the health care system.

The spatial politics of place and health policy: Exploring Sustainability and Transformation Plans in the English NHS.

Science.gov (United States)

Hammond, Jonathan; Lorne, Colin; Coleman, Anna; Allen, Pauline; Mays, Nicholas; Dam, Rinita; Mason, Thomas; Checkland, Kath

2017-10-01

This paper explores how 'place' is conceptualised and mobilized in health policy and considers the implications of this. Using the on-going spatial reorganizing of the English NHS as an exemplar, we draw upon relational geographies of place for illumination. We focus on the introduction of 'Sustainability and Transformation Plans' (STPs): positioned to support improvements in care and relieve financial pressures within the health and social care system. STP implementation requires collaboration between organizations within 44 bounded territories that must reach 'local' consensus about service redesign under conditions of unprecedented financial constraint. Emphasising the continued influence of previous reorganizations, we argue that such spatialized practices elude neat containment within coherent territorial geographies. Rather than a technical process financially and spatially 'fixing' health and care systems, STPs exemplify post-politics-closing down the political dimensions of policy-making by associating 'place' with 'local' empowerment to undertake highly resource-constrained management of health systems, distancing responsibility from national political processes. Relational understandings of place thus provide value in understanding health policies and systems, and help to identify where and how STPs might experience difficulties. Copyright © 2017 Elsevier Ltd. All rights reserved.

Developing a clinical pathway for the identification and management of anxiety and depression in adult cancer patients: an online Delphi consensus process.

Science.gov (United States)

Shaw, Joanne M; Price, Melanie A; Clayton, Josephine M; Grimison, Peter; Shaw, Tim; Rankin, Nicole; Butow, Phyllis N

2016-01-01

People with cancer and their families experience high levels of psychological morbidity. However, many cancer services do not routinely screen patients for anxiety and depression, and there are no standardized clinical referral pathways. This study aimed to establish consensus on elements of a draft clinical pathway tailored to the Australian context. A two-round Delphi study was conducted to gain consensus among Australian oncology and psycho-oncology clinicians about the validity of 39 items that form the basis of a clinical pathway that includes screening, assessment, referral and stepped care management of anxiety and depression in the context of cancer. The expert panel comprised 87 multidisciplinary clinician members of the Australian Psycho-oncology Co-operative Research Group (PoCoG). Respondents rated their level of agreement with each statement on a 5-point Likert scale. Consensus was defined as >80% of respondents scoring within 2 points on the Likert scale. Consensus was reached for 21 of 39 items, and a further 15 items approached consensus except for specific contextual factors, after two Delphi rounds. Formal screening for anxiety and depression, a stepped care model of management and recommendations for inclusion of length of treatment and time to review were endorsed. Consensus was not reached on items related to roles and responsibilities, particularly those not applicable across cancer settings. This study identified a core set of evidence- and consensus-based principles considered essential to a stepped care model of care incorporating identification, referral and management of anxiety and depression in adult cancer patients.

A case study exploring the ethical and policy dimensions of allocating acute care resources to a dying patient.

Science.gov (United States)

Cooke, Mary; Hurley, Ciarán

2008-05-01

We aimed to identify policy, process and ethical issues related to allocation of National Health Service resources when patients with end-of-life illness are referred to acute care services. Sharing healthcare decisions denotes a different partnership between professionals and patients when patients are empowered to define their needs. Implementation of a transition from professional to patient decision-making appears to be dependent upon its interpretation by personnel delivering care using the local trust policy. The outcome of this is a reformation of responsibility for budget allocation, choice of acute care provider and selecting services, currently in the realm of primary care; be it the general practitioner, community practitioners, or the patient. We used a 'lens' approach to case study analysis in which the lens is constructed of a model of policy analysis and four principles of biomedical ethics. A patient's decision to decline care proposed by an Accident and Emergency department nurse and the nurse's response to that decision expose a policy that restricts the use of ambulance transport and with that, flexibility in responses to patients' decisions. End-of-life care partnership decisions require sensitivity and flexibility from all healthcare practitioners. We found that policy-based systems currently used to deliver care across the primary care - hospital care border are far from seamless and can lead to foreseeable problems. Health professionals responsible for the care of a patient at the end of life should consider the holistic outcomes of resource allocation decisions for patients. Government and health professional agenda suggest that patients should be given a greater element of control over their healthcare than has historically been the case. When patients take responsibility for their decisions, healthcare personnel should recognize that this signals a shift in the nature of the professional-patient relationship to one of partnership.

Policy commercializing nonprofits in health: the history of a paradox from the 19th century to the ACA.

Science.gov (United States)

Fox, Daniel M

2015-03-01

POLICY POINTS: Health policy in the United States has, for more than a century, simultaneously and paradoxically incentivized the growth as well as the commercialization of nonprofit organizations in the health sector. This policy paradox persists during the implementation of the Affordable Care Act of 2010. For more than a century, policy in the United States has incentivized both expansion in the number and size of tax-exempt nonprofit organizations in the health sector and their commercialization. The implementation of the Affordable Care Act of 2010 (ACA) began yet another chapter in the history of this policy paradox. This article explores the origin and persistence of the paradox using what many scholars call "interpretive social science." This methodology prioritizes history and contingency over formal theory and methods in order to present coherent and plausible narratives of events and explanations for them. These narratives are grounded in documents generated by participants in particular events, as well as conversations with them, observing them in action, and analysis of pertinent secondary sources. The methodology achieves validity and reliability by gathering information from multiple sources and making disciplined judgments about its coherence and correspondence with reality. A paradox with deep historical roots persists as a result of consensus about its value for both population health and the revenue of individuals and organizations in the health sector. Participants in this consensus include leaders of governance who have disagreed about many other issues. The paradox persists because of assumptions about the burden of disease and how to address it, as well as about the effects of biomedical science that is translated into professional education, practice, and the organization of services for the prevention, diagnosis, treatment, and management of illness. The policy paradox that has incentivized the growth and commercialization of nonprofits in

Using the modified Delphi method to establish clinical consensus for the diagnosis and treatment of patients with rotator cuff pathology

Directory of Open Access Journals (Sweden)

Breda H. Eubank

2016-05-01

Full Text Available Abstract Background Patients presenting to the healthcare system with rotator cuff pathology do not always receive high quality care. High quality care occurs when a patient receives care that is accessible, appropriate, acceptable, effective, efficient, and safe. The aim of this study was twofold: 1 to develop a clinical pathway algorithm that sets forth a stepwise process for making decisions about the diagnosis and treatment of rotator cuff pathology presenting to primary, secondary, and tertiary healthcare settings; and 2 to establish clinical practice guidelines for the diagnosis and treatment of rotator cuff pathology to inform decision-making processes within the algorithm. Methods A three-step modified Delphi method was used to establish consensus. Fourteen experts representing athletic therapy, physiotherapy, sport medicine, and orthopaedic surgery were invited to participate as the expert panel. In round 1, 123 best practice statements were distributed to the panel. Panel members were asked to mark “agree” or “disagree” beside each statement, and provide comments. The same voting method was again used for round 2. Round 3 consisted of a final face-to-face meeting. Results In round 1, statements were grouped and reduced to 44 statements that met consensus. In round 2, five statements reached consensus. In round 3, ten statements reached consensus. Consensus was reached for 59 statements representing five domains: screening, diagnosis, physical examination, investigations, and treatment. The final face-to-face meeting was also used to develop clinical pathway algorithms (i.e., clinical care pathways for three types of rotator cuff pathology: acute, chronic, and acute-on-chronic. Conclusion This consensus guideline will help to standardize care, provide guidance on the diagnosis and treatment of rotator cuff pathology, and assist in clinical decision-making for all healthcare professionals.

Using the modified Delphi method to establish clinical consensus for the diagnosis and treatment of patients with rotator cuff pathology.

Science.gov (United States)

Eubank, Breda H; Mohtadi, Nicholas G; Lafave, Mark R; Wiley, J Preston; Bois, Aaron J; Boorman, Richard S; Sheps, David M

2016-05-20

Patients presenting to the healthcare system with rotator cuff pathology do not always receive high quality care. High quality care occurs when a patient receives care that is accessible, appropriate, acceptable, effective, efficient, and safe. The aim of this study was twofold: 1) to develop a clinical pathway algorithm that sets forth a stepwise process for making decisions about the diagnosis and treatment of rotator cuff pathology presenting to primary, secondary, and tertiary healthcare settings; and 2) to establish clinical practice guidelines for the diagnosis and treatment of rotator cuff pathology to inform decision-making processes within the algorithm. A three-step modified Delphi method was used to establish consensus. Fourteen experts representing athletic therapy, physiotherapy, sport medicine, and orthopaedic surgery were invited to participate as the expert panel. In round 1, 123 best practice statements were distributed to the panel. Panel members were asked to mark "agree" or "disagree" beside each statement, and provide comments. The same voting method was again used for round 2. Round 3 consisted of a final face-to-face meeting. In round 1, statements were grouped and reduced to 44 statements that met consensus. In round 2, five statements reached consensus. In round 3, ten statements reached consensus. Consensus was reached for 59 statements representing five domains: screening, diagnosis, physical examination, investigations, and treatment. The final face-to-face meeting was also used to develop clinical pathway algorithms (i.e., clinical care pathways) for three types of rotator cuff pathology: acute, chronic, and acute-on-chronic. This consensus guideline will help to standardize care, provide guidance on the diagnosis and treatment of rotator cuff pathology, and assist in clinical decision-making for all healthcare professionals.

High performance work systems: the gap between policy and practice in health care reform.

Science.gov (United States)

Leggat, Sandra G; Bartram, Timothy; Stanton, Pauline

2011-01-01

Studies of high-performing organisations have consistently reported a positive relationship between high performance work systems (HPWS) and performance outcomes. Although many of these studies have been conducted in manufacturing, similar findings of a positive correlation between aspects of HPWS and improved care delivery and patient outcomes have been reported in international health care studies. The purpose of this paper is to bring together the results from a series of studies conducted within Australian health care organisations. First, the authors seek to demonstrate the link found between high performance work systems and organisational performance, including the perceived quality of patient care. Second, the paper aims to show that the hospitals studied do not have the necessary aspects of HPWS in place and that there has been little consideration of HPWS in health system reform. The paper draws on a series of correlation studies using survey data from hospitals in Australia, supplemented by qualitative data collection and analysis. To demonstrate the link between HPWS and perceived quality of care delivery the authors conducted regression analysis with tests of mediation and moderation to analyse survey responses of 201 nurses in a large regional Australian health service and explored HRM and HPWS in detail in three casestudy organisations. To achieve the second aim, the authors surveyed human resource and other senior managers in all Victorian health sector organisations and reviewed policy documents related to health system reform planned for Australia. The findings suggest that there is a relationship between HPWS and the perceived quality of care that is mediated by human resource management (HRM) outcomes, such as psychological empowerment. It is also found that health care organisations in Australia generally do not have the necessary aspects of HPWS in place, creating a policy and practice gap. Although the chief executive officers of health

Consensus guidelines on management of childhood convulsive status epilepticus.

Science.gov (United States)

Mishra, Devendra; Sharma, Suvasini; Sankhyan, Naveen; Konanki, Ramesh; Kamate, Mahesh; Kanhere, Sujata; Aneja, Satinder

2014-12-01

Status epilepticus has a wide etiological spectrum, and significant morbidity and mortality. Management using a pre-determined uniform protocol leads to better outcomes. Multiple protocols for management of childhood status epilepticus are available, without much consensus. A 'Multi-disciplinary Consensus Development Workshop on Management of Status Epilepticus in Children in India' was organized. The invited experts included Pediatricians, Pediatric neurologists, Neurologists, Epileptologists, and Pediatric intensive care specialists from India, with experience in the relevant field. Experts had previously been divided into focus groups and had interacted on telephone and e-mail regarding their group recommendations, and developed consensus on the topic. During the meeting, each group presented their recommendations, which were deliberated upon by the house and a consensus was reached on various issues; the document was finalized after incorporating suggestions of experts on the draft document. To provide consensus guidelines on evaluation and management of convulsive status epilepticus in children in India (excluding neonatal and super-refractory status epilepticus). Each institution should use a pre-determined protocol for management of status epilepticus; pre-hospital management and early stabilization is the key to a satisfactory outcome of status epilepticus. Pharmacotherapy should not be delayed for any investigations; the initial management should consist of a parenteral benzodiazepine by any route feasible. Subsequent management has been detailed. The group also felt the need for more epidemiological research on status epilepticus from India, and identified certain research areas for the purpose.

Core Clinical Data Elements for Cancer Genomic Repositories: A Multi-stakeholder Consensus.

Science.gov (United States)

Conley, Robert B; Dickson, Dane; Zenklusen, Jean Claude; Al Naber, Jennifer; Messner, Donna A; Atasoy, Ajlan; Chaihorsky, Lena; Collyar, Deborah; Compton, Carolyn; Ferguson, Martin; Khozin, Sean; Klein, Roger D; Kotte, Sri; Kurzrock, Razelle; Lin, C Jimmy; Liu, Frank; Marino, Ingrid; McDonough, Robert; McNeal, Amy; Miller, Vincent; Schilsky, Richard L; Wang, Lisa I

2017-11-16

The Center for Medical Technology Policy and the Molecular Evidence Development Consortium gathered a diverse group of more than 50 stakeholders to develop consensus on a core set of data elements and values essential to understanding the clinical utility of molecularly targeted therapies in oncology. Copyright © 2017 Elsevier Inc. All rights reserved.

Tensions in Constructions of Quality in Australian Early Childhood Education and Care Policy History

Science.gov (United States)

Logan, Helen

2017-01-01

In pronouncements of early childhood education and care (ECEC) policy the importance of quality appears as a seemingly irrefutable concept. Yet, attention to ECEC policy history reveals tensions between discourses that construct quality in ways that endure whereas other ways are ostensibly forgotten. Drawing on a Foucauldian-influenced…

[First SIBEN clinical consensus: diagnostic and therapeutic approach to patent ductus arteriosus in premature newborns].

Science.gov (United States)

Golombek, S G; Sola, A; Baquero, H; Borbonet, D; Cabañas, F; Fajardo, C; Goldsmit, G; Lemus, L; Miura, E; Pellicer, A; Pérez, J M; Rogido, M; Zambosco, G; van Overmeire, B

2008-11-01

To report the process and results of the first neonatal clinical consensus of the Ibero-American region. Two recognized experts in the field (Clyman and Van Overmeire) and 45 neonatologists from 23 countries were invited for active participation and collaboration. We developed 46 questions of clinical-physiological relevance in all aspects of patent ductus arteriosus (PDA). Guidelines for consensus process, literature search and future preparation of educational material and authorship were developed, reviewed and agreed by all. Participants from different countries were distributed in groups, and assigned to interact and work together to answer 3-5 questions, reviewing all global literature and local factors. Answers and summaries were received, collated and reviewed by 2 coordinators and the 2 experts. Participants and experts met in Granada, Spain for 4.5 h (lectures by experts, presentations by groups, discussion, all literature available). 31 neonatologists from 16 countries agreed to participate. Presentations by each group and general discussion were used to develop a consensus regarding: general management, availability of drugs (indomethacin vs. ibuprofen), costs, indications for echo/surgery, etc. Many steps were learnt by all present in a collaborative forum. This first consensus group of Ibero-American neonatologists SIBEN led to active and collaborative participation of neonatologists of 16 countries, improved education of all participants and ended with consensus development on clinical approaches to PDA. Furthermore, it provides recommendations for clinical care reached by consensus. Additionally, it will serve as a useful foundation for future SIBEN Consensus on other topics and it could become valuable as a model to decrease disparity in care and improve outcomes in this and other regions.

Point of Care Testing Services Delivery: Policy Analysis using a ...

African Journals Online (AJOL)

Annals of Biomedical Sciences ... The service providers (hospital management) and the testing personnel are faced with the task of trying to explain these problems. Objective of the study: To critically do a policy analysis of the problems of point of care testing with the aim of identifying the causes of these problems and ...

Incomplete Markets and Imperfect Institutions: Some Challenges Posed by Trust for Contemporary Health Care and Health Policy.

Science.gov (United States)

Schlesinger, Mark; Gray, Bradford H

2016-08-01

As contemporary health policy promotes evidence-based practices using targeted incentives, policy makers may lose track of vital aspects of care that are difficult to measure. For more than a half century, scholars have recognized that these latter aspects play a crucial role in high-quality care and equitable health system performance but depend on the potentially frail reed of providers' trustworthiness: that is, their commitment to facets and outcomes of care not easily assessed by external parties. More recently, early experience with pay for performance in health settings suggests that enhancing financial rewards for the measurable undermines providers' commitment to the unmeasurable, degrading the trustworthiness of their practices. Reformers have looked to revised professional norms or reorganized practice arrangements to bolster the intrinsic motivations required for trustworthiness. We suggest here that these responses are likely to prove inadequate. We propose that they be complemented by a renewed policy-making commitment to nonprofit ownership among health care providers, insurers, and integrated delivery systems. We identify some of the concerns raised in the past with ownership-based policies and propose a set of responses. If these are pursued in combination, they hold the promise of a sustainable ownership-based policy reform for the United States. Copyright © 2016 by Duke University Press.

Integration for coexistence? Implementation of intercultural health care policy in Ghana from the perspective of service users and providers.

Science.gov (United States)

Gyasi, Razak Mohammed; Poku, Adjoa Afriyie; Boateng, Simon; Amoah, Padmore Adusei; Mumin, Alhassan Abdul; Obodai, Jacob; Agyemang-Duah, Williams

2017-01-01

In spite of the World Health Organization's recommendations over the past decades, Ghana features pluralistic rather than truly integrated medical system. Policies about the integration of complementary medicine into the national health care delivery system need to account for individual-level involvement and cultural acceptability of care rendered by health care providers. Studies in Ghana, however, have glossed over the standpoint of the persons of the illness episode about the intercultural health care policy framework. This paper explores the health care users, and providers' experiences and attitudes towards the implementation of intercultural health care policy in Ghana. In-depth interviews, augmented with informal conversations, were conducted with 16 health service users, 7 traditional healers and 6 health professionals in the Sekyere South District and Kumasi Metropolis in the Ashanti Region of Ghana. Data were thematically analysed and presented based on the a posteriori inductive reduction approach. Findings reveal a widespread positive attitude to, and support for integrative medical care in Ghana. However, inter-provider communication in a form of cross-referrals and collaborative mechanisms between healers and health professionals seldom occurs and remains unofficially sanctioned. Traditional healers and health care professionals are skeptical about intercultural health care policy mainly due to inadequate political commitment for provider education. The medical practitioners have limited opportunity to undergo training for integrative medical practice. We also find a serious mistrust between the practitioners due to the "diversity of healing approaches and techniques." Weak institutional support, lack of training to meet standards of practice, poor registration and regulatory measures as well as negative perception of the integrative medical policy inhibit its implementation in Ghana. In order to advance any useful intercultural health care policy in

Spanish consensus for the management of patients with anaplastic cell thyroid carcinoma.

Science.gov (United States)

Gómez Sáez, José Manuel; Jiménez-Fonseca, Paula; Santamaría Sandi, Javier; Capdevila Castillón, Jaume; Navarro González, Elena; Zafón Llopis, Carles; Ramón Y Cajal Asensio, Teresa; Riesco Eizaguirre, Garcilaso; Grande Pulido, Enrique; Galofré Ferrater, Juan Carlos

2015-03-01

Anaplastic thyroid cancer (ATC) is the most aggressive solid tumour known and is a rare but highly lethal form of thyroid cancer that requires a multidisciplinary team approach. No Spanish consensus exists for management of patients with ATC. The Thyroid Cancer Group of the Spanish Society of Endocrinology and Nutrition and the GETHI (Grupo Español de Enfermedades Huérfanas e Infrecuentes) of the Spanish Society of Oncology, in agreement with the Boards of these Societies, commissioned an independent task force to develop a wide consensus on ATC. The relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The consensus includes the characteristics, diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, systemic therapy, supportive care during active treatment), approaches to advanced/metastatic disease, palliative care options, monitoring, and long-term follow-up of ATC. For operable disease, a combination of radical surgery with adjuvant radiotherapy or chemotherapy, using agents such as doxorubicin, cisplatin and paclitaxel, is the best treatment strategy. Cytotoxic drugs are poorly effective for advanced/metastatic ATC. On the other hand, targeted agents may represent a viable therapeutic option. Patients with stage IVA/IVB resectable disease have the best prognosis, particularly if a multimodal approach is used, and some stage IVB unresectable patients may respond to aggressive therapy. Patients with stage IVC disease should be considered for clinical trials or for hospice/palliative care depending on their preference. This is the first Spanish consensus for ATC, and provides recommendations for management of this extremely aggressive malignancy. Novel systemic therapies are being tested, and more effective combinations are needed to improve patient outcomes. Although more aggressive radiotherapy has reduced locoregional recurrence, mean

The ''Article Act'' - a substitute for the miscarried energy consensus?

International Nuclear Information System (INIS)

Knott, G.

1994-01-01

A prerequisite for arriving at a long-term energy policy is that all political parties come to an energy consensus. This paper reviews the chronology of the energy consensus negatiations, their failure, and the consequent energy-political rerouting which is to be realised by an act securing hard coal a share in electricity generation and amending the Atomic Energy Act (termed 'Article Act'). The Article Act is an attempt at a binding definition of central issues of the energy consensus talks even in the absence of an all-party agreement. It is particularly noteworthy that the bill makes mention of both coal and nuclear energy, reviving this link-up between the two energy sources already decined lost. The German electricity industry considers the provisions on atomic energy law contained in the Article Act insufficient for securing already existing power plants an untroubled future and for providing the investment climate needed by the manufacturing industry. To the electricity industry the main problems lie in the execution deficits at the Laender level, but these are not affected by the Article Act. It is concluded that an all-party consensus on an answerable nuclear energy utilisation will have to be found by 1995 at the latest in order to give the manufacturing industry the go-alread for continuing research and provide electricity producers with a sound basis for investment decisions. (orig./HSCH) [de

Evaluation of Nutrition and Physical Activity Policies and Practices in Child Care Centers within Rural Communities.

Science.gov (United States)

Foster, Jaime S; Contreras, Dawn; Gold, Abby; Keim, Ann; Oscarson, Renee; Peters, Paula; Procter, Sandra; Remig, Valentina; Smathers, Carol; Mobley, Amy R

2015-10-01

Although some researchers have examined nutrition and physical activity policies within urban child care centers, little is known about the potentially unique needs of rural communities. Child care centers serving preschool children located within low-income rural communities (n = 29) from seven states (Indiana, Kansas, Michigan, North Dakota, Ohio, South Dakota, and Wisconsin) were assessed to determine current nutrition and physical activity (PA) practices and policies. As part of a large-scale childhood obesity prevention project, the Community Healthy Living Index's previously validated Early Childhood Program Assessment Tool was used to collect data. Descriptive statistical analysis was conducted to identify high-priority areas. Healthy People 2020 and the Academy of Nutrition and Dietetics' recommendations for nutrition and PA policies in child care centers were used as benchmarks. Reports of not fully implementing (nutrition-related policies or practices within rural early child care centers were identified. Centers not consistently serving a variety of fruits (48%), vegetables (45%), whole grains (41%), limiting saturated fat intake (31%), implementing healthy celebration guidelines (41%), involving children in mealtime (62%), and referring families to nutrition assistance programs (24%) were identified. More than one third of centers also had limited structured PA opportunities. Although eligible, only 48% of the centers participated in the Child and Adult Care Food Program. Overall, centers lacked parental outreach, staff training, and funding/resources to support nutrition and PA. These results provide insight into where child care centers within low-income, rural communities may need assistance to help prevent childhood obesity.

Core Competencies for Pain Management: Results of an Interprofessional Consensus Summit

Science.gov (United States)

Fishman, Scott M; Young, Heather M; Lucas Arwood, Ellyn; Chou, Roger; Herr, Keela; Murinson, Beth B; Watt-Watson, Judy; Carr, Daniel B; Gordon, Debra B; Stevens, Bonnie J; Bakerjian, Debra; Ballantyne, Jane C; Courtenay, Molly; Djukic, Maja; Koebner, Ian J; Mongoven, Jennifer M; Paice, Judith A; Prasad, Ravi; Singh, Naileshni; Sluka, Kathleen A; St Marie, Barbara; Strassels, Scott A

2013-01-01

Objective The objective of this project was to develop core competencies in pain assessment and management for prelicensure health professional education. Such core pain competencies common to all prelicensure health professionals have not been previously reported. Methods An interprofessional executive committee led a consensus-building process to develop the core competencies. An in-depth literature review was conducted followed by engagement of an interprofessional Competency Advisory Committee to critique competencies through an iterative process. A 2-day summit was held so that consensus could be reached. Results The consensus-derived competencies were categorized within four domains: multidimensional nature of pain, pain assessment and measurement, management of pain, and context of pain management. These domains address the fundamental concepts and complexity of pain; how pain is observed and assessed; collaborative approaches to treatment options; and application of competencies across the life span in the context of various settings, populations, and care team models. A set of values and guiding principles are embedded within each domain. Conclusions These competencies can serve as a foundation for developing, defining, and revising curricula and as a resource for the creation of learning activities across health professions designed to advance care that effectively responds to pain. PMID:23577878

Understanding public elderly care policy in Norway: A narrative analysis of governmental White papers.

Science.gov (United States)

Jacobsen, Frode F

2015-08-01

How the general public in Norway conceives being an older adult and the meaning of chronological age has changed over the last few decades. As narratives of aging may be identified in the Norwegian mass media and in the population at large, dominant narratives may also be identified in policy documents, such as government health policy papers. This article explores a narrative analytical framework based on stories, subtexts, and counterstories; it argues that such narratives are characterized as much by what is unsaid as by what is said, and as much by choice of words and word combinations as by explicit messages. Culture strongly influences the conception of a likely future (what will be) and an envisioned future (what ought to be) regarding aging and geriatric care in Norway, as expressed in the public policy papers. The public policy story is discussed as both a story continuously developing, where later health policy papers relate to and comment on earlier documents, and as a story characterized by a measure of cultural incoherence. Some recent government documents dealing with professional geriatric care will serve as material for a narrative analysis. Copyright © 2015 Elsevier Inc. All rights reserved.

For whom and for what the definition of severe dementia is useful: an EDCON consensus.

Science.gov (United States)

Byrne, E J; Benoit, M; Lopez Arrieta, J M; Geraldi, C; Koopmans, R; Rolland, Y; Sartorius, N; Stoppe, G; Robert, P

2008-12-01

The European Dementia Consensus Network (EDCON) is a special project of the Madariaga Foundation located in Brussels. The Madariaga Foundation seeks to facilitate collaboration between European countries and between the public and private sector. This paper will review the differences in the definitions of Severe Dementia and summarise the EDCON consensus on their implications for management. EDCON recommends that:--The attributes of the person suffering from dementia should be given as much attention (and are as important for care) as the severity of cognitive decline in dementia;--The dementia syndrome (particularly in it's severe form) is inadequately defined by criteria which only includes the domain of cognition;--Physical, legal, social and cultural factors defining the environment of patients and their families should be carefully examined and that the results of this examination should be used in conjunction with the results of the somatic and psychiatric assessment in planning care and placement of the patient;--patients with severe dementia should have access to palliative care; - family members should be included in the care plans for those with severe dementia who are in institutional care.

Development of geriatric competencies for emergency medicine residents using an expert consensus process.

Science.gov (United States)

Hogan, Teresita M; Losman, Eve D; Carpenter, Christopher R; Sauvigne, Karen; Irmiter, Cheryl; Emanuel, Linda; Leipzig, Rosanne M

2010-03-01

The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. The aging population will increase elder ED patient utilization to 35% to 60% of all visits. Older patients can have complex clinical presentations and be resource-intensive. Evidence indicates that emergency physicians fail to provide consistent high-quality care for elder ED patients, resulting in poor clinical outcomes. The objective was to develop a consensus document, "Geriatric Competencies for Emergency Medicine Residents," by identified experts. This is a minimum set of behaviorally based performance standards that all residents should be able to demonstrate by completion of their residency training. This consensus-based process utilized an inductive, qualitative, multiphase method to determine the minimum geriatric competencies needed by emergency medicine (EM) residents. Assessments of face validity and reliability were used throughout the project. In Phase I, participants (n=363) identified 12 domains and 300 potential competencies. In Phase II, an expert panel (n=24) clustered the Phase I responses, resulting in eight domains and 72 competencies. In Phase III, the expert panel reduced the competencies to 26. In Phase IV, analysis of face validity and reliability yielded a 100% consensus for eight domains and 26 competencies. The domains identified were atypical presentation of disease; trauma, including falls; cognitive and behavioral disorders; emergent intervention modifications; medication management; transitions of care; pain management and palliative care; and effect of comorbid conditions. The Geriatric Competencies for EM Residents is a consensus document that can form the basis for EM residency curricula and assessment to meet the demands of our aging population. Copyright (c) 2010 by the Society for Academic Emergency Medicine.

Education, implementation, and policy barriers to greater integration of palliative care: A literature review.

Science.gov (United States)

Aldridge, Melissa D; Hasselaar, Jeroen; Garralda, Eduardo; van der Eerden, Marlieke; Stevenson, David; McKendrick, Karen; Centeno, Carlos; Meier, Diane E

2016-03-01

Early integration of palliative care into the management of patients with serious disease has the potential to both improve quality of life of patients and families and reduce healthcare costs. Despite these benefits, significant barriers exist in the United States to the early integration of palliative care in the disease trajectory of individuals with serious illness. To provide an overview of the barriers to more widespread palliative care integration in the United States. A literature review using PubMed from 2005 to March 2015 augmented by primary data collected from 405 hospitals included in the Center to Advance Palliative Care's National Palliative Care Registry for years 2012 and 2013. We use the World Health Organization's Public Health Strategy for Palliative Care as a framework for analyzing barriers to palliative care integration. We identified key barriers to palliative care integration across three World Health Organization domains: (1) education domain: lack of adequate education/training and perception of palliative care as end-of-life care; (2) implementation domain: inadequate size of palliative medicine-trained workforce, challenge of identifying patients appropriate for palliative care referral, and need for culture change across settings; (3) policy domain: fragmented healthcare system, need for greater funding for research, lack of adequate reimbursement for palliative care, and regulatory barriers. We describe the key policy and educational opportunities in the United States to address and potentially overcome the barriers to greater integration of palliative care into the healthcare of Americans with serious illness. © The Author(s) 2015.

The diagnostic work up of growth failure in secondary health care; An evaluation of consensus guidelines

Directory of Open Access Journals (Sweden)

Dekker Friedo W

2008-05-01

Full Text Available Abstract Background As abnormal growth might be the first manifestation of undetected diseases, it is important to have accurate referral criteria and a proper diagnostic work-up. In the present paper we evaluate the diagnostic work-up in secondary health care according to existing consensus guidelines and study the frequency of underlying medical disorders. Methods Data on growth and additional diagnostic procedures were collected from medical records of new patients referred for short stature to the outpatient clinics of the general paediatric departments of two hospitals (Erasmus MC – Sophia Children's Hospital, Rotterdam and Spaarne Hospital, Haarlem between January 1998 and December 2002. As the Dutch Consensus Guideline (DCG is the only guideline addressing referral criteria as well as diagnostic work-up, the analyses were based on its seven auxological referral criteria to determine the characteristics of children who are incorrectly referred and the adequacy of workup of those who are referred. Results Twenty four percent of children older than 3 years were inappropriately referred (NCR. Of the correctly referred children 74–88% were short corrected for parental height, 40–61% had a height SDS Conclusion Existing guidelines for workup of children with suspected growth failure are poorly implemented. Although poorly implemented the DCG detects at least 5% pathologic causes of growth failure in children referred for short stature. New guidelines for referral are required with a better sensitivity and specificity, wherein distance to target height should get more attention. The general diagnostic work up for short stature should include testing for celiac disease in all children and for Turner syndrome in girls.

Possibilities And Limitations In The Implementation Of The Policy For Men's Health In Primary Care

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Flávio William Brito de Azevedo Ramalho

2017-05-01

Full Text Available Objective: Investigate the possibilities and limitations to implement the National Policy for Integrated Healthcare in Human Primary João Pessoa - Paraíba. Method: An exploratory study with a qualitative approach using semi-structured interviews. Data were collected from September 2010 to February 2011. The study subjects were 12 nurses who engage in Integrated Health Units in João Pessoa-Paraíba. Results: In the treatment of the results we used the Content Analysis of Bardin. All respondents were female, aged 28-43 years, operating time of 7-12 years and most have expertise. The research affirms the occurrence of major deficits in the perception of health professionals regarding the implementation of the policy. Conclusion: The limits revealed require actions by users, professionals and management, so that policy becomes a reality in everyday primary care. Descriptors: Primary Health Care; Health Policy; Men's Health. Nursing.

Triage: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

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Christian, Michael D; Sprung, Charles L; King, Mary A; Dichter, Jeffrey R; Kissoon, Niranjan; Devereaux, Asha V; Gomersall, Charles D

2014-10-01

Pandemics and disasters can result in large numbers of critically ill or injured patients who may overwhelm available resources despite implementing surge-response strategies. If this occurs, critical care triage, which includes both prioritizing patients for care and rationing scarce resources, will be required. The suggestions in this chapter are important for all who are involved in large-scale pandemics or disasters with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. The Triage topic panel reviewed previous task force suggestions and the literature to identify 17 key questions for which specific literature searches were then conducted to identify studies upon which evidence-based recommendations could be made. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Suggestions from the previous task force that were not being updated were also included for validation by the expert panel. The suggestions from the task force outline the key principles upon which critical care triage should be based as well as a path for the development of the plans, processes, and infrastructure required. This article provides 11 suggestions regarding the principles upon which critical care triage should be based and policies to guide critical care triage. Ethical and efficient critical care triage is a complex process that requires significant planning and preparation. At present, the prognostic tools required to produce an effective decision support system (triage protocol) as well as the infrastructure, processes, legal protections, and training are largely lacking in most jurisdictions. Therefore, critical care triage should be a last resort after mass critical care surge strategies.

Rethinking Medicaid Coverage and Payment Policy to Promote High Value Care: The Case of Long-Acting Reversible Contraception.

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Vela, Veronica X; Patton, Elizabeth W; Sanghavi, Darshak; Wood, Susan F; Shin, Peter; Rosenbaum, Sara

Long-acting reversible contraception (LARC) is the most effective reversible method to prevent unplanned pregnancies. Variability in state-level policies and the high cost of LARC could create substantial inconsistencies in Medicaid coverage, despite federal guidance aimed at enhancing broad access. This study surveyed state Medicaid payment policies and outreach activities related to LARC to explore the scope of services covered. Using publicly available information, we performed a content analysis of state Medicaid family planning and LARC payment policies. Purposeful sampling led to a selection of nine states with diverse geographic locations, political climates, Medicaid expansion status, and the number of women covered by Medicaid. All nine states' Medicaid programs covered some aspects of LARC. However, only a single state's payment structure incorporated all core aspects of high-quality LARC service delivery, including counseling, device, insertion, removal, and follow-up care. Most states did not explicitly address counseling, device removal, or follow-up care. Some states had strategies to enhance access, including policies to increase device reimbursement, stocking and delivery programs to remove cost barriers, and covering devices and insertion after an abortion. Although Medicaid policy encourages LARC methods, state payment policies frequently fail to address key aspects of care, including counseling, follow-up care, and removal, resulting in highly variable state-level practices. Although some states include payment policy innovations to support LARC access, significant opportunities remain. Published by Elsevier Inc.

Development of a nationwide consensus syllabus of palliative medicine for undergraduate medical education in Japan: a modified Delphi method.

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Kizawa, Yoshiyuki; Tsuneto, Satoru; Tamba, Kaichiro; Takamiya, Yusuke; Morita, Tatsuya; Bito, Seiji; Otaki, Junji

2012-07-01

There is currently no consensus syllabus of palliative medicine for undergraduate medical education in Japan, although the Cancer Control Act proposed in 2007 covers the dissemination of palliative care. To develop a nationwide consensus syllabus of palliative medicine for undergraduate medical education in Japan using a modified Delphi method. We adopted the following three-step method: (1) a workshop to produce the draft syllabus; (2) a survey-based provisional syllabus; (3) Delphi rounds and a panel meeting (modified Delphi method) to produce the working syllabus. Educators in charge of palliative medicine from 63% of the medical schools in Japan collaborated to develop a survey-based provisional syllabus before the Delphi rounds. A panel of 32 people was then formed for the modified Delphi rounds comprising 28 educators and experts in palliative medicine, one cancer survivor, one bereaved family member, and two medical students. The final consensus syllabus consists of 115 learning objectives across seven sections as follows: basic principles; disease process and comprehensive assessment; symptom management; psychosocial care; cultural, religious, and spiritual issues; ethical issues; and legal frameworks. Learning objectives were categorized as essential or desirable (essential: 66; desirable: 49). A consensus syllabus of palliative medicine for undergraduate medical education was developed using a clear and innovative methodology. The final consensus syllabus will be made available for further dissemination of palliative care education throughout the country.

Consensus guidelines for the identification and treatment of biofilms in chronic nonhealing wounds

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Schultz, Gregory; Bjarnsholt, Thomas; James, Garth A.

2017-01-01

diagnostic options; clinical indicators of biofilms; future options for diagnostic tests; treatment strategies; mechanical debridement; topical antiseptics; screening antibiofilm agents; and levels of evidence when choosing antibiofilm treatments. Conclusion: This consensus document attempts to clarify...... misunderstandings about the role of biofilms in clinical practice, and provides a basis for clinicians to recognize biofilms in chronic nonhealing wounds and manage patients optimally. A new paradigm for wound care, based on a stepped-down treatment approach, was derived from the consensus statements....

Latin American Consensus for Pediatric Cardiopulmonary Resuscitation 2017: Latin American Pediatric Critical Care Society Pediatric Cardiopulmonary Resuscitation Committee.

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López-Herce, Jesús; Almonte, Enma; Alvarado, Manuel; Bogado, Norma Beatriz; Cyunel, Mariana; Escalante, Raffo; Finardi, Christiane; Guzmán, Gustavo; Jaramillo-Bustamante, Juan C; Madrid, Claudia C; Matamoros, Martha; Moya, Luis Augusto; Obando, Grania; Reboredo, Gaspar; López, Lissette R; Scheu, Christian; Valenzuela, Alejandro; Yerovi, Rocío; Yock-Corrales, Adriana

2018-03-01

To develop a Latin American Consensus about Pediatric Cardiopulmonary Resuscitation. To clarify, reinforce, and adapt some specific recommendations for pediatric patients and to stimulate the implementation of these recommendations in clinical practice. Expert consensus recommendations with Delphi methodology. Latin American countries. Experts in pediatric cardiopulmonary resuscitation from 19 Latin American countries. Delphi methodology for expert consensus. The goal was to reach consensus with all the participating experts for every recommendation. An agreement of at least 80% of the participating experts had to exist in order to deliver a recommendation. Two Delphi voting rounds were sent out electronically. The experts were asked to score between 1 and 9 their level of agreement for each recommendation. The score was then classified into three groups: strong agreement (score 7-9), moderate agreement (score 4-6), and disagreement (score 1-3). Nineteen experts from 19 countries participated in both voting rounds and in the whole process of drafting the recommendations. Sixteen recommendations about organization of cardiopulmonary resuscitation, prevention, basic resuscitation, advanced resuscitation, and postresuscitation measures were approved. Ten of them had a consensus of 100%. Four of them were agreed by all the participants except one (94.7% consensus). One recommendation was agreed by all except two experts (89.4%), and finally, one was agreed by all except three experts (84.2%). All the recommendations reached a level of agreement. This consensus adapts 16 international recommendations to Latin America in order to improve the practice of cardiopulmonary resuscitation in children. Studies should be conducted to analyze the effectiveness of the implementation of these recommendations.

Collaborative Approaches and Policy Opportunities for Accelerated Progress toward Effective Disease Prevention, Care, and Control: Using the Case of Poverty Diseases to Explore Universal Access to Affordable Health Care.

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Laokri, Samia

2017-01-01

There is a massive global momentum to progress toward the sustainable development and universal health coverage goals. However, effective policies to health-care coverage can only emerge through high-quality services delivered to empowered care users by means of strong local health systems and a translational standpoint. Health policies aimed at removing user fees for a defined health-care package may fail at reaching desired results if not applied with system thinking. Secondary data analysis of two country-based cost-of-illness studies was performed to gain knowledge in informed decision-making toward enhanced access to care in the context of resource-constraint settings. A scoping review was performed to map relevant experiences and evidence underpinning the defined research area, the economic burden of illness. Original studies reflected on catastrophic costs to patients because of care services use and related policy gaps. Poverty diseases such as tuberculosis (TB) may constitute prime examples to assess the extent of effective high-priority health-care coverage. Our findings suggest that a share of the economic burden of illness can be attributed to implementation failures of health programs and supply-side features, which may highly impair attainment of the global stated goals. We attempted to define and discuss a knowledge development framework for effective policy-making and foster system levers for integrated care. Bottlenecks to effective policy persist and rely on interrelated patterns of health-care coverage. Health system performance and policy responsiveness have to do with collaborative work among all health stakeholders. Public-private mix strategies may play a role in lowering the economic burden of disease and solving some policy gaps. We reviewed possible added value and pitfalls of collaborative approaches to enhance dynamic local knowledge development and realize integration with the various health-care silos. Despite a large political

Collaborative Approaches and Policy Opportunities for Accelerated Progress toward Effective Disease Prevention, Care, and Control: Using the Case of Poverty Diseases to Explore Universal Access to Affordable Health Care

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Samia Laokri

2017-08-01

Full Text Available BackgroundThere is a massive global momentum to progress toward the sustainable development and universal health coverage goals. However, effective policies to health-care coverage can only emerge through high-quality services delivered to empowered care users by means of strong local health systems and a translational standpoint. Health policies aimed at removing user fees for a defined health-care package may fail at reaching desired results if not applied with system thinking.MethodSecondary data analysis of two country-based cost-of-illness studies was performed to gain knowledge in informed decision-making toward enhanced access to care in the context of resource-constraint settings. A scoping review was performed to map relevant experiences and evidence underpinning the defined research area, the economic burden of illness.FindingsOriginal studies reflected on catastrophic costs to patients because of care services use and related policy gaps. Poverty diseases such as tuberculosis (TB may constitute prime examples to assess the extent of effective high-priority health-care coverage. Our findings suggest that a share of the economic burden of illness can be attributed to implementation failures of health programs and supply-side features, which may highly impair attainment of the global stated goals. We attempted to define and discuss a knowledge development framework for effective policy-making and foster system levers for integrated care.DiscussionBottlenecks to effective policy persist and rely on interrelated patterns of health-care coverage. Health system performance and policy responsiveness have to do with collaborative work among all health stakeholders. Public–private mix strategies may play a role in lowering the economic burden of disease and solving some policy gaps. We reviewed possible added value and pitfalls of collaborative approaches to enhance dynamic local knowledge development and realize integration with the various

Financing Child Care. A Public Policy Report from the Ewing Marion Kauffman Foundation. Winter 2002.

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Ewing Marion Kauffman Foundation, Kansas City, MO.

This public policy report focuses on financing child care in the United States. The report contains brief articles on the following topics: (1) child care wages in comparison to other positions; (2) benefits to businesses when employees have high-quality child care; (3) resources for funding early education systems; (4) comparison of the cost of…

Implementation of a health care policy: An analysis of barriers and facilitators to practice change

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Sword Wendy

2005-08-01

Full Text Available Abstract Background Governments often create policies that rely on implementation by arms length organizations and require practice changes on the part of different segments of the health care system without understanding the differences in and complexities of these agencies. In 2000, in response to publicity about the shortening length of postpartum hospital stay, the Ontario government created a universal program offering up to a 60-hour postpartum stay and a public health follow-up to mothers and newborn infants. The purpose of this paper is to examine how a health policy initiative was implemented in two different parts of a health care system and to analyze the barriers and facilitators to achieving practice change. Methods The data reported came from two studies of postpartum health and service use in Ontario Canada. Data were collected from newly delivered mothers who had uncomplicated vaginal deliveries. The study samples were drawn from the same five purposefully selected hospitals for both studies. Questionnaires prior to discharge and structured telephone interviews at 4-weeks post discharge were used to collect data before and after policy implementation. Qualitative data were collected using focus groups with hospital and community-based health care practitioners and administrators at each site. Results In both studies, the respondents reflected a population of women who experienced an "average" or non-eventful hospital-based, singleton vaginal delivery. The findings of the second study demonstrated wide variance in implementation of the offer of a 60-hour stay among the sites and focus groups revealed that none of the hospitals acknowledged the 60-hour stay as an official policy. The uptake of the offer of a 60-hour stay was unrelated to the rate of offer. The percentage of women with a hospital stay of less than 25 hours and the number with the guideline that the call be within 48 hours of hospital discharge. Public health

Development of the Migrant Friendly Maternity Care Questionnaire (MFMCQ) for migrants to Western societies: an international Delphi consensus process

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2014-01-01

Background Through the World Health Assembly Resolution, ‘Health of Migrants’, the international community has identified migrant health as a priority. Recommendations for general hospital care for international migrants in receiving-countries have been put forward by the Migrant Friendly Hospital Initiative; adaptations of these recommendations specific to maternity care have yet to be elucidated and validated. We aimed to develop a questionnaire measuring migrant-friendly maternity care (MFMC) which could be used in a range of maternity care settings and countries. Methods This study was conducted in four stages. First, questions related to migrant friendly maternity care were identified from existing questionnaires including the Migrant Friendliness Quality Questionnaire, developed in Europe to capture recommended general hospital care for migrants, and the Mothers In a New Country (MINC) Questionnaire, developed in Australia and revised for use in Canada to capture the maternity care experiences of migrant women, and combined to create an initial MFMC questionnaire. Second, a Delphi consensus process in three rounds with a panel of 89 experts in perinatal health and migration from 17 countries was undertaken to identify priority themes and questions as well as to clarify wording and format. Third, the draft questionnaire was translated from English to French and Spanish and back-translated and subsequently culturally validated (assessed for cultural appropriateness) by migrant women. Fourth, the questionnaire was piloted with migrant women who had recently given birth in Montreal, Canada. Results A 112-item questionnaire on maternity care from pregnancy, through labour and birth, to postpartum care, and including items on maternal socio-demographic, migration and obstetrical characteristics, and perceptions of care, has been created - the Migrant Friendly Maternity Care Questionnaire (MFMCQ) – in three languages (English, French and Spanish). It is

Development of the Migrant Friendly Maternity Care Questionnaire (MFMCQ) for migrants to Western societies: an international Delphi consensus process.

Science.gov (United States)

Gagnon, Anita J; DeBruyn, Rebecca; Essén, Birgitta; Gissler, Mika; Heaman, Maureen; Jeambey, Zeinab; Korfker, Dineke; McCourt, Christine; Roth, Carolyn; Zeitlin, Jennifer; Small, Rhonda

2014-06-10

Through the World Health Assembly Resolution, 'Health of Migrants', the international community has identified migrant health as a priority. Recommendations for general hospital care for international migrants in receiving-countries have been put forward by the Migrant Friendly Hospital Initiative; adaptations of these recommendations specific to maternity care have yet to be elucidated and validated. We aimed to develop a questionnaire measuring migrant-friendly maternity care (MFMC) which could be used in a range of maternity care settings and countries. This study was conducted in four stages. First, questions related to migrant friendly maternity care were identified from existing questionnaires including the Migrant Friendliness Quality Questionnaire, developed in Europe to capture recommended general hospital care for migrants, and the Mothers In a New Country (MINC) Questionnaire, developed in Australia and revised for use in Canada to capture the maternity care experiences of migrant women, and combined to create an initial MFMC questionnaire. Second, a Delphi consensus process in three rounds with a panel of 89 experts in perinatal health and migration from 17 countries was undertaken to identify priority themes and questions as well as to clarify wording and format. Third, the draft questionnaire was translated from English to French and Spanish and back-translated and subsequently culturally validated (assessed for cultural appropriateness) by migrant women. Fourth, the questionnaire was piloted with migrant women who had recently given birth in Montreal, Canada. A 112-item questionnaire on maternity care from pregnancy, through labour and birth, to postpartum care, and including items on maternal socio-demographic, migration and obstetrical characteristics, and perceptions of care, has been created--the Migrant Friendly Maternity Care Questionnaire (MFMCQ)--in three languages (English, French and Spanish). It is completed in 45 minutes via interview

A Proposal for a Policy on the Ethical Care and Use of Cadavers and Their Tissues

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Champney, Thomas H.

2011-01-01

Recent events have occurred that indicate the need for policies on the ethical care and use of cadavers and their tissues in the United States. At present, there are policies that address the procurement, handling and disposition of cadavers, but there are no national or society sponsored policies that clearly state the ethically appropriate use…

Clinical practice guidelines and consensus statements in oncology--an assessment of their methodological quality.

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Carmel Jacobs

Full Text Available Consensus statements and clinical practice guidelines are widely available for enhancing the care of cancer patients. Despite subtle differences in their definition and purpose, these terms are often used interchangeably. We systematically assessed the methodological quality of consensus statements and clinical practice guidelines published in three commonly read, geographically diverse, cancer-specific journals. Methods Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents.Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents.Thirty-four consensus statements and 67 clinical practice guidelines were evaluated. The rigour of development score for consensus statements over the three journals was 32% lower than that of clinical practice guidelines. The editorial independence score was 15% lower for consensus statements than clinical practice guidelines. One journal scored

Moving toward a national policy on palliative and end of life care

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Stanley C Macaden

2011-01-01

Full Text Available Indian Palliative Care has developed over the past 17 years but it has also developed disabilities due to lack of a National Policy and hence has compromised its effectiveness. It is true that we have come a long way but we still have many miles to go and we will get there only if we have a proper road map and sign posts. This article attempts to suggest some specific measures in establishing such a National Policy

Policy revision in health enterprise information security: P3WG final report

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Sostrom, Kristen; Collmann, Jeff R.

2003-05-01

Health information management policies usually address the use of paper records with little or no mention of electronic health records. Information Technology (IT) policies often ignore the health care business needs and operational use of the information stored in its systems. Representatives from the Telemedicine & Advanced Technology Research Center (TATRC), TRICARE and Offices of the Surgeon General of each Military Service, collectively referred to as the Policies, Procedures and Practices Work Group (P3WG) examined military policies and regulations relating to computer-based information systems and medical records management. Using an interdisciplinary and interservice QA approach they compared existing military policies with the Health Insurance Portability and Accountability Act (HIPAA) Security Rule to identify gaps and discrepancies. The final report, including a plain English explanation of the individual standards and relevance to the Department of Defense (DoD), a comparative analysis and recommendations, will feed in to the security management process and HIPAA implementation efforts at multiple levels within the DoD. In light of High Reliability Theory, this process models how large enterprises may coordinate policy revision and reform across broad organizational and work domains, building consensus on key policy reforms among military stakeholders across different disciplines, levels of command hierarchy and services.

Deliberative Governance in Higher Education: The Utility of John Dryzek's Concept of Meta-Consensus

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Hampton, Greg

2013-01-01

A rapprochement between managerialism and collegialism has become commonplace within policy discussion on governance within higher education. Processes of deliberation within university governance are suggested as one means of fostering this apparent accord. I suggest that Dryzek's notion of meta-consensus can assist processes of deliberative…

Policies and protocols for preventing transmission of HIV infection in oral health care in South Africa.

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Ogunbodede, E O; Rudolph, M J

2002-12-01

Human immunodeficiency virus (HIV) infection constitutes an unparalleled public health challenge. The unique nature of most oral health procedures, instrumentation and patient-care settings requires specific strategies and protocols aimed at preventing the transmission of HIV/AIDS between oral health care providers and patients, as well as between patients themselves. The present study investigated the level of information and training about protocols and policies for preventing the transmission of HIV/AIDS in oral health care settings in South Africa. The data collection techniques utilised available information, in-depth interviews and an open-ended questionnaire. The respondents were 20 purposively selected key informants who were senior officers for HIV/AIDS programmes and/or oral health organisations. Sixteen (80%) of the respondents reported that there were no existing oral health policies on HIV/AIDS in their health care institutions or organisations. None of the interviewees knew of any specific protocols on HIV/AIDS in the oral health care setting that emanated from South Africa. In addition, none of the dental professional associations had established an infection control committee or a support system for members who might become infected with HIV and develop AIDS. Territorial boundaries existed between sectors within the medical disciplines, as well as between the medical and oral health disciplines. Numerous general impediments were identified, such as prejudice, denial and fear, inadequate training and/or information about the infection, lack of representation and resources for policy planning, a lack of interest from the business sector, and approaching HIV/AIDS in the workplace as a 'one-time issue' Other obstacles identified included unemployment, poverty, illiteracy, disempowerment of women and inadequate communication of policies to service providers. Additional issues raised included the migrant labour systeM, complexities of language and culture

Establishing research priorities for patient safety in emergency medicine: a multidisciplinary consensus panel.

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Plint, Amy C; Stang, Antonia S; Calder, Lisa A

2015-01-01

Patient safety in the context of emergency medicine is a relatively new field of study. To date, no broad research agenda for patient safety in emergency medicine has been established. The objective of this study was to establish patient safety-related research priorities for emergency medicine. These priorities would provide a foundation for high-quality research, important direction to both researchers and health-care funders, and an essential step in improving health-care safety and patient outcomes in the high-risk emergency department (ED) setting. A four-phase consensus procedure with a multidisciplinary expert panel was organized to identify, assess, and agree on research priorities for patient safety in emergency medicine. The 19-member panel consisted of clinicians, administrators, and researchers from adult and pediatric emergency medicine, patient safety, pharmacy, and mental health; as well as representatives from patient safety organizations. In phase 1, we developed an initial list of potential research priorities by electronically surveying a purposeful and convenience sample of patient safety experts, ED clinicians, administrators, and researchers from across North America using contact lists from multiple organizations. We used simple content analysis to remove duplication and categorize the research priorities identified by survey respondents. Our expert panel reached consensus on a final list of research priorities through an in-person meeting (phase 3) and two rounds of a modified Delphi process (phases 2 and 4). After phases 1 and 2, 66 unique research priorities were identified for expert panel review. At the end of phase 4, consensus was reached for 15 research priorities. These priorities represent four themes: (1) methods to identify patient safety issues (five priorities), (2) understanding human and environmental factors related to patient safety (four priorities), (3) the patient perspective (one priority), and (4) interventions for

Clinical Policy Recommendations from the VHA State-of-the-Art Conference on Non-Pharmacological Approaches to Chronic Musculoskeletal Pain.

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Kligler, Benjamin; Bair, Matthew J; Banerjea, Ranjana; DeBar, Lynn; Ezeji-Okoye, Stephen; Lisi, Anthony; Murphy, Jennifer L; Sandbrink, Friedhelm; Cherkin, Daniel C

2018-05-01

As a large national healthcare system, Veterans Health Administration (VHA) is ideally suited to build on its work to date and develop a safe, evidence-based, and comprehensive approach to the care of chronic musculoskeletal pain conditions that de-emphasizes opioid use and emphasizes non-pharmacological strategies. The VHA Office of Health Services Research and Development (HSR&D) held a state-of-the-art (SOTA) conference titled "Non-pharmacological Approaches to Chronic Musculoskeletal Pain Management" in November 2016. Goals of the conference were (1) to establish consensus on the current state of evidence regarding non-pharmacological approaches to chronic musculoskeletal pain to inform VHA policy in this area and (2) to begin to identify priorities for the future VHA research agenda. Workgroups were established and asked to reach consensus recommendations on clinical and research priorities for the following treatment strategies: psychological/behavioral therapies, exercise/movement therapies, manual therapies, and models for delivering multimodal pain care. Participants in the SOTA identified nine non-pharmacological therapies with sufficient evidence to be implemented across the VHA system as part of pain care. Participants further recommended that effective integration of these non-pharmacological approaches across the VHA and especially into VHA primary care, pain care, and mental health settings should be a priority, and that these treatments should be offered early in the course of pain treatment and delivered in a team-based, multimodal treatment setting concurrently with active self-care and self-management approaches. In addition, we recommend that VHA leadership and policy makers systematically address the barriers to implementation of these approaches by expanding opportunities for clinician and veteran education on the effectiveness of these strategies; supporting and funding further research to determine optimal dosage, duration, sequencing

Evaluating mental health care and policy in Spain.

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Salvador-Carulla, Luis; Costa-Font, Joan; Cabases, Juan; McDaid, David; Alonso, Jordi

2010-06-01

The reform and expansion of mental health care (MHC) systems is a key health policy target worldwide. Evidence informed policy aims to make use of a wide range of relevant data, taking into account past experience and local culture and context. To discuss the organisation, provision and financing of MHC in Spain visa vis the goals of recent psychiatric reforms. We draw upon existing literature, reports and empirical data from regional and national health plans, as well as European reports pertinent to Spain. In addition we have made use of iterative discussion by an expert panel on the features of Spanish MHC services, namely its history, characteristics and determinants in comparison to reforms in other European health systems. In contrast to most other European health systems, the Spanish case reveals that political regional devolution leads to a greater heterogeneity in MHC systems, with some of the 17 autonomous communities (ACs) or region states that make up the country moving more rapidly to full de-institutionalisation alongside coverage expansion and policy innovation. There remains a lack of specific earmarked budgets for MHC at a time of under-funding. There has been an imbalance in MHC reforms, with more focus on the principles underpinning the process of de-institutionalisation and less on the actual development of alternative community based mental health services. Moreover there has been a lack of monitoring of the reform process. Common to other countries, attempts to develop a more informed evidence policy have been hampered by a dislocation between the production of research evidence and the timing of actual policy reform implementation. Much of the focus of policy attention is on how to improve coordination within and across sectors, tackle socioeconomic inequalities and thus reduce the gap between perceived and observed need while monitoring any trends suggesting trans-institutionalisation. Other issues include developing and strengthening

Management of the Potential Organ Donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement.

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Kotloff, Robert M; Blosser, Sandralee; Fulda, Gerard J; Malinoski, Darren; Ahya, Vivek N; Angel, Luis; Byrnes, Matthew C; DeVita, Michael A; Grissom, Thomas E; Halpern, Scott D; Nakagawa, Thomas A; Stock, Peter G; Sudan, Debra L; Wood, Kenneth E; Anillo, Sergio J; Bleck, Thomas P; Eidbo, Elling E; Fowler, Richard A; Glazier, Alexandra K; Gries, Cynthia; Hasz, Richard; Herr, Dan; Khan, Akhtar; Landsberg, David; Lebovitz, Daniel J; Levine, Deborah Jo; Mathur, Mudit; Naik, Priyumvada; Niemann, Claus U; Nunley, David R; O'Connor, Kevin J; Pelletier, Shawn J; Rahman, Omar; Ranjan, Dinesh; Salim, Ali; Sawyer, Robert G; Shafer, Teresa; Sonneti, David; Spiro, Peter; Valapour, Maryam; Vikraman-Sushama, Deepak; Whelan, Timothy P M

2015-06-01

This document was developed through the collaborative efforts of the Society of Critical Care Medicine, the American College of Chest Physicians, and the Association of Organ Procurement Organizations. Under the auspices of these societies, a multidisciplinary, multi-institutional task force was convened, incorporating expertise in critical care medicine, organ donor management, and transplantation. Members of the task force were divided into 13 subcommittees, each focused on one of the following general or organ-specific areas: death determination using neurologic criteria, donation after circulatory death determination, authorization process, general contraindications to donation, hemodynamic management, endocrine dysfunction and hormone replacement therapy, pediatric donor management, cardiac donation, lung donation, liver donation, kidney donation, small bowel donation, and pancreas donation. Subcommittees were charged with generating a series of management-related questions related to their topic. For each question, subcommittees provided a summary of relevant literature and specific recommendations. The specific recommendations were approved by all members of the task force and then assembled into a complete document. Because the available literature was overwhelmingly comprised of observational studies and case series, representing low-quality evidence, a decision was made that the document would assume the form of a consensus statement rather than a formally graded guideline. The goal of this document is to provide critical care practitioners with essential information and practical recommendations related to management of the potential organ donor, based on the available literature and expert consensus.

The International Glossary on Infertility and Fertility Care, 2017.

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Zegers-Hochschild, Fernando; Adamson, G David; Dyer, Silke; Racowsky, Catherine; de Mouzon, Jacques; Sokol, Rebecca; Rienzi, Laura; Sunde, Arne; Schmidt, Lone; Cooke, Ian D; Simpson, Joe Leigh; van der Poel, Sheryl

2017-09-01

Can a consensus and evidence-driven set of terms and definitions be generated to be used globally in order to ensure consistency when reporting on infertility issues and fertility care interventions, as well as to harmonize communication among the medical and scientific communities, policy-makers, and lay public including individuals and couples experiencing fertility problems? A set of 283 consensus-based and evidence-driven terminologies used in infertility and fertility care has been generated through an inclusive consensus-based process with multiple stakeholders. In 2006 the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) published a first glossary of 53 terms and definitions. In 2009 ICMART together with WHO published a revised version expanded to 87 terms, which defined infertility as a disease of the reproductive system, and increased standardization of fertility treatment terminology. Since 2009, limitations were identified in several areas and enhancements were suggested for the glossary, especially concerning male factor, demography, epidemiology and public health issues. Twenty-five professionals, from all parts of the world and representing their expertise in a variety of sub-specialties, were organized into five working groups: clinical definitions; outcome measurements; embryology laboratory; clinical and laboratory andrology; and epidemiology and public health. Assessment for revisions, as well as expansion on topics not covered by the previous glossary, were undertaken. A larger group of independent experts and representatives from collaborating organizations further discussed and assisted in refining all terms and definitions. Members of the working groups and glossary co-ordinators interacted through electronic mail and face-to-face in international/regional conferences. Two formal meetings were held in Geneva, Switzerland, with a final consensus meeting including independent experts as well as observers and

The International Glossary on Infertility and Fertility Care, 2017.

Science.gov (United States)

Zegers-Hochschild, Fernando; Adamson, G David; Dyer, Silke; Racowsky, Catherine; de Mouzon, Jacques; Sokol, Rebecca; Rienzi, Laura; Sunde, Arne; Schmidt, Lone; Cooke, Ian D; Simpson, Joe Leigh; van der Poel, Sheryl

2017-09-01

Can a consensus and evidence-driven set of terms and definitions be generated to be used globally in order to ensure consistency when reporting on infertility issues and fertility care interventions, as well as to harmonize communication among the medical and scientific communities, policy-makers, and lay public including individuals and couples experiencing fertility problems? A set of 283 consensus-based and evidence-driven terminologies used in infertility and fertility care has been generated through an inclusive consensus-based process with multiple stakeholders. In 2006 the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) published a first glossary of 53 terms and definitions. In 2009 ICMART together with WHO published a revised version expanded to 87 terms, which defined infertility as a disease of the reproductive system, and increased standardization of fertility treatment terminology. Since 2009, limitations were identified in several areas and enhancements were suggested for the glossary, especially concerning male factor, demography, epidemiology and public health issues. Twenty-five professionals, from all parts of the world and representing their expertise in a variety of sub-specialties, were organized into five working groups: clinical definitions; outcome measurements; embryology laboratory; clinical and laboratory andrology; and epidemiology and public health. Assessment for revisions, as well as expansion on topics not covered by the previous glossary, were undertaken. A larger group of independent experts and representatives from collaborating organizations further discussed and assisted in refining all terms and definitions. Members of the working groups and glossary co-ordinators interacted through electronic mail and face-to-face in international/regional conferences. Two formal meetings were held in Geneva, Switzerland, with a final consensus meeting including independent experts as well as observers and

Cultural Policy in Iceland

DEFF Research Database (Denmark)

Gudmundsson, Gestur

2003-01-01

on the continuing emphasis on central cultural institution and the Icelandic language. Since the 1970s Cold War conflicts have been replaced by a consensus on growing support to artists and an armth's length policy, and furthermore the 1990s have seen a strong move towards NPM and international participation.......The article examines the history of cultural policy in Iceland from a Nordic comparative perspective. National cultural policy takes form in the 19th and early 20th century as a part of the nation-building, emphasising the Icelandic language as the core of national identity, building cultural...

Controlling, Modeling, Consensus, and Substance Use(r) Policy Intervention: Unfinished Business.

Science.gov (United States)

Ferguson, Brian

2015-01-01

This article looks at certain aspects of unfinished business in substance use policy from the economist's perspective. It takes the view that in tackling a policy issue such as cigarette smoking, it is likely to be necessary to use a portfolio of policy tools, rather than on just one tool, and that it is likely to be necessary to accept that complete elimination of the activity being considered will almost certainly cost more than it is worth-we will probably always have to live with some nonzero level of such activities.

Social science and the public agenda: reflections on the relation of knowledge to policy in the United States and abroad.

Science.gov (United States)

Wilensky, H L

1997-10-01

It is tempting to oversell the practical value of applied research. A hard look at the effects of U.S. social science on public policy in areas such as active labor market policies (training, job creation, placement, etc.), crime prevention, fiscal policy, poverty reduction, and health care reform suggests an inverse relationship between social science consensus and policy and budgetary decisions. Fragmented and decentralized political economies (e.g., the United States) foster policy segmentation and isolated, short-run single-issue research--often politicized and misleading. More corporatist democracies (such as Sweden, Norway, Austria, and Germany) evidence a tighter relation between knowledge and power in which a wider range of issues is connected, longer-range effects are sometimes considered, and research is more often actually used for planning and implementation. Even in less hospitable societies, however, social science does make its way in the long run. Favorable conditions and examples are discussed.

Nutrition and Physical Activity Policies and Practices in Family Child Care Homes in Oregon: Baseline Findings from the Healthy Home Child Care Project

Science.gov (United States)

Gunter, Katherine B.; Rice, Kelly R.; Trost, Stewart G.

2012-01-01

Baseline findings from the Healthy Home Child Care Project include data from Family Child Care Providers (FCCPs) in Oregon (n=53) who completed assessments of nutrition and physical activity policies and practices and BMI data for children in the care of FCCPs (n=205). Results show that a significant percentage of FCCPs failed to meet child care…

Emergence of a Policy, closure of a sector: regarding the management of penitentiary health care in Brazil.

Science.gov (United States)

Batista E Silva, Martinho Braga

2016-06-01

The aim of this study is to understand recent transformations in penitentiary health care management in Brazil, during the implementation of the National Policy for Comprehensive Health Care for People Deprived of Liberty in the Prison System, and the closure of the National Sector for Penitentiary Health Care. The scientific problem investigated is the language of penitentiary health care policy. The theoretical-methodological framework adopted is Pierre Bourdieu's genetic structuralism. In this manner, we carry out an analysis of documents and public statements in search of State categories and classifications. We note the consolidation of a state classification that separates the 'penitentiary' domain from the 'prison' domain, as well as the creation of the State category of 'person deprived of liberty in the prison system'. Penitentiary health care management constitutes itself as a question of primary care.

Sorry doctor, I can't afford the root canal, I have a job: Canadian dental care policy and the working poor.

Science.gov (United States)

Quiñonez, Carlos; Figueiredo, Rafael

2010-01-01

In Canada, most dental care is privately financed through employment-based insurance, with only a small amount of care supported by governments for groups deemed in social need. Recently, this low level of public financing has been linked to problems in accessing dental care, and one group that has received major attention are the working poor (WP), or those who maintain regular employment but remain in relative poverty. The WP highlight a significant gap in Canadian dental care policy, as they are generally not eligible for either public or private insurance. This is a mixed methods study, comprised of an historical review of Canadian dental care policy and a telephone interview survey of WP Canadian adults. By its very definitions, Canadian dental care policy recognizes the WP as persons with employment, yet incorrectly assumes that they will have ready access to employment-based insurance. In addition, through historically developed biases, it also fails to recognize them as persons in social need. Our telephone survey suggests that this policy approach has important impacts in that oral health and dental care outcomes are significantly mitigated by the presence of dental insurance. Canadian dental care policy should be reassessed in terms of how it determines need in order to close a gap that holds negative consequences for many Canadian families.

Doctors commitment and long-term effectiveness for cost containment policies: lesson learned from biosimilar drugs.

Science.gov (United States)

Menditto, Enrica; Orlando, Valentina; Coretti, Silvia; Putignano, Daria; Fiorentino, Denise; Ruggeri, Matteo

2015-01-01

Agency is a pervasive feature of the health care market, with doctors acting as agents for both patients and the health care system. In a context of scarce resources, doctors are required to take opportunity cost into account when prescribing treatments, while cost containment policies cannot overlook their active role in determining health care resource allocation. This paper addresses this issue, investigating the effects of cost containment measures in the market of biosimilar drugs that represent a viable and cost-saving strategy for the reduction of health care expenditure. The analysis focuses on a particular region in Italy, where several timely policies to incentivize biosimilar prescribing were launched. Drugs were identified by the anatomical therapeutic chemical classification system. Information about biosimilar drugs and their originator biological products was extracted from the IMS Health regional database. Drug consumption was expressed in terms of counting units, while expenditure was evaluated in Euro (€). The market penetration of biosimilars was analyzed by year and quarterly. In the Campania region of Italy, the effects of cost containment policies, launched between 2009 and 2013, showed the prescription of biosimilars strongly increasing in 2010 until prescribing levels reached and exceeded the market share of the reference biological products in 2012. After a slight reduction, a plateau was observed at the beginning of 2013. At the same time, the use of the originator products had been decreasing until the first quarter of 2011. However, after a 1-year plateau, this trend was reversed, with a new increase in the consumption of the originators observed. Results show that the cost containment policies, applied to cut health expenditure "to cure and not to care", did not produce the cultural change necessary to make these policies effective in the long run. Therefore, top-down policies for cost containment are not successful; rather, a bottom

Losing an only child: the one-child policy and elderly care in China.

Science.gov (United States)

Song, Yu

2014-05-01

China has had the one-child policy for more than 30 years. It reduced China's population growth within a short period of time and promoted economic development. However, it has also led to difficulties, and this paper focuses on those which pertain to ageing and losing one's only child. Approximately one million families have lost their only child in China. They suffer mentally and physically, and sometimes face social stigma and economic loss. What worries them most, however, is elderly care, which has become a severe crisis for the families who have lost their only children. This article draws upon several qualitative studies and 12 cases reported by the Chinese media in 2012 and 2013, and existing laws and policies for supporting those who have lost only children. It also analyses the current elderly care situation facing these families. The Chinese government has recognized the predicament and provides some help, which is increasing but is still not always adequate. To both sustain China's economic development and limit population growth, it is essential for the government to reform the one-child policy and provide a comprehensive support system for the families who have lost their only children, including financial relief and elderly care, and work to reduce stigma against these families. Copyright © 2014 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Energy policy in Denmark

Energy Technology Data Exchange (ETDEWEB)

Lidegaard, M.

2012-12-15

Denmark has a long tradition of active energy policy, initiated by the first oil crisis in 1973. Over the years, numerous actions have been taken on the basis of a broad consensus in the Danish Parliament - both in order to reduce the energy consumption and in order to increase the share of renewable energy. Now, the cornerstones for the Danish energy future have also been laid. The Danish Government has set the long-term goal to abandon fossil fuels by 2050. An important milestone was reached in March 2012 with an Energy Agreement for the period 2012-2020 - again based on a broad consensus in the Danish Parliament. This Agreement contains a wide range of ambitious initiatives, bringing Denmark a good step closer to the target of 100% renewable energy. In the present publication, a selection of past and present Danish energy policies is presented, together with the results achieved in terms of energy savings, use of renewables etc. (LN)

Achieving consensus in environmental programs

International Nuclear Information System (INIS)

Kurstedt, H.A.; Jones, R.M.; Walker, J.A.; Middleman, L.I.

1989-01-01

In this paper, the authors describe a research effort on consensus tied to the Environmental Restoration Program (ERP) within the U.S. Department of Energy's Office of Defense Waste and Transportation Management (DWTM). They define consensus and explain why consensus decisions are not merely desirable but necessary in furthering ERP activities. As examples of their planned applied research, the authors first discuss nominal group technique as a representative consensus-generating tool, and conclude by describing the consensus-related mission of the Waste Management Review Group, established to conduct independent, third-party review of DWTM/ERP plans and activities

Achieving consensus in environmental programs

Energy Technology Data Exchange (ETDEWEB)

Kurstedt, Jr., H. A.; Jones, R. M.; Walker, J. A.; Middleman, L. I.

1989-01-01

In this paper, we describe a new research effort on consensus tied to the Environmental Restoration Program (ERP) within the US Department of Energy's Office of Defense Waste and Transportation Management (DWTM). We define consensus and explain why consensus decisions are not merely desirable but necessary in furthering ERP activities. As examples of our planned applied research, we first discuss Nominal Group Technique as a representative consensus-generating tool, and we conclude by describing the consensus-related mission of the Waste Management Review Group, established at Virginia Tech to conduct independent, third-party review of DWTM/ERP plans and activities. 10 refs.

Definition of Terms Used in Limitation of Treatment and Providing Palliative Care at the End of Life: The Indian Council of Medical Research Commission Report

Science.gov (United States)

Salins, Naveen; Gursahani, Roop; Mathur, Roli; Iyer, Shivakumar; Macaden, Stanley; Simha, Nagesh; Mani, Raj Kumar; Rajagopal, M. R.

2018-01-01

Background: Indian hospitals, in general, lack policies on the limitation of inappropriate life-sustaining interventions at the end of life. To facilitate discussion, preparation of guidelines and framing of laws, terminologies relating to the treatment limitation, and providing palliative care at the end-of-life care (EOLC) need to be defined and brought up to date. Methodology: This consensus document on terminologies and definitions of terminologies was prepared under the aegis of the Indian Council of Medical Research. The consensus statement was created using Nominal Group and Delphi Method. Results: Twenty-five definitions related to the limitations of treatment and providing palliative care at the end of life were created by reviewing existing international documents and suitably modifying it to the Indian sociocultural context by achieving national consensus. Twenty-five terminologies defined within the scope of this document are (1) terminal illness, (2) actively dying, (3) life-sustaining treatment, (4) potentially inappropriate treatment, (5) cardiopulmonary resuscitation (CPR), (6) do not attempt CPR, (7) withholding life-sustaining treatment, (8) withdrawing life-sustaining treatment, (9) euthanasia (10) active shortening of the dying process, (11) physician-assisted suicide, (12) palliative care, (13) EOLC, (14) palliative sedation, (15) double effect, (16) death, (17) best interests, (18) health-care decision-making capacity, (19) shared decision-making, (20) advance directives, (21) surrogates, (22) autonomy, (23) beneficence, (24) nonmaleficence, and (25) justice.

Increased Utilization of Primary Health Care Centers for Birthing Care in Tamil Nadu, India: A Visible Impact of Policies, Initiatives, and Innovations

Science.gov (United States)

Pandian, Jayanthi; Suresh, Saradha; Desikachari, B. R.; Padmanaban, P.

2013-01-01

Background: Tamil Nadu has been showing an increasing trend in institutional deliveries since early 1990's and has now achieved near 100%. Among the institutional deliveries, a change was observed since 2006, wherein primary health centers (PHCs) showed a four-fold increase in deliveries, while other public and private health facilities showed a decline, despite equal access to all categories of health facilities. What led to this increased utilization of PHCs for birthing care? Material and Methods: Policies, documents, and published reports of the Government of Tamil Nadu (GoTN) were reviewed and interviews were conducted with the various stakeholders involved in providing birthing care in the PHCs. This study analyzes the impact of the policies and supply side initiatives and innovations which led to increase utilization of the PHCs for birthing care. Results: Scaling up of 24 × 7 services in all PHCs, upgrading PHCs with good infrastructure, human resources, and women friendly services have helped to boost the image of the PHCs. Pro-women policies like maternity benefit schemes, birth companionship, providing food, and compulsory stay for 48 h following delivery have attracted women towards PHC. Innovative strategies like maternity picnics and use of expected date of delivery (EDD) chart for follow-up have made women choose PHCs, while periodic reviews and support to staff has improved service delivery. Conclusion: Women centered policies, efficient managerial systems, quality care, and innovative marketing of services have together contributed to increased utilization of PHCs for birthing. Other states could explore the possibility of replicating this model to make optimal use the PHC facilities. PMID:26664836

Developing a research agenda for patient safety in primary care. Background, aims and output of the LINNEAUS collaboration on patient safety in primary care.

Science.gov (United States)

Esmail, Aneez; Valderas, Jose M; Verstappen, Wim; Godycki-Cwirko, Maciek; Wensing, Michel

2015-09-01

This paper is an introduction to a supplement to The European Journal of General Practice, bringing together a body of research focusing on the issue of patient safety in relation to primary care. The supplement represents the outputs of the LINNEAUS collaboration on patient safety in primary care, which was a four-year (2009-2013) coordination and support action funded under the Framework 7 programme by the European Union. Being a coordination and support action, its aim was not to undertake new research, but to build capacity through engaging primary care researchers and practitioners in identifying some of the key challenges in this area and developing consensus statements, which will be an essential part in developing a future research agenda. This introductory article describes the aims of the LINNEAUS collaboration, provides a brief summary of the reasons to focus on patient safety in primary care, the epidemiological and policy considerations, and an introduction to the papers included in the supplement.

Linking the Unitary Paradigm to Policy through a Synthesis of Caring Science and Integrative Nursing.

Science.gov (United States)

Koithan, Mary S; Kreitzer, Mary Jo; Watson, Jean

2017-07-01

The principles of integrative nursing and caring science align with the unitary paradigm in a way that can inform and shape nursing knowledge, patient care delivery across populations and settings, and new healthcare policy. The proposed policies may transform the healthcare system in a way that supports nursing praxis and honors the discipline's unitary paradigm. This call to action provides a distinct and hopeful vision of a healthcare system that is accessible, equitable, safe, patient-centered, and affordable. In these challenging times, it is the unitary paradigm and nursing wisdom that offer a clear path forward.

Does Health Insurance Premium Exemption Policy for Older People Increase Access to Health Care? Evidence from Ghana.

Science.gov (United States)

Duku, Stephen Kwasi Opuku; van Dullemen, Caroline Elisabeth; Fenenga, Christine

2015-01-01

Aging in Sub-Saharan Africa causes major challenges for policy makers in social protection. Our study focuses on Ghana, one of the few Sub-Saharan African countries that passed a National Policy on Aging in 2010. Ghana is also one of the first Sub-Saharan African countries that launched a National Health Insurance Scheme (NHIS; NHIS Act 650, 2003) with the aim to improve access to quality health care for all citizens, and as such can be considered as a means of poverty reduction. Our study assesses whether premium exemption policy under the NHIS that grants non-payments of annual health insurance premiums for older people increases access to health care. We assessed differences in enrollment coverage among four different age groups (18-49, 50-59, 60-69, and 70+). We found higher enrollment for the 70+ and 60-69 age groups. The likelihood of enrollment was 2.7 and 1.7 times higher for the 70+ and 60-69 age groups, respectively. Our results suggest the NHIS exemption policy increases insurance coverage of the aged and their utilization of health care services.

Competing Foreign Policy Visions: Rhetorical Hybrids after the Cold War.

Science.gov (United States)

Stuckey, Mary E.

1995-01-01

Examines ways in which two very different political actors, George Bush and Bill Clinton, attempted to construct a new foreign policy consensus by blending the rhetorical forms of the Cold War with other foreign policy metaphors. Argues that these hybrids have not proven persuasive as justifications for American actions in foreign policy. (SR)

Model-based consensus

NARCIS (Netherlands)

Boumans, M.; Martini, C.; Boumans, M.

2014-01-01

The aim of the rational-consensus method is to produce "rational consensus", that is, "mathematical aggregation", by weighing the performance of each expert on the basis of his or her knowledge and ability to judge relevant uncertainties. The measurement of the performance of the experts is based on

Health care justice and its implications for current policy of a mandatory waiting period for elective tubal sterilization.

Science.gov (United States)

Moaddab, Amirhossein; McCullough, Laurence B; Chervenak, Frank A; Fox, Karin A; Aagaard, Kjersti Marie; Salmanian, Bahram; Raine, Susan P; Shamshirsaz, Alireza A

2015-06-01

Tubal sterilization during the immediate postpartum period is 1 of the most common forms of contraception in the United States. This time of the procedure has the advantage of 1-time hospitalization, which results in ease and convenience for the woman. The US Collaborative Review of Sterilization Study indicates the high efficacy and effectiveness of postpartum tubal sterilization. Oral and written informed consent is the ethical and legal standard for the performance of elective tubal sterilization for permanent contraception for all patients, regardless of source of payment. Current health care policy and practice regarding elective tubal sterilization for Medicaid beneficiaries places a unique requirement on these patients and their obstetricians: a mandatory waiting period. This requirement originates in decades-old legislation, which we briefly describe. We then introduce the concept of health care justice in professional obstetric ethics and explain how it originates in the ethical concepts of medicine as a profession and of being a patient and its deontologic and consequentialist dimensions. We next identify the implications of health care justice for the current policy of a mandatory 30-day waiting period. We conclude that Medicaid policy allocates access to elective tubal sterilization differently, based on source of payment and gender, which violates health care justice in both its deontologic and consequentialist dimensions. Obstetricians should invoke health care justice in women's health care as the basis for advocacy for needed change in law and health policy, to eliminate health care injustice in women's access to elective tubal sterilization. Copyright © 2015 Elsevier Inc. All rights reserved.

The influence of hospital drug formulary policies on the prescribing patterns of proton pump inhibitors in primary care

DEFF Research Database (Denmark)

Larsen, Michael Due; Schou, Mette; Kristiansen, Anja Sparre

2014-01-01

decreased from 33.5 to 9.4 %, corresponding to a risk ratio of 0.28. In primary care after discharge, 13.4 % of esomeprazole use was initiated in the hospital, and this was 8.4 % for PPIs in general. After the change of hospital drug policy, this decreased to 6.5 % for esomeprazole and increased......AIM: This study had two aims: Firstly, to describe how prescriptions for proton pump inhibitor (PPI) in primary care were influenced by a change of the hospital drug policy, and secondly, to describe if a large discount on an expensive PPI (esomeprazole) to a hospital would influence prescribing...... policy on prescribings in primary care was measured by the likelihood of having a high-cost PPI prescribed before and after change of drug policy. RESULTS: In total, 9,341 hospital stays in 2009 and 2010 were included. The probability of a patient to be prescribed an expensive PPI after discharge...

World Endometriosis Society consensus on the classification of endometriosis.

Science.gov (United States)

Johnson, Neil P; Hummelshoj, Lone; Adamson, G David; Keckstein, Jörg; Taylor, Hugh S; Abrao, Mauricio S; Bush, Deborah; Kiesel, Ludwig; Tamimi, Rulla; Sharpe-Timms, Kathy L; Rombauts, Luk; Giudice, Linda C

2017-02-01

What is the global consensus on the classification of endometriosis that considers the views of women with endometriosis? We have produced an international consensus statement on the classification of endometriosis through systematic appraisal of evidence and a consensus process that included representatives of national and international, medical and non-medical societies, patient organizations, and companies with an interest in endometriosis. Classification systems of endometriosis, developed by several professional organizations, traditionally have been based on lesion appearance, pelvic adhesions, and anatomic location of disease. One system predicts fertility outcome and none predicts pelvic pain, response to medications, disease recurrence, risks for associated disorders, quality of life measures, and other endpoints important to women and health care providers for guiding appropriate therapeutic options and prognosis. A consensus meeting, in conjunction with pre- and post-meeting processes, was undertaken. A consensus meeting was held on 30 April 2014 in conjunction with the World Endometriosis Society's 12th World Congress on Endometriosis. Rigorous pre- and post-meeting processes, involving 55 representatives of 29 national and international, medical and non-medical organizations from a range of disciplines, led to this consensus statement. A total of 28 consensus statements were made. Of all, 10 statements had unanimous consensus, however none of the statements was made without expression of a caveat about the strength of the statement or the statement itself. Two statements did not achieve majority consensus. The statements covered women's priorities, aspects of classification, impact of low resources, as well as all the major classification systems for endometriosis. Until better classification systems are developed, we propose a classification toolbox (that includes the revised American Society for Reproductive Medicine and, where appropriate, the

Evidence- and consensus-based practice guidelines for the diagnosis of irritable bowel syndrome.

Science.gov (United States)

Fass, R; Longstreth, G F; Pimentel, M; Fullerton, S; Russak, S M; Chiou, C F; Reyes, E; Crane, P; Eisen, G; McCarberg, B; Ofman, J

2001-09-24

Irritable bowel syndrome (IBS) presents a significant diagnostic and management challenge for primary care practitioners. Improving the accuracy and timeliness of diagnosis may result in improved quality and efficiency of care. To systematically appraise the existing diagnostic criteria and combine the evidence with expert opinion to derive evidence- and consensus-based guidelines for a diagnostic approach to patients with suspected IBS. We performed a systematic literature review (January 1966-April 2000) of computerized bibliographic databases. Articles meeting explicit inclusion criteria for diagnostic studies in IBS were subjected to critical appraisal, which formed the basis of guideline statements presented to an expert panel. To develop a diagnostic algorithm, an expert panel of specialists and primary care physicians was used to fill in gaps in the literature. Consensus was developed using a modified Delphi technique. The systematic literature review identified only 13 published studies regarding the effectiveness of competing diagnostic approaches for IBS, the accuracy of diagnostic tests, and the internal validity of current diagnostic symptom criteria. Few studies met accepted methodological criteria. While symptom criteria have been validated, the utility of endoscopic and other diagnostic interventions remains unknown. An analysis of the literature, combined with consensus from experienced clinicians, resulted in the development of a diagnostic algorithm relevant to primary care that emphasizes a symptom-based diagnostic approach, refers patients with alarm symptoms to subspecialists, and reserves radiographic, endoscopic, and other tests for referral cases. The resulting algorithm highlights the reliance on symptom criteria and comprises a primary module, 3 submodules based on the predominant symptom pattern (constipation, diarrhea, and pain) and severity level, and a subspecialist referral module. The dearth of available evidence highlights the need

Medicare's post-acute care payment: a review of the issues and policy proposals.

Science.gov (United States)

Linehan, Kathryn

2012-12-07

Medicare spending on post-acute care provided by skilled nursing facility providers, home health providers, inpatient rehabilitation facility providers, and long-term care hospitals has grown rapidly in the past several years. The Medicare Payment Advisory Commission and others have noted several long-standing problems with the payment systems for post-acute care and have suggested refinements to Medicare's post-acute care payment systems that are intended to encourage the delivery of appropriate care in the right setting for a patient's condition. The Patient Protection and Affordable Care Act of 2010 contained several provisions that affect the Medicare program's post-acute care payment systems and also includes broader payment reforms, such as bundled payment models. This issue brief describes Medicare's payment systems for post-acute care providers, evidence of problems that have been identified with the payment systems, and policies that have been proposed or enacted to remedy those problems.

Policies to improve end-of-life decisions in Flemish hospitals: communication, training of health care providers and use of quality assessments

Directory of Open Access Journals (Sweden)

Noortgate Nele

2009-12-01

Full Text Available Abstract Background The prevalence and implementation of institutional end-of-life policies has been comprehensively studied in Flanders, Belgium, a country where euthanasia was legalised in 2002. Developing end-of-life policies in hospitals is a first step towards improving the quality of medical decision-making at the end-of-life. Implementation of policies through quality assessments, communication and the training and education of health care providers is equally important in improving actual end-of-life practice. The aim of the present study is to report on the existence and nature of end-of-life policy implementation activities in Flemish acute hospitals. Methods A cross-sectional mail survey was sent to all acute hospitals (67 main campuses in Flanders (Belgium. The questionnaire asked about hospital characteristics, the prevalence of policies on five types of end-of-life decisions: euthanasia, palliative sedation, alleviation of symptoms with possible life-shortening effect, do-not-resuscitate decision, and withdrawing or withholding of treatment, the internal and external communication of these policies, training and education on aspects of end-of-life care, and quality assessments of end-of-life care on patient and family level. Results The response rate was 55%. Results show that in 2007 written policies on most types of end-of-life decisions were widespread in acute hospitals (euthanasia: 97%, do-not-resuscitate decisions: 98%, palliative sedation: 79%. While standard communication of these policies to health care providers was between 71% and 91%, it was much lower to patients and/or family (between 17% and 50%. More than 60% of institutions trained and educated their caregivers in different aspects on end-of-life care. Assessment of the quality of these different aspects at patient and family level occurred in 25% to 61% of these hospitals. Conclusions Most Flemish acute hospitals have developed a policy on end-of-life practices

Policies to improve end-of-life decisions in Flemish hospitals: communication, training of health care providers and use of quality assessments.

Science.gov (United States)

D'Haene, Ina; Vander Stichele, Robert H; Pasman, H Roeline W; Noortgate, Nele Van den; Bilsen, Johan; Mortier, Freddy; Deliens, Luc

2009-12-30

The prevalence and implementation of institutional end-of-life policies has been comprehensively studied in Flanders, Belgium, a country where euthanasia was legalised in 2002. Developing end-of-life policies in hospitals is a first step towards improving the quality of medical decision-making at the end-of-life. Implementation of policies through quality assessments, communication and the training and education of health care providers is equally important in improving actual end-of-life practice. The aim of the present study is to report on the existence and nature of end-of-life policy implementation activities in Flemish acute hospitals. A cross-sectional mail survey was sent to all acute hospitals (67 main campuses) in Flanders (Belgium). The questionnaire asked about hospital characteristics, the prevalence of policies on five types of end-of-life decisions: euthanasia, palliative sedation, alleviation of symptoms with possible life-shortening effect, do-not-resuscitate decision, and withdrawing or withholding of treatment, the internal and external communication of these policies, training and education on aspects of end-of-life care, and quality assessments of end-of-life care on patient and family level. The response rate was 55%. Results show that in 2007 written policies on most types of end-of-life decisions were widespread in acute hospitals (euthanasia: 97%, do-not-resuscitate decisions: 98%, palliative sedation: 79%). While standard communication of these policies to health care providers was between 71% and 91%, it was much lower to patients and/or family (between 17% and 50%). More than 60% of institutions trained and educated their caregivers in different aspects on end-of-life care. Assessment of the quality of these different aspects at patient and family level occurred in 25% to 61% of these hospitals. Most Flemish acute hospitals have developed a policy on end-of-life practices. However, communication, training and the education of health care

As CMS makes another policy change, policy makers distinguish between different forms of care.

Science.gov (United States)

2013-10-01

As observation care continues to draw fire from critics who charge that the designation ends up costing hospitals money while also sticking patients with exorbitant fees, the medical directors of dedicated observation units counter that the kind of care delivered by their specialized units actually saves money and gets patients out of the hospital sooner. They note that the problem is that only about one-third of hospitals actually have dedicated observation units, so patients placed on observation typically wind up in inpatient beds, where they may only be evaluated once a day. CMS has just released a new policy rule on observation that should help patients avoid excessive charges, but many experts would like to see the agency take steps to incentivize the kind of quality care that is delivered in dedicated units. The new CMS rule for 2014 caps observation stays at 48 hours. Patients who remain in the hospital beyond this point become inpatients, as long as they meet inpatient criteria. Proponents of observation care contend that the average length-of-stay in a dedicated observation unit is just 15 hours--typically much shorter than the LOS of patients who are placed on observation in inpatient beds. Care in a dedicated observation unit is generally driven by protocol in an emergency medicine environment where there is continuous rounding. Discharges can occur at any time of the day or night. Experts note that observation patients account for the largest portion of both misdiagnoses and malpractice lawsuits stemming from emergency settings.

Use of national clinical databases for informing and for evaluating health care policies.

Science.gov (United States)

Black, Nick; Tan, Stefanie

2013-02-01

Policy-makers and analysts could make use of national clinical databases either to inform or to evaluate meso-level (organisation and delivery of health care) and macro-level (national) policies. Reviewing the use of 15 of the best established databases in England, we identify and describe four published examples of each use. These show that policy-makers can either make use of the data itself or of research based on the database. For evaluating policies, the major advantages are the huge sample sizes available, the generalisability of the data, its immediate availability and historic information. The principal methodological challenges involve the need for risk adjustment and time-series analysis. Given their usefulness in the policy arena, there are several reasons why national clinical databases have not been used more, some due to a lack of 'push' by their custodians and some to the lack of 'pull' by policy-makers. Greater exploitation of these valuable resources would be facilitated by policy-makers' and custodians' increased awareness, minimisation of legal restrictions on data use, improvements in the quality of databases and a library of examples of applications to policy. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Creating value in health care through big data: opportunities and policy implications.

Science.gov (United States)

Roski, Joachim; Bo-Linn, George W; Andrews, Timothy A

2014-07-01

Big data has the potential to create significant value in health care by improving outcomes while lowering costs. Big data's defining features include the ability to handle massive data volume and variety at high velocity. New, flexible, and easily expandable information technology (IT) infrastructure, including so-called data lakes and cloud data storage and management solutions, make big-data analytics possible. However, most health IT systems still rely on data warehouse structures. Without the right IT infrastructure, analytic tools, visualization approaches, work flows, and interfaces, the insights provided by big data are likely to be limited. Big data's success in creating value in the health care sector may require changes in current polices to balance the potential societal benefits of big-data approaches and the protection of patients' confidentiality. Other policy implications of using big data are that many current practices and policies related to data use, access, sharing, privacy, and stewardship need to be revised. Project HOPE—The People-to-People Health Foundation, Inc.

Obesity as a Socially Defined Disease: Philosophical Considerations and Implications for Policy and Care.

Science.gov (United States)

Hofmann, Bjørn

2016-03-01

Obesity has generated significant worries amongst health policy makers and has obtained increased attention in health care. Obesity is unanimously defined as a disease in the health care and health policy literature. However, there are pragmatic and not principled reasons for this. This warrants an analysis of obesity according to standard conceptions of disease in the literature of philosophy of medicine. According to theories and definitions of disease referring to (abnormal functioning of) internal processes, obesity is not a disease. Obesity undoubtedly can result in disease, making it a risk factor for disease, but not a disease per se. According to several social conceptions of disease, however, obesity clearly is a disease. Obesity can conflict with aesthetic, moral, or other social norms. Making obesity a "social disease" may very well be a wise health policy, assuring and improving population health, especially if we address the social determinants of obesity, such as the food supply and marketing system. However, applying biomedical solutions to social problems may also have severe side effects. It can result in medicalization and enhance stigmatization and discrimination of persons based on appearance or behavior. Approaching social problems with biomedical means may also serve commercial and professionals' interests more than the health and welfare of individuals; it may make quick fix medical solutions halt more sustainable structural solutions. This urges health insurers, health care professionals, and health policy makers to be cautious. Especially if we want to help and respect persons that we classify and treat as obese.

System-level planning, coordination, and communication: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

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Dichter, Jeffrey R; Kanter, Robert K; Dries, David; Luyckx, Valerie; Lim, Matthew L; Wilgis, John; Anderson, Michael R; Sarani, Babak; Hupert, Nathaniel; Mutter, Ryan; Devereaux, Asha V; Christian, Michael D; Kissoon, Niranjan

2014-10-01

System-level planning involves uniting hospitals and health systems, local/regional government agencies, emergency medical services, and other health-care entities involved in coordinating and enabling care in a major disaster. We reviewed the literature and sought expert opinions concerning system-level planning and engagement for mass critical care due to disasters or pandemics and offer suggestions for system-planning, coordination, communication, and response. The suggestions in this chapter are important for all of those involved in a pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. The American College of Chest Physicians (CHEST) consensus statement development process was followed in developing suggestions. Task Force members met in person to develop nine key questions believed to be most relevant for system-planning, coordination, and communication. A systematic literature review was then performed for relevant articles and documents, reports, and other publications reported since 1993. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Suggestions were developed and grouped according to the following thematic elements: (1) national government support of health-care coalitions/regional health authorities (HC/RHAs), (2) teamwork within HC/RHAs, (3) system-level communication, (4) system-level surge capacity and capability, (5) pediatric patients and special populations, (6) HC/RHAs and networks, (7) models of advanced regional care systems, and (8) the use of simulation for preparedness and planning. System-level planning is essential to provide care for large numbers of critically ill patients because of disaster or pandemic. It also entails a departure from the routine, independent system and

European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium

DEFF Research Database (Denmark)

Aldecoa, César; Bettelli, Gabriella; Bilotta, Federico

2017-01-01

The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care, postoper...

European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium

NARCIS (Netherlands)

Aldecoa, César; Bettelli, Gabriella; Bilotta, Federico; Sanders, Robert D.; Audisio, Riccardo; Borozdina, Anastasia; Cherubini, Antonio; Jones, Christina; Kehlet, Henrik; Maclullich, Alasdair; Radtke, Finn; Riese, Florian; Slooter, Arjen J C; Veyckemans, Francis; Kramer, Sylvia; Neuner, Bruno; Weiss, Bjoern; Spies, Claudia D.

2017-01-01

The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care,

Employers' knowledge and attitudes regarding organizational policy toward workers caring for aging family members.

Science.gov (United States)

Katz, Ruth; Lowenstein, Ariela; Prilutzky, Dana; Halperin, Dafna

2011-04-01

The study examined employers' knowledge of and attitudes toward working carers who care for aging family members. The study was based on the ecological model. One hundred employers were interviewed using structured questionnaires and 13 employers by additional in-depth interviews. Both research instruments included areas of disruption to the organization, existing policies, and feasibility as to developing appropriate policies to support working carers. Results show that caregiving caused a disruption in workers' functioning mainly by being absent, leaving work early, and coming to work late. Usually, there was "no policy," and half of the employers did not support introducing such a policy. Women managers in public organizations, who had less seniority and less previous experience with working-carers, tended to be more positive about supportive policies. Recommendations are included.

End-of-life care in the United States: policy issues and model programs of integrated care

Directory of Open Access Journals (Sweden)

Joshua M. Wiener

2003-05-01

Full Text Available Background: End-of-life care financing and delivery in the United States is fragmented and uncoordinated, with little integration of acute and long-term care services. Objective: To assess policy issues involving end-of-life care, especially involving the hospice benefit, and to analyse model programs of integrated care for people who are dying. Methods: The study conducted structured interviews with stakeholders and experts in end-of-life care and with administrators of model programs in the United States, which were nominated by the experts. Results: The two major public insurance programs—Medicare and Medicaid—finance the vast majority of end-of-life care. Both programs offer a hospice benefit, which has several shortcomings, including requiring physicians to make a prognosis of a six month life expectancy and insisting that patients give up curative treatment—two steps which are difficult for doctors and patients to make—and payment levels that may be too low. In addition, quality of care initiatives for nursing homes and hospice sometimes conflict. Four innovative health systems have overcome these barriers to provide palliative services to beneficiaries in their last year of life. Three of these health systems are managed care plans which receive capitated payments. These providers integrate health, long-term and palliative care using an interdisciplinary team approach to management of services. The fourth provider is a hospice that provides palliative services to beneficiaries of all ages, including those who have not elected hospice care. Conclusions: End-of-life care is deficient in the United States. Public payers could use their market power to improve care through a number of strategies.

Doctors commitment and long-term effectiveness for cost containment policies: lesson learned from biosimilar drugs

Directory of Open Access Journals (Sweden)

Menditto E

2015-11-01

was reversed, with a new increase in the consumption of the originators observed. Conclusion: Results show that the cost containment policies, applied to cut health expenditure "to cure and not to care", did not produce the cultural change necessary to make these policies effective in the long run. Therefore, top-down policies for cost containment are not successful; rather, a bottom-up approach based on consensus among professionals should become the preferred option. Keywords: cost containment policy, biosimilar drugs, health care expenditure, policy making

Nordic Energy Policy Cooperation

DEFF Research Database (Denmark)

Jørgensen, Birte Holst

2016-01-01

Brundtland Commission Report, and climate change became a common concern. Energy technology cooperation was an integral part of Nordic energy policy cooperation from the very beginning. The Nordic Energy Research Programme was established with funding from each of the Nordic countries, and was earmarked...... by a committee of senior officials and a secretariat. This was characterised by an incremental development of the cooperation based on consensus, mutual understanding and trust facilitated through exchange of experiences, work groups, seminars, educational activities and mobility schemes for energy policy...

The crisis as catalyst for reframing health care policies in the European Union.

Science.gov (United States)

Helderman, Jan-Kees

2015-01-01

Seen from the perspective of health, the global financial crisis (GFC) may be conceived of as an exogenous factor that has undermined the fiscal sustainability of European welfare states and consequently, their (expanding) health systems as well. Being one of the core programs of European welfare states, health care has always belonged to the sovereignty of European Member States. However, in past two decades, European welfare states have in fact become semi-sovereign states and the European Union (EU) no longer is an exogenous actor in European health policy making. Today, the EU not only puts limits to unsustainable growth levels in health care spending, it also acts as an health policy agenda setter. Since the outbreak of the GFC, it does so in an increasingly coercive and persuasive way, claiming authority over health system reforms alongside the responsibilities of its Member States.

Does public reporting measure up? Federalism, accountability and child-care policy in Canada.

Science.gov (United States)

Anderson, Lynell; Findlay, Tammy

2010-01-01

Governments in Canada have recently been exploring new accountability measures within intergovernmental relations. Public reporting has become the preferred mechanism in a range of policy areas, including early learning and child-care, and the authors assess its effectiveness as an accountability measure. The article is based on their experience with a community capacity-building project that considers the relationship between the public policy, funding and accountability mechanisms under the federal/provincial/territorial agreements related to child-care. The authors argue that in its current form, public reporting has not lived up to its promise of accountability to citizens. This evaluation is based on the standards that governments have set for themselves under the federal/provincial/territorial agreements, as well as guidelines set by the Public Sector Accounting Board, an independent body that develops accounting standards over time through consultation with governments.

Sharing the caring : State, family and gender equality in parental leave policy

NARCIS (Netherlands)

Widener, Anmarie J.

2006-01-01

Parental leave policies give parents a temporary leave from employment in order to care for a child. Secondary aims are to increase women’s attachment to the labour force as well as supporting gender equal roles in paid and unpaid work. This study researched parent satisfaction of parental leave

Dynamic Average Consensus and Consensusability of General Linear Multiagent Systems with Random Packet Dropout

Directory of Open Access Journals (Sweden)

Wen-Min Zhou

2013-01-01

Full Text Available This paper is concerned with the consensus problem of general linear discrete-time multiagent systems (MASs with random packet dropout that happens during information exchange between agents. The packet dropout phenomenon is characterized as being a Bernoulli random process. A distributed consensus protocol with weighted graph is proposed to address the packet dropout phenomenon. Through introducing a new disagreement vector, a new framework is established to solve the consensus problem. Based on the control theory, the perturbation argument, and the matrix theory, the necessary and sufficient condition for MASs to reach mean-square consensus is derived in terms of stability of an array of low-dimensional matrices. Moreover, mean-square consensusable conditions with regard to network topology and agent dynamic structure are also provided. Finally, the effectiveness of the theoretical results is demonstrated through an illustrative example.

Policy-Making for Australian Schooling: The New Corporate Federalism.

Science.gov (United States)

Lingard, Bob

1991-01-01

The corporate federalism concept illustrates the way a national approach to policy development for Australian schooling has been utilized by the Hawke Labor government. Negotiated consensus at the Australian Education Council has been used to arrive at these policies and to circumvent politically the constitutional and financial realities of…

[Consensus document for the detection and management of chronic kidney disease].

Science.gov (United States)

Martínez-Castelao, Alberto; Górriz, José L; Bover, Jordi; Segura-de la Morena, Julián; Cebollada, Jesús; Escalada, Javier; Esmatjes, Enric; Fácila, Lorenzo; Gamarra, Javier; Gràcia, Silvia; Hernández-Moreno, Julio; Llisterri-Caro, José L; Mazón, Pilar; Montañés, Rosario; Morales-Olivas, Francisco; Muñoz-Torres, Manuel; de Pablos-Velasco, Pedro; de Santiago, Ana; Sánchez-Celaya, Marta; Suárez, Carmen; Tranche, Salvador

2014-11-01

Chronic kidney disease (CKD) is an important global health problem, involving to 10% of the Spanish population, promoting high morbidity and mortality for the patient and an elevate consumption of the total health resources for the National Health System. This is a summary of an executive consensus document of ten scientific societies involved in the care of the renal patient, that actualizes the consensus document published in 2007. The central extended document can be consulted in the web page of each society. The aspects included in the document are: Concept, epidemiology and risk factors for CKD. Diagnostic criteria, evaluation and stages of CKD, albuminuria and glomerular filtration rate estimation. Progression factors for renal damage. Patient remission criteria. Follow-up and objectives of each speciality control. Nephrotoxicity prevention. Cardio-vascular damage detection. Diet, life-style and treatment attitudes: hypertension, dyslipidaemia, hyperglycemia, smoking, obesity, hyperuricemia, anemia, mineral and bone disorders. Multidisciplinary management for Primary Care, other specialities and Nephrology. Integrated management of CKD patient in haemodialysis, peritoneal dialysis and renal transplant patients. Management of the uremic patient in palliative care. We hope that this document may be of help for the multidisciplinary management of CKD patients by summarizing the most updated recommendations. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Policy challenges for the pediatric rheumatology workforce: Part II. Health care system delivery and workforce supply

Directory of Open Access Journals (Sweden)

Henrickson Michael

2011-08-01

Full Text Available Abstract The United States pediatric population with chronic health conditions is expanding. Currently, this demographic comprises 12-18% of the American child and youth population. Affected children often receive fragmented, uncoordinated care. Overall, the American health care delivery system produces modest outcomes for this population. Poor, uninsured and minority children may be at increased risk for inferior coordination of services. Further, the United States health care delivery system is primarily organized for the diagnosis and treatment of acute conditions. For pediatric patients with chronic health conditions, the typical acute problem-oriented visit actually serves as a barrier to care. The biomedical model of patient education prevails, characterized by unilateral transfer of medical information. However, the evidence basis for improvement in disease outcomes supports the use of the chronic care model, initially proposed by Dr. Edward Wagner. Six inter-related elements distinguish the success of the chronic care model, which include self-management support and care coordination by a prepared, proactive team. United States health care lacks a coherent policy direction for the management of high cost chronic conditions, including rheumatic diseases. A fundamental restructure of United States health care delivery must urgently occur which places the patient at the center of care. For the pediatric rheumatology workforce, reimbursement policies and the actions of health plans and insurers are consistent barriers to chronic disease improvement. United States reimbursement policy and overall fragmentation of health care services pose specific challenges for widespread implementation of the chronic care model. Team-based multidisciplinary care, care coordination and self-management are integral to improve outcomes. Pediatric rheumatology demand in the United States far exceeds available workforce supply. This article reviews the career

Policy challenges for the pediatric rheumatology workforce: Part II. Health care system delivery and workforce supply.

Science.gov (United States)

Henrickson, Michael

2011-01-01

The United States pediatric population with chronic health conditions is expanding. Currently, this demographic comprises 12-18% of the American child and youth population. Affected children often receive fragmented, uncoordinated care. Overall, the American health care delivery system produces modest outcomes for this population. Poor, uninsured and minority children may be at increased risk for inferior coordination of services. Further, the United States health care delivery system is primarily organized for the diagnosis and treatment of acute conditions. For pediatric patients with chronic health conditions, the typical acute problem-oriented visit actually serves as a barrier to care. The biomedical model of patient education prevails, characterized by unilateral transfer of medical information. However, the evidence basis for improvement in disease outcomes supports the use of the chronic care model, initially proposed by Dr. Edward Wagner. Six inter-related elements distinguish the success of the chronic care model, which include self-management support and care coordination by a prepared, proactive team. United States health care lacks a coherent policy direction for the management of high cost chronic conditions, including rheumatic diseases. A fundamental restructure of United States health care delivery must urgently occur which places the patient at the center of care. For the pediatric rheumatology workforce, reimbursement policies and the actions of health plans and insurers are consistent barriers to chronic disease improvement. United States reimbursement policy and overall fragmentation of health care services pose specific challenges for widespread implementation of the chronic care model. Team-based multidisciplinary care, care coordination and self-management are integral to improve outcomes. Pediatric rheumatology demand in the United States far exceeds available workforce supply. This article reviews the career choice decision-making process

Continuing nursing education policy in China and its impact on health equity.

Science.gov (United States)

Xiao, Lily Dongxia

2010-09-01

The aim of this study was to evaluate the mandatory continuing nursing education (MCNE) policy in China and to examine whether or not the policy addresses health equity. MCNE was instituted in 1996 in China to support healthcare reform was to include producing greater equity in health-care. However, the literature increasingly reports inequity in participation in MCNE, which is likely to have had a detrimental effect on the pre-existing discrepancies of education in the nursing workforce, and thereby failing to really address health equity. Despite a growing appeal for change, there is lack of critical reflection on the issues of MCNE policy. Critical ethnography underpinned by Habermas' Communicative Action Theory and Giddens' Structuration Theory were used to guide this study. Findings are presented in four themes: (i) inaccessibility of learning programs for nurses; (ii) undervaluation of workplace-based learning; (iii) inequality of the allocation of resources; and (iv) demands for additional support in MCNE from non-tertiary hospitals. The findings strongly suggest the need for an MCNE policy review based on rational consensus with stakeholders while reflecting the principles of health equity.

Special Care Dentistry Association consensus statement on sedation, anesthesia, and alternative techniques for people with special needs.

Science.gov (United States)

Glassman, Paul; Caputo, Anthony; Dougherty, Nancy; Lyons, Ray; Messieha, Zakaria; Miller, Christine; Peltier, Bruce; Romer, Maureen

2009-01-01

Many people with special needs (PSN) have difficulty having good oral health or accessing oral health services because of a disability or medical condition. The number of people with these conditions living in community settings and needing oral health services is increasing dramatically due to advances in medical care, deinstitutionalization, and changing societal values. Many of these individuals require additional supports beyond local anesthesia in order to receive dental treatment services. The purpose of this consensus statement is to focus on the decision-making process for choosing a method of treatment or a combination of methods for facilitating dental treatment for these individuals. These guidelines are intended to assist oral health professionals and other interested parties in planning and carrying out oral health treatment for PSN. Considerations for planning treatment and considerations for each of several alternative modalities are listed. Also discussed are considerations for the use of combinations of modalities and considerations for the repeated or frequent use of these modalities. Finally, the need to advocate for adequate education and reimbursement for the full range of support alternatives is addressed. The Special Care Dentistry Association (SCDA) is dedicated to improving oral health and well being of PSN. The SCDA hopes that these guidelines can help oral health professionals and other interested individuals and groups to work together to ensure that PSN can achieve a "lifetime of oral health."

Work-life policies for faculty at the top ten medical schools.

Science.gov (United States)

Bristol, Mirar N; Abbuhl, Stephanie; Cappola, Anne R; Sonnad, Seema S

2008-10-01

There exists a growing consensus that career flexibility is critical to recruiting and retaining talented faculty, especially women faculty. This study was designed to determine both accessibility and content of work-life policies for faculty at leading medical schools in the United States. The sample includes the top ten medical schools in the United States published by U.S. News and World Report in August 2006. We followed a standardized protocol to collect seven work-life policies at each school: maternity leave, paternity leave, adoption leave, extension of the probationary period for family responsibilities, part-time faculty appointments, job sharing, and child care. A review of information provided on school websites was followed by e-mail or phone contact if needed. A rating system of 0-3 (low to high flexibility) developed by the authors was applied to these policies. Rating reflected flexibility and existing opinions in published literature. Policies were often difficult to access. Individual scores ranged from 7 to 15 out of a possible 21 points. Extension of the probationary period received the highest cumulative score across schools, and job sharing received the lowest cumulative score. For each policy, there were important differences among schools. Work-life policies showed considerable variation across schools. Policy information is difficult to access, often requiring multiple sources. Institutions that develop flexible work-life policies that are widely promoted, implemented, monitored, and reassessed are likely at an advantage in attracting and retaining faculty while advancing institutional excellence.

Improvement attributes in healthcare: implications for integrated care.

Science.gov (United States)

Harnett, Patrick John

2018-04-16

Purpose Healthcare quality improvement is a key concern for policy makers, regulators, carers and service users. Despite a contemporary consensus among policy makers that integrated care represents a means to substantially improve service outcomes, progress has been slow. Difficulties achieving sustained improvement at scale imply that methods employed are not sufficient and that healthcare improvement attributes may be different when compared to prior reference domains. The purpose of this paper is to examine and synthesise key improvement attributes relevant to a complex healthcare change process, specifically integrated care. Design/methodology/approach This study is based on an integrative literature review on systemic improvement in healthcare. Findings A central theme emerging from the literature review indicates that implementing systemic change needs to address the relationship between vision, methods and participant social dynamics. Practical implications Accommodating personal and professional network dynamics is required for systemic improvement, especially among high autonomy individuals. This reinforces the need to recognise the change process as taking place in a complex adaptive system where personal/professional purpose/meaning is central to the process. Originality/value Shared personal/professional narratives are insufficiently recognised as a powerful change force, under-represented in linear and rational empirical improvement approaches.

Priority target conditions for algorithms for monitoring children's growth: Interdisciplinary consensus.

Directory of Open Access Journals (Sweden)

Pauline Scherdel

Full Text Available Growth monitoring of apparently healthy children aims at early detection of serious conditions through the use of both clinical expertise and algorithms that define abnormal growth. Optimization of growth monitoring requires standardization of the definition of abnormal growth, and the selection of the priority target conditions is a prerequisite of such standardization.To obtain a consensus about the priority target conditions for algorithms monitoring children's growth.We applied a formal consensus method with a modified version of the RAND/UCLA method, based on three phases (preparatory, literature review, and rating, with the participation of expert advisory groups from the relevant professional medical societies (ranging from primary care providers to hospital subspecialists as well as parent associations. We asked experts in the pilot (n = 11, reading (n = 8 and rating (n = 60 groups to complete the list of diagnostic classification of the European Society for Paediatric Endocrinology and then to select the conditions meeting the four predefined criteria of an ideal type of priority target condition.Strong agreement was obtained for the 8 conditions selected by the experts among the 133 possible: celiac disease, Crohn disease, craniopharyngioma, juvenile nephronophthisis, Turner syndrome, growth hormone deficiency with pituitary stalk interruption syndrome, infantile cystinosis, and hypothalamic-optochiasmatic astrocytoma (in decreasing order of agreement.This national consensus can be used to evaluate the algorithms currently suggested for growth monitoring. The method used for this national consensus could be re-used to obtain an international consensus.

From theoretical concepts to policies and applied programmes: the landscape of integration of oral health in primary care.

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Harnagea, Hermina; Lamothe, Lise; Couturier, Yves; Esfandiari, Shahrokh; Voyer, René; Charbonneau, Anne; Emami, Elham

2018-02-15

Despite its importance, the integration of oral health into primary care is still an emerging practice in the field of health care services. This scoping review aims to map the literature and provide a summary on the conceptual frameworks, policies and programs related to this concept. Using the Levac et al. six-stage framework, we performed a systematic search of electronic databases, organizational websites and grey literature from 1978 to April 2016. All relevant original publications with a focus on the integration of oral health into primary care were retrieved. Content analyses were performed to synthesize the results. From a total of 1619 citations, 67 publications were included in the review. Two conceptual frameworks were identified. Policies regarding oral heath integration into primary care were mostly oriented toward common risk factors approach and care coordination processes. In general, oral health integrated care programs were designed in the public health sector and based on partnerships with various private and public health organizations, governmental bodies and academic institutions. These programmes used various strategies to empower oral health integrated care, including building interdisciplinary networks, training non-dental care providers, oral health champion modelling, enabling care linkages and care coordinated process, as well as the use of e-health technologies. The majority of studies on the programs outcomes were descriptive in nature without reporting long-term outcomes. This scoping review provided a comprehensive overview on the concept of integration of oral health in primary care. The findings identified major gaps in reported programs outcomes mainly because of the lack of related research. However, the results could be considered as a first step in the development of health care policies that support collaborative practices and patient-centred care in the field of primary care sector.

Impact of Individual-, Environmental-, and Policy-Level Factors on Health Care Utilization Among US Farmworkers

Science.gov (United States)

Mayer, Joni A.; Gabbard, Susan; Kronick, Richard G.; Roesch, Scott C.; Malcarne, Vanessa L.; Zuniga, Maria L.

2011-01-01

Objectives. We examined individual-, environmental-, and policy-level correlates of US farmworker health care utilization, guided by the behavioral model for vulnerable populations and the ecological model. Methods. The 2006 and 2007 administrations of the National Agricultural Workers Survey (n = 2884) provided the primary data. Geographic information systems, the 2005 Uniform Data System, and rurality and border proximity indices provided environmental variables. To identify factors associated with health care use, we performed logistic regression using weighted hierarchical linear modeling. Results. Approximately half (55.3%) of farmworkers utilized US health care in the previous 2 years. Several factors were independently associated with use at the individual level (gender, immigration and migrant status, English proficiency, transportation access, health status, and non-US health care utilization), the environmental level (proximity to US–Mexico border), and the policy level (insurance status and workplace payment structure). County Federally Qualified Health Center resources were not independently associated. Conclusions. We identified farmworkers at greatest risk for poor access. We made recommendations for change to farmworker health care access at all 3 levels of influence, emphasizing Federally Qualified Health Center service delivery. PMID:21330594

Establishing Core Outcome Domains in Hemodialysis: Report of the Standardized Outcomes in Nephrology−Hemodialysis (SONG-HD) Consensus Workshop

Science.gov (United States)

Tong, Allison; Manns, Braden; Hemmelgarn, Brenda; Wheeler, David C.; Evangelidis, Nicole; Tugwell, Peter; Crowe, Sally; Van Biesen, Wim; Winkelmayer, Wolfgang C.; O’Donoghue, Donal; Tam-Tham, Helen; Shen, Jenny; Pinter, Jule; Larkins, Nicholas; Youssouf, Sajeda; Mandayam, Sreedhar; Ju, Angela; Craig, Jonathan C.

2017-01-01

Evidence-informed decision-making in clinical care and policy in nephrology is undermined by trials that selectively report a large number of heterogeneous outcomes, many of which are not patient-centered. The Standardized Outcomes in Nephrology−Hemodialysis (SONG-HD) Initiative convened an international consensus workshop on November 7, 2015, to discuss the identification and implementation of a potential core outcome set for all trials in hemodialysis. The purpose of this article is to report qualitative analyses of the workshop discussions, describing the key aspects to consider when establishing core outcomes in trials involving patients on hemodialysis. Key stakeholders including eight patients/caregivers and 47 health professionals (nephrologists, policy makers, industry, researchers) attended the workshop. Attendees suggested that identifying core outcomes required equitable stakeholder engagement to ensure relevance across patient populations; flexibility to consider evolving priorities over time; deconstruction of language and meaning for conceptual consistency and clarity; understanding of potential overlap and associations between outcomes; and an assessment of applicability to the range of interventions in hemodialysis. For implementation, they proposed that core outcomes must have simple, inexpensive and validated outcome measures that could be used in clinical care (quality ndicators) and trials (including pragmatic trials), and endorsement by regulatory agencies. Integrating these recommendations may foster acceptance and optimize the uptake and translation of core outcomes in hemodialysis, leading to more informative research, for better treatment, and improved patient outcomes. PMID:27497527

Corrupt practices in chinese medical care: the root in public policies and a call for Confucian-market approach.

Science.gov (United States)

Fan, Ruiping

2007-06-01

This paper argues that three salient corrupt practices that mark contemporary Chinese health care, namely the over-prescription of indicated drugs, the prescription of more expensive forms of medication and more expensive diagnostic work-ups than needed, and illegal cash payments to physicians-i.e., red packages-result not from the introduction of the market to China, but from two clusters of circumstances. First, there has been a loss of the Confucian appreciation of the proper role of financial reward for good health care. Second, misguided governmental policies have distorted the behavior of physicians and hospitals. The distorting policies include (1) setting very low salaries for physicians, (2) providing bonuses to physicians and profits to hospitals from the excessive prescription of drugs and the use of more expensive drugs and unnecessary expensive diagnostic procedures, and (3) prohibiting payments by patients to physicians for higher quality care. The latter problem is complicated by policies that do not allow the use of governmental insurance and funds from medical savings accounts in private hospitals as well as other policies that fail to create a level playing field for both private and government hospitals. The corrupt practices currently characterizing Chinese health care will require not only abolishing the distorting governmental policies but also drawing on Confucian moral resources to establish a rightly directed appreciation of the proper place of financial reward in the practice of medicine.

Consensus Building Through Systems Thinking: the case of policy and planning in healthcare

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Kambiz E. Maani

2002-05-01

Full Text Available This paper discusses a methodology and a case study using qualitative system dynamics to create consensus, team learning and shared vision in a public organisation. The case involves determining planning priorities for a Division of the Ministry of Health in New Zealand, leading to the creation of a business plan. The methodology involves Systems Thinking using Group Model Building (GMB - A three-step process starting with structured brainstorming using the partial KJ (Jiro Kawakita technique to identify priority areas and then clustering them into 'affinity' groups. Next, the priority clusters are used by the participants to construct causal loop diagrams representing 'systems of priorities'(in contrast with list of priorities. Finally, through a group process, leverage points or key priorities are identified as the basis for a business plan. While the above process was well agreed upon by the participants at the outset, strong group resistance was encountered when managers attempted to reduce the number of priority areas. Systems thinking approach was used to create consensus and the commitment to the outcome. The GMB approach offers significant promise in using qualitative system dynamics with non-systems experts. The methodology can be applied to change management initiative and complex decisions such as restructuring, reengineering, and supply chain design. The expected outcomes are greater commitment and shared vision.

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumours

DEFF Research Database (Denmark)

Partelli, Stefano; Bartsch, Detlef K.; Capdevila, Jaume

2017-01-01

The small intestine and pancreas are among the most frequent abdominal sites of origin of neuroendocrine tumours. Distinctive features of these forms are represented by the relatively low incidence and the wide heterogeneity in biological behaviour. In this light, it is difficult to standardize...... indications for surgery and the most appropriate approach. It would be helpful for surgeons managing patients with these tumours to have guidelines for surgical treatment of small intestinal neuroendocrine tumours and pancreatic neuroendocrine tumours. The proposed guidelines represent a consensus...

[Managing the discharge of diabetic patients from the emergency department: a consensus paper].

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Cuervo Pinto, Rafael; Álvarez-Rodríguez, Esther; González Pérez de Villar, Noemí; Artola-Menéndez, Sara; Girbés Borrás, Juan; Mata-Cases, Manel; Galindo Rubio, Mercedes; Puig Larrosa, Juan; Muñoz Albert, Ricardo; Díaz Pérez, José Ángel

2017-10-01

Eighty to 90% of patients attended in emergency departments are discharged to home. Emergency department physicians are therefore responsible for specifying how these patients are treated afterwards. An estimated 30% to 40% of emergency patients have diabetes mellitus that was often decompensated or poorly controlled prior to the emergency. It is therefore necessary to establish antidiabetic treatment protocols that contribute to adequate metabolic control for these patients in the interest of improving the short-term prognosis after discharge. The protocols should also maintain continuity of outpatient care from other specialists and contribute to improving the long-term prognosis. This consensus paper presents the consensus of experts from 3 medical associations whose members are directly involved with treating patients with diabetes. The aim of the paper is to facilitate the assessment of antidiabetic treatment when the patient is discharged from the emergency department and referred to outpatient care teams.

Interdisciplinary consensus document for the treatment of fibromyalgia.

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de Miquel, C Alegre; Campayo, J García; Flórez, M Tomás; Arguelles, J M Gómez; Tarrio, E Blanco; Montoya, M Gobbo; Martin, Á Pérez; Salio, A Martínez; Fuentes, J Vidal; Alberch, E Altarriba; de la Cámara, A Gómez

2010-01-01

Backgrounds. The elevated prevalence and enormous clinical and social impact of fibromyalgia, together with the complexity of its treatment, require action consensuses that guide health care professionals. Although there are some similar documents in our language, most have been made from the perspective of a single discipline.Objective. To develop a consensus on the treatment of fibromyalgia made by selected representatives and supported by the principal medical associations that intervene in its treatment (rheumatology, neurology, psychiatry,rehabilitation and family medicine) and representatives of the associations of patients. On the other hand, understanding the disease not as a homogenous disorders but also as the sum of different clinical subtypes,having specific symptomatic characteristics and different therapeutic needs is stressed. This approach represented a need perceived by the clinicians and a novelty regarding previous consensuses.Methods. The different clinical classifications proposed in fibromyalgia and the scientific evidence of the treatments used in this disease were reviewed. For the selection of the classification used and performance of the therapeutic recommendations, some of the usual techniques to obtain the consensus (nominal group and brainstorming) were used.Conclusion. The classification of Giesecke of fibromyalgia into 3 subgroups seems to have the greatest scientific evidence and the most useful for the clinician. The guide offers a series of general recommendations for all the patients with fibromyalgia. However, in addition, for each subgroup, there are a series of specific pharmacological and psychological-type recommendations and those of modification of the environment, which will make it possible to have a personalized approach to the patient with fibromyalgia in accordance with their individual clinical characteristics (pain, catastrophizing levels, etc.).

Supportive care during treatment for breast cancer: resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement.

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Cardoso, Fatima; Bese, Nuran; Distelhorst, Sandra R; Bevilacqua, Jose Luiz B; Ginsburg, Ophira; Grunberg, Steven M; Gralla, Richard J; Steyn, Ann; Pagani, Olivia; Partridge, Ann H; Knaul, Felicia Marie; Aapro, Matti S; Andersen, Barbara L; Thompson, Beti; Gralow, Julie R; Anderson, Benjamin O

2013-10-01

Breast cancer patients may have unmet supportive care needs during treatment, including symptom management of treatment-related toxicities, and educational, psychosocial, and spiritual needs. Delivery of supportive care is often a low priority in low- and middle-income settings, and is also dependent on resources available. This consensus statement describes twelve key recommendations for supportive care during treatment in low- and middle-income countries, identified by an expert international panel as part of the 5th Breast Health Global Initiative (BHGI) Global Summit for Supportive Care, which was held in October 2012, in Vienna, Austria. Panel recommendations are presented in a 4-tier resource-stratified table to illustrate how health systems can provide supportive care services during treatment to breast cancer patients, starting at a basic level of resource allocation and incrementally adding program resources as they become available. These recommendations include: health professional and patient and family education; management of treatment related toxicities, management of treatment-related symptoms of fatigue, insomnia and non-specific pain, and management of psychosocial and spiritual issues related to breast cancer treatment. Establishing supportive care during breast cancer treatment will help ensure that breast cancer patients receive comprehensive care that can help 1) improve adherence to treatment recommendations, 2) manage treatment-related toxicities and other treatment related symptoms, and 3) address the psychosocial and spiritual aspects of breast cancer and breast cancer treatments. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Current practice and views of neurologists on the transition from pediatric to adult care.

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Oskoui, Maryam; Wolfson, Christina

2012-12-01

To describe the current practice and views of neurologists on transitioning patients from pediatric to adult care, a cross-sectional study of all pediatric and adult neurologists in the province of Quebec, Canada, was conducted. The response rate was 73% for pediatric and 49% for adult neurologists. Most pediatric neurologists do not have a patient transition program or policy in place. Although a transfer summary is commonly provided, critical information is often lacking. Nearly half of neurologists believed that patients experience a gap in care during the transition process, and most agreed that the transition process is often poorly coordinated, highlighting patient, family, and health care factors. Current practice does not follow existing consensus statements for transition of care with respect to timing, communication, and preparation, and many pediatric neurologists experience difficulty in finding an appropriate adult health care provider for their patients. Neurologists reported many challenges in the current transition of care process.

Early Childhood Education and Care Policy in Portugal = A Educacao Pre-Escolar e os Cuidados para a Infancia em Portugal.

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Ministry of Education, Lisbon (Portugal).

Based on the view that the rapid expansion and development of preschool education requires careful scrutiny of both educational policy and practices, this book presents information on current early childhood education and care policy in Portugal. Section 1 of the book provides a historical framework for the development of early childhood education…

Quando uma proposição não se converte em política?: O caso da Política Nacional de Atenção Integral à Saúde de Adolescentes e Jovens - PNAISAJ When does a proposition not become a policy?: The case of the Brazilian Comprehensive Health Care Policy for Adolescents and Youths - PNAISAJ - in Brazil

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Martha Cristina Nunes Moreira

2013-04-01

Full Text Available As três últimas décadas foram fecundas à instituição de políticas públicas voltadas para a saúde integral de vários extratos populacionais no Brasil. Pretendemos apresentar os resultados parciais da análise das narrativas de atores participantes da construção da proposta da Política Nacional de Atenção Integral à Saúde de Adolescentes e Jovens (PNAISAJ, com o objetivo de explorar os dissensos observados neste processo. A análise se baseou nas narrativas de 8 atores partícipes do processo e buscou identificar as unidades temáticas que expressam tais dissensos numa leitura compreensivista segundo a perspectiva socio­lógica de Bourdieu. Concluímos que a não legitimação de uma Política Nacional para este extrato populacional expressa o não reconhecimento dos adolescentes e jovens como sujeitos autônomos e protagonistas de decisões políticas a estes afetas. Apesar do protagonismo juvenil ser enunciado nos textos políticos como um novo paradigma para a promoção da saúde integral dos adolescente e dos jovens, concluímos que, culturalmente, o que prevalece é a legitimação de outros sentidos. Sentidos estes deliberados segundo os interesses e a compreensão da adolescência e da juventude pelas instâncias sociais mais ampliadas, se constituindo como políticas culturais.The last three decades have been fertile for the establishment of public policies geared to comprehensive health care for various population groups in Brazil. The scope of this article is to present the partial results of the analysis of the narratives of actors who participated in the creation of the Comprehensive Health Care policy for Adolescents and Youths - PNAISAJ in Brazil, in order to explore the lack of consensus in this process. The analysis was based on the narratives of eight actors who participated in the process and sought to identify the thematic units that express the lack of consensus by a comprehensive analysis based on Bourdieu

From coordinated care trials to medicare locals: what difference does changing the policy driver from efficiency to quality make for coordinating care?

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Gardner, Karen; Yen, Laurann; Banfield, Michelle; Gillespie, James; McRae, Ian; Wells, Robert

2013-02-01

The terms coordination and integration refer to a wide range of interventions, from strategies aimed at coordinating clinical care for individuals to organizational and system interventions such as managed care, which contract medical and support services. Ongoing debate about whether financial and organizational integration are needed to achieve clinical integration is evident in policy debates over several decades, from a focus through the 1990s on improving coordination through structural reform and the use of market mechanisms to achieve allocative efficiencies (better overall service mix) to more recent attention on system performance to improve coordination and quality. We examine this shift in Australia and ask how has changing the policy driver affected efforts to achieve coordination? Care planning, fund pooling and purchasing are still important planks in coordination. Evidence suggests that financial strategies can be used to drive improvements for particular patient groups, but these are unlikely to improve outcomes without being linked to clinical strategies that support coordination through multidisciplinary teamwork, IT, disease management guidelines and audit and feedback. Meso level organizational strategies might align the various elements to improve coordination. Changing the policy driver has refocused research and policy over the last two decades from a focus on achieving allocative efficiencies to achieving quality and value for money. Research is yet to develop theoretical approaches that can deal with the implications for assessing effectiveness. Efforts need to identify intervention mechanisms, plausible relationships between these and their measurable outcomes and the components of contexts that support the emergence of intervention attributes.

Causal Evaluation of Acute Recurrent and Chronic Pancreatitis in Children: Consensus From the INSPPIRE Group.

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Gariepy, Cheryl E; Heyman, Melvin B; Lowe, Mark E; Pohl, John F; Werlin, Steven L; Wilschanski, Michael; Barth, Bradley; Fishman, Douglas S; Freedman, Steven D; Giefer, Matthew J; Gonska, Tanja; Himes, Ryan; Husain, Sohail Z; Morinville, Veronique D; Ooi, Chee Y; Schwarzenberg, Sarah J; Troendle, David M; Yen, Elizabeth; Uc, Aliye

2017-01-01

Acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) have been diagnosed in children at increasing rates during the past decade. As pediatric ARP and CP are still relatively rare conditions, little quality evidence is available on which to base the diagnosis and determination of etiology. The aim of the study was to review the current state of the literature regarding the etiology of these disorders and to developed a consensus among a panel of clinically active specialists caring for children with these disorders to help guide the diagnostic evaluation and identify areas most in need of future research. A systematic review of the literature was performed and scored for quality, followed by consensus statements developed and scored by each individual in the group for level of agreement and strength of the supporting data using a modified Delphi method. Scores were analyzed for the level of consensus achieved by the group. The panel reached consensus on 27 statements covering the definitions of pediatric ARP and CP, evaluation for potential etiologies of these disorders, and long-term monitoring. Statements for which the group reached consensus to make no recommendation or could not reach consensus are discussed. This consensus helps define the minimal diagnostic evaluation and monitoring of children with ARP and CP. Even in areas in which we reached consensus, the quality of the evidence is weak, highlighting the need for further research. Improved understanding of the underlying cause will facilitate treatment development and targeting.

Do not do in COPD: consensus statement on overuse

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Villar-Álvarez F

2018-02-01

Full Text Available Felipe Villar-Álvarez,1 Raúl Moreno-Zabaleta,2 Jose Joaquin Mira-Solves,3 Eduardo Calvo-Corbella,4 Salvador Díaz-Lobato,5 Fernando González-Torralba,6 Ascensión Hernando-Sanz,7 Sara Núñez-Palomo,8 Sergio Salgado-Aranda,9 Beatriz Simón-Rodríguez,10 Paz Vaquero-Lozano,11 Isabel María Navarro-Soler12On behalf of “Do not do in COPD” Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid1Department of Pulmonology, IIS–Fundación Jiménez Díaz, CIBERES, UAM, 2Pulmonology, Inpatient and Noninvasive Mechanical Ventilation, Hospital Universitario Infanta Sofía, Madrid, 3Alicante-Sant Joan Health District, Alicante/Universidad Miguel Hernández Elche/REDISEC, 4Family and Community Medicine, CSU Pozuelo Estación, School of Medicine, UAM, 5Department of Pulmonology, Hospital Ramón y Cajal, Madrid, 6Pulmonology Section, Hospital Universitario del Tajo, Aranjuez, 7Department of Pulmonology, Hospital Universitario 12 de Octubre, 8C.S. Torrelaguna, 9Pulmonology Section, Hospital del Sureste, 10FisioRespiración-Respiratory Physiotherapy Unit, Escuela Universitaria Gimbernat Cantabria, 11S. Pulmonology, CEP Hnos. Sangro HGU Gregorio Marañón, Madrid, 12Calitè Research Group, Universidad Miguel Hernández de Elche, Elche, SpainBackground: To identify practices that do not add value, cause harm, or subject patients with chronic obstructive pulmonary disease (COPD to a level of risk that outweighs possible benefits (overuse.Methods: A qualitative approach was applied. First, a multidisciplinary group of healthcare professionals used the Metaplan technique to draft and rank a list of overused procedures as well as self-care practices in patients with stable and exacerbated COPD. Second, in successive consensus-building rounds, description files were created for each “do not do” (DND recommendation, consisting of a definition, description, quality of supporting evidence for the recommendation, and the indicator

Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review

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Christos Lionis

2009-07-01

Full Text Available Background: Over the past years, Greece has undergone several endeavors aimed at modernizing and improving national health care services with a focus on PHC. However, the extent to which integrated primary health care has been achieved is still questioned. Purpose: This paper explores the extent to which integrated primary health care (PHC is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country. Methods: A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care. Results: Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care. Conclusion: Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development.

Normative Power vs. Political Interest: EU Aid Selectivity beyond the European Consensus on Development, 2008-13

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W. Hout (Wil)

2013-01-01

markdownabstract__Abstract__ This paper focuses on the ‘governance turn’ in the development policies of the European Union, represented in particular by the adoption of the ‘European Consensus on Development’ in 2005. The main assumption inherent in the EU approach to development is that the

A new spin on research translation: the Boston Consensus Conference on Human Biomonitoring.

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Nelson, Jessica W; Scammell, Madeleine Kangsen; Altman, Rebecca Gasior; Webster, Thomas F; Ozonoff, David M

2009-04-01

Translating research to make it more understandable and effective (research translation) has been declared a priority in environmental health but does not always include communication to the public or residents of communities affected by environmental hazards. Their unique perspectives are also commonly missing from discussions about science and technology policy. The consensus conference process, developed in Denmark, offers a way to address this gap. The Boston Consensus Conference on Human Biomonitoring, held in Boston, Massachusetts, in the fall of 2006, was designed to educate and elicit input from 15 Boston-area residents on the scientifically complex topic of human biomonitoring for environmental chemicals. This lay panel considered the many ethical, legal, and scientific issues surrounding biomonitoring and prepared a report expressing their views. The lay panel's findings provide a distinct and important voice on the expanding use of biomonitoring. In some cases, such as a call for opt-in reporting of biomonitoring results to study participants, they mirror recommendations raised elsewhere. Other conclusions have not been heard previously, including the recommendation that an individual's results should be statutorily exempted from the medical record unless permission is granted, and the opportunity to use biomonitoring data to stimulate green chemistry. The consensus conference model addresses both aspects of a broader conception of research translation: engaging the public in scientific questions, and bringing their unique perspectives to bear on public health research, practice, and policy. In this specific application, a lay panel's recommendations on biomonitoring surveillance, communication, and ethics have practical implications for the conduct of biomonitoring studies and surveillance programs.

Italian consensus on Eular 2003 recommendations for the treatment of knee osteoarthritis

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P. Patrignani

2011-09-01

Full Text Available The recommendations for the management of osteoarthritis (OA of the knee firstly proposed by the EULAR in 2000, have been updated in 2003. One of the most important objectives of the expert charged to provide these recommendations was their dissemination. Thus, the information generated may be used by each individual country to produce their own set of management guidelines and algorithms for treatment in primary care. The Italian Society of Rheumatology (SIR and the Italian League against Rheumatism (LIMAR have organised a Consensus on the EULAR recommendations 2003 with the aim to analyse their acceptability and the applicability according to our own experience and local situations in the Italy. The results of this Consensus have demonstrated that a large majority of the EULAR recommendations are endorsed by the Italian experts. Furthermore, the final document of the Italian Consensus clearly indicated the need that the specialists involved in the management of knee OA strongly encourage the dissemination of the EULAR 2003 recommendations also in Italy.

Associations between state minimum wage policy and health care access: a multi-level analysis of the 2004 Behavioral Risk Factor survey.

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McCarrier, Kelly P; Martin, Diane P; Ralston, James D; Zimmerman, Frederick J

2010-05-01

Minimum wage policies have been advanced as mechanisms to improve the economic conditions of the working poor. Both positive and negative effects of such policies on health care access have been hypothesized, but associations have yet to be thoroughly tested. To examine whether the presence of minimum wage policies in excess of the federal standard of $5.15 per hour was associated with health care access indicators among low-skilled adults of working age, a cross-sectional analysis of 2004 Behavioral Risk Factor Surveillance System data was conducted. Self-reported health insurance status and experience with cost-related barriers to needed medical care were adjusted in multi-level logistic regression models to control for potential confounding at the state, county, and individual levels. State-level wage policy was not found to be associated with insurance status or unmet medical need in the models, providing early evidence that increased minimum wage rates may neither strengthen nor weaken access to care as previously predicted.

Governance and Development: Changing EU Policies

OpenAIRE

Hout, Wil

2010-01-01

textabstractAbstract This introductory article to the special issue on European Union, development policies and governance discusses how notions of ('good') governance have come to dominate development discourses and policies since the mid-1990s. The article argues that governance was part of the so-called Post-Washington Consensus, which understands governance reform as part of the creation of market societies. Although academics have commonly emphasised the fact that governance concerns the...

National quality indicators and policies from 15 countries leading in adult end-of-life care: a systematic environmental scan.

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Virdun, Claudia; Luckett, Tim; Lorenz, Karl A; Phillips, Jane

2018-06-01

The importance of measuring the quality of end-of-life care provision is undisputed, but determining how best to achieve this is yet to be confirmed. This study sought to identify and describe national end-of-life care quality indicators and supporting policies used by countries leading in their end-of-life care provision. A systematic environmental scan that included a web search to identify relevant national policies and indicators; hand searching for additional materials; information from experts listed for the top 10 (n=15) countries ranked in the 'quality of care' category of the 2015 Quality of Death Index study; and snowballing from Index experts. Ten countries (66%) have national policy support for end-of-life care measurement, five have national indicator sets, with two indicator sets suitable for all service providers. No countries mandate indicator use, and there is limited evidence of consumer engagement in development of indicators. Two thirds of the 128 identified indicators are outcomes measures (62%), and 38% are process measures. Most indicators pertain to symptom management (38%), social care (32%) or care delivery (27%). Measurement of end-of-life care quality varies globally and rarely covers all care domains or service providers. There is a need to reduce duplication of indicator development, involve consumers, consider all care providers and ensure measurable and relevant indicators to improve end-of-life care experiences for patients and families. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Implementation of an electronic surgical referral service. Collaboration, consensus and cost of the surgeon – general practitioner Delphi approach

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Augestad KM

2014-09-01

Full Text Available Knut Magne Augestad,1–3 Arthur Revhaug,1,3 Roar Johnsen,4 Stein-Olav Skrøvseth,2 Rolv-Ole Lindsetmo1,3 1Department of Gastrointestinal Surgery, 2Department of Integrated Care and Telemedicine, University Hospital North Norway, Tromsø, Norway; 3Department of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA; 4Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway Background: Poor coordination between levels of care plays a central role in determining the quality and cost of health care. To improve patient coordination, systematic structures, guidelines, and processes for creating, transferring, and recognizing information are needed to facilitate referral routines. Methods: Prospective observational survey of implementation of electronic medical record (EMR-supported guidelines for surgical treatment. Results: One university clinic, two local hospitals, 31 municipalities, and three EMR vendors participated in the implementation project. Surgical referral guidelines were developed using the Delphi method; 22 surgeons and seven general practitioners (GPs needed 109 hours to reach consensus. Based on consensus guidelines, an electronic referral service supported by a clinical decision support system, fully integrated into the GPs' EMR, was developed. Fifty-five information technology personnel and 563 hours were needed (total cost 67,000 £ to implement a guideline supported system in the EMR for 139 GPs. Economical analyses from a hospital and societal perspective, showed that 504 (range 401–670 and 37 (range 29–49 referred patients, respectively, were needed to provide a cost-effective service. Conclusion: A considerable amount of resources were needed to reach consensus on the surgical referral guidelines. A structured approach by the Delphi method and close collaboration between IT personnel, surgeons and primary care physicians were needed to

Integrated care: a fresh perspective for international health policies in low and middle-income countries

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Jean-Pierre Unger

2006-09-01

Full Text Available Purpose: To propose a social-and-democrat health policy alternative to the current neoliberal one. Context of case: The general failure of neoliberal health policies in low and middle-income countries justifies the design of an alternative to bring disease control and health care back in step with ethical principles and desired outcomes. Data sources: National policies, international programmes and pilot experiments—including those led by the authors—are examined in both scientific and grey literature. Case description: We call for the promotion of a publicly-oriented health sector as a cornerstone of such alternative policy. We define ‘publicly-oriented’ as opposed to ‘private-for-profit’ in terms of objectives and commitment, not of ownership. We classify development strategies for such a sector according to an organisation-based typology of health systems defined by Mintzberg. As such, strategies are adapted to three types of health systems: machine bureaucracies, professional bureaucracies and divisionalized forms. We describe avenues for family and community health and for hospital care. We stress social control at the peripheral level to increase accountability and responsiveness. Community-based, national and international sources are required to provide viable financing. Conclusions and discussion: Our proposed social-and-democrat health policy calls for networking, lobbying and training as a joint effort in which committed health professionals can lead the way.

Consensus modeling to develop the farmers' market readiness assessment and decision instrument.

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Lee, Eunlye; Dalton, Jarrod; Ngendahimana, David; Bebo, Pat; Davis, Ashley; Remley, Daniel; Smathers, Carol; Freedman, Darcy A

2017-09-01

Nutrition-related policy, system, and environmental (PSE) interventions such as farmers' markets have been recommended as effective strategies for promoting healthy diet for chronic disease prevention. Tools are needed to assess community readiness and capacity factors influencing successful farmers' market implementation among diverse practitioners in different community contexts. We describe a multiphase consensus modeling approach used to develop a diagnostic tool for assessing readiness and capacity to implement farmers' market interventions among public health and community nutrition practitioners working with low-income populations in diverse contexts. Modeling methods included the following: phase 1, qualitative study with community stakeholders to explore facilitators and barriers influencing successful implementation of farmers' market interventions in low-income communities; phase 2, development of indicators based on operationalization of qualitative findings; phase 3, assessment of relevance and importance of indicators and themes through consensus conference with expert panel; phase 4, refinement of indicators based on consensus conference; and phase 5, pilot test of the assessment tool. Findings illuminate a range of implementation factors influencing farmers' market PSE interventions and offer guidance for tailoring intervention delivery based on levels of community, practitioner, and organizational readiness and capacity.

Foster Care Dynamics and System Science: Implications for Research and Policy.

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Wulczyn, Fred; Halloran, John

2017-10-05

Although system is a word frequently invoked in discussions of foster care policy and practice, there have been few if any attempts by child welfare researchers to understand the ways in which the foster care system is a system. As a consequence, insights from system science have yet to be applied in meaningful ways to the problem of making foster care systems more effective. In this study, we draw on population biology to organize a study of admissions and discharges to foster care over a 15-year period. We are interested specifically in whether resource constraints, which are conceptualized here as the number of beds, lead to a coupling of admissions and discharges within congregate care. The results, which are descriptive in nature, are consistent with theory that ties admissions and discharges together because of a resource constraint. From the data, it is clear that the underlying system exerts an important constraint on what are normally viewed as individual-level decisions. Our discussion calls on extending efforts to understand the role of system science in studies of child welfare systems, with a particular emphasis on the role of feedback as a causal influence.

When the private sphere goes public: exploring the issues facing family caregiver organizations in the development of long-term care policies.

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Rozario, Philip A; Palley, Elizabeth

2008-01-01

Though family caregiving forms the backbone of the long-term care system in the United States, long-term care policies have traditionally focused on paid services that frail older people and people with disabilities utilize for their day-to-day functioning. Part of the exclusion of family caregiving from the long-term care discourse stems from the traditional separation of the private sphere, where family caregiving occurs, from the public sphere of policy making. However, the passage of the Family and Medical Leave Act (FMLA), the National Family Caregiver Support Program (NFCSP) and Medicaid waiver legislation may reflect recent changes in the government's position on their role in addressing issues related to the "private spheres." In this article, we explore the nature of family caregiving in the United States, the divide between the public and private spheres and provide an overview of family caregiving-related policies and programs in the U.S. In our review, we examine the provisions in the FMLA, NFCSP, and Medicaid waiver legislation that support family caregiving efforts. We also examine the roles of family caregiver organizations in making family caregiving an important element of long-term care policy and influencing policy-making.

The Oslo consensus conference on protection of the environment

International Nuclear Information System (INIS)

Oughton, D.H.; Strand, P.

2004-01-01

A number of international organisations are focussing on a revision of radiation protection policy from the existing system which addresses only effects on man, to one which also addresses effects on the wider environment. These developments are expected to effect a wide range of stakeholders, including industry, regulators, scientists, users and the public. With this in mind a 'Consensus Conference on Protection of the Environment' was arranged as part of an International Seminar on 'Radiation Protection in the 21st Century: Ethical, Philosophical and Environmental Issues' held at the Norwegian Academy of Science and Letters. The conference attracted 46 international experts representing various disciplines and affiliations including Environmental Science, Health Physics, Radioecology, Ethics and Philosophy and a wide spectrum of perspectives bearing on the question of radiation protection of the environment. The conference was novel in that the participants were professionals rather than laypersons, and the purpose of the consensus procedure was to identify areas of agreement as an input to the ongoing regulatory developments. The success and innovation of the model is reflected in the significant areas of agreement identified in the final consensus statement, and the subsequent interest at an international level. Participants also noted the need for furthering the debate through ongoing work. Notable issues were the harmonisation of standards for radiation with other environmental stressors, guidance for balancing different interests and values within practical management, and the need for assessment criteria

Beware of Data Gaps in Home Care Research: The Streetlight Effect and Its Implications for Policy Making on Long-Term Services and Supports

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Newquist, Deborah D.; DeLiema, Marguerite; Wilber, Kathleen H.

2016-01-01

Policy initiatives increasingly seek greater use of home- and community-based services for older persons and those with chronic care needs, yet large gaps persist in our knowledge of home care, an indispensable component of long-term services and supports. Unrecognized data gaps, including the scope of home care provided by private hire and nonmedical providers, can distort knowledge and poorly inform long-term services and supports policy. The purpose of this article is to examine these gaps by describing the universe of formal home care services and provider types in relationship to major national sources. Findings reveal four distinct home care sectors and that the majority of formal home care is provided in the sectors that are understudied. We discuss the policy implications of data gaps and conclude with recommendations on where to expand and refine home care research. PMID:26062611

2003 Canadian Asthma Consensus Guidelines Executive Summary

Directory of Open Access Journals (Sweden)

Becker Allan

2006-03-01

Full Text Available Abstract Background Guidelines for the diagnosis and management of asthma have been published over the last 15 years; however, there has been little focus on issues relating to asthma in childhood. Since the last revision of the 1999 Canadian Asthma Consensus Report, important new studies, particularly in children, have highlighted the need to incorporate new information into the asthma guidelines. The objectives of this article are to review the literature on asthma published between January 2000 and June 2003 and to evaluate the influence of new evidence on the recommendations made in the 1999 Canadian Asthma Consensus Report and its 2001 update, with a major focus on pediatric issues. Methods The diagnosis of asthma in young children and prevention strategies, pharmacotherapy, inhalation devices, immunotherapy, and asthma education were selected for review by small expert resource groups. The reviews were discussed in June 2003 at a meeting under the auspices of the Canadian Network For Asthma Care and the Canadian Thoracic Society. Data published through December 2004 were subsequently reviewed by the individual expert resource groups. Results This report evaluates early-life prevention strategies and focuses on treatment of asthma in children, emphasizing the importance of early diagnosis and preventive therapy, the benefits of additional therapy, and the essential role of asthma education. Conclusion We generally support previous recommendations and focus on new issues, particularly those relevant to children and their families. This document is a guide for asthma management based on the best available published data and the opinion of health care professionals, including asthma experts and educators.

Interpretive policy analysis: Marshallese COFA migrants and the Affordable Care Act.

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McElfish, Pearl Anna; Purvis, Rachel S; Maskarinec, Gregory G; Bing, Williamina Ioanna; Jacob, Christopher J; Ritok-Lakien, Mandy; Rubon-Chutaro, Jellesen; Lang, Sharlynn; Mamis, Sammie; Riklon, Sheldon

2016-06-11

Since the enactment of the Affordable Care Act (ACA), the rate of uninsured in the United States has declined significantly. However, not all legal residents have benefited equally. As part of a community-based participatory research (CBPR) partnership with the Marshallese community, an interpretative policy analysis research project was conducted to document Marshallese Compact of Free Association (COFA) migrants' understanding and experiences regarding the ACA and related health policies. This article is structured to allow the voice of Marshallese COFA migrants to explain their understanding and interpretation of the ACA and related polices on their health in their own words. Qualitative data was collected from 48 participants in five focus groups conducted at the local community center and three individual interviews for those unable to attend the focus groups. Marshallese community co-investigators participated throughout the research and writing process to ensure that cultural context and nuances in meaning were accurately captured and presented. Community co-investigators assisted with the development of the semi-structured interview guide, facilitated focus groups, and participated in qualitative data analysis. Content analysis revealed six consistent themes across all focus groups and individual interviews that include: understanding, experiences, effect on health, relational/historical lenses, economic contribution, and pleas. Working with Marshallese community co-investigators, we selected quotations that most represented the participants' collective experiences. The Marshallese view the ACA and their lack of coverage as part of the broader relationship between the Republic of the Marshall Islands (RMI) and the United States. The Marshallese state that they have honored the COFA relationship, and they believe the United States is failing to meet its obligations of care and support outlined in the COFA. While the ACA and Medicaid Expansion have reduced

Informal care and the self-management partnership: implications for Australian health policy and practice.

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Essue, Beverley M; Jowsey, Tanisha; Jeon, Yun-Hee; Mirzaei, Masoud; Pearce-Brown, Carmen L; Aspin, Clive; Usherwood, Tim P

2010-11-01

The Serious and Continuing Illness Policy and Practice Study (SCIPPS) aims to improve the care and support for patients with chronic illness and their family carers. Here we describe the carers' contribution to the self-management partnership and discuss the policy and practice implications that are relevant to improving the support available for informal care in Australia. A secondary analysis of SCIPPS data. Fourteen carers of patients between 45 and 85 years with chronic heart failure, chronic obstructive pulmonary disease and diabetes were conveniently sampled from western Sydney and the Australian Capital Territory. Semi-structured interviews were conducted. Data were analysed using qualitative content analysis. Key roles that carers perform in the self-management partnership included: home helper; lifestyle coach; advocate; technical care manager; and health information interpreter. Two negative consequences of juggling these roles included: self-neglect and conflict. Rigid eligibility criteria limit carers' access to essential support programs which underestimates and undervalues their contributions to the self-management partnership. Support services should focus on the development of practical skills to perform the caregiving roles. In addition, health professionals require support to work more effectively with carers to minimise the conflict that can overshadow the care and self-management partnership.

Finnish Media Literacy Education Policies and Best Practices in Early Childhood Education and Care since 2004

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Rantala, Leena

2011-01-01

The purpose of the article is to describe Finnish media literacy policies and good media education practices in early childhood education and care. This article will focus on describing two central action lines related to the Children and Media Program, initiated by the Division for Cultural Policy of the Ministry of Education and Culture in 2004.…

Policy environment for prevention, control and management of cardiovascular diseases in primary health care in Kenya.

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Asiki, Gershim; Shao, Shuai; Wainana, Carol; Khayeka-Wandabwa, Christopher; Haregu, Tilahun N; Juma, Pamela A; Mohammed, Shukri; Wambui, David; Gong, Enying; Yan, Lijing L; Kyobutungi, Catherine

2018-05-09

In Kenya, cardiovascular diseases (CVDs) accounted for more than 10% of total deaths and 4% of total Disability-Adjusted Life Years (DALYs) in 2015 with a steady increase over the past decade. The main objective of this paper was to review the existing policies and their content in relation to prevention, control and management of CVDs at primary health care (PHC) level in Kenya. A targeted document search in Google engine using keywords "Kenya national policy on cardiovascular diseases" and "Kenya national policy on non-communicable diseases (NCDs)" was conducted in addition to key informant interviews with Kenyan policy makers. Relevant regional and international policy documents were also included. The contents of documents identified were reviewed to assess how well they aligned with global health policies on CVD prevention, control and management. Thematic content analysis of the key informant interviews was also conducted to supplement the document reviews. A total of 17 documents were reviewed and three key informants interviewed. Besides the Tobacco Control Act (2007), all policy documents for CVD prevention, control and management were developed after 2013. The national policies were preceded by global initiatives and guidelines and were similar in content with the global policies. The Kenya health policy (2014-2030), The Kenya Health Sector Strategic and Investment Plan (2014-2018) and the Kenya National Strategy for the Prevention and Control of Non-communicable diseases (2015-2020) had strategies on NCDs including CVDs. Other policy documents for behavioral risk factors (The Tobacco Control Act 2007, Alcoholic Drinks Control (Licensing) Regulations (2010)) were available. The National Nutrition Action Plan (2012-2017) was available as a draft. Although Kenya has a tiered health care system comprising primary healthcare, integration of CVD prevention and control at PHC level was not explicitly mentioned in the policy documents. This review revealed

How Intense Policy Demanders Shape Postreform Politics: Evidence from the Affordable Care Act.

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Rocco, Philip; Haeder, Simon F

2018-04-01

The implementation of the Affordable Care Act (ACA) has been a politically volatile process. The ACA's institutional design and delayed feedback effects created a window of opportunity for its partisan opponents to launch challenges at both the federal and state level. Yet as recent research suggests, postreform politics depends on more than policy feedback alone; rather, it is shaped by the partisan and interest-group environment. We argue that "intense policy demanders" played an important role in defining the policy alternatives that comprised congressional Republicans' efforts to repeal and replace the ACA. To test this argument, we drew on an original data set of bill introductions in the House of Representatives between 2011 and 2016. Our analysis suggests that business contributions and political ideology affected the likelihood that House Republicans would introduce measures repealing significant portions of the ACA. A secondary analysis shows that intense policy demanders also shaped the vote on House Republicans' initial ACA replacement plan. These findings highlight the role intense policy demanders can play in shaping the postreform political agenda. Copyright © 2018 by Duke University Press.

Have out-of-pocket health care payments risen under free health care policy? The case of Sri Lanka.

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Pallegedara, Asankha; Grimm, Michael

2018-04-26

Compared to its neighbors, Sri Lanka performs well in terms of health. Health care is provided for free in the public sector, yet households' out-of-pocket health expenditures are steadily increasing. We explore whether this increase can be explained by supply shortages and insufficient public health care financing or whether it is rather the result of an income-induced demand for supplementary and higher quality services from the private sector. We focus on total health care expenditures and health care expenditures for specific services such as expenses on private outpatient treatments and expenses on laboratory and other diagnostic services. Overall, we find little indication that limited supply of public health care per se pushes patients into the private sector. Yet income is identified as one key driver of rising health care expenditures, ie, as households get richer, they spend an increasing amount on private services suggesting a dissatisfaction with the quality offered by the public sector. Hence, quality improvements in the public sector seem to be necessary to ensure sustainability of the public health care sector. If the rich and the middle class increasingly opt out of public health care, the willingness to pay taxes to finance the free health care policy will certainly shrink. Copyright © 2018 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.

Seeking consensus on universal health coverage indicators in the sustainable development goals.

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Reddock, Jennifer

2017-01-01

There is optimism that the inclusion of universal health coverage in the Sustainable Development Goals advances its prominence in global and national health policy. However, formulating indicators for Target 3.8 through the Inter-Agency Expert Group on Sustainable Development Indicators has been challenging. Achieving consensus on the conceptual and methodological aspects of universal health coverage is likely to take some time in multi-stakeholder fora compared with national efforts to select indicators.

What European gynaecologists need to master: Consensus on medical expertise outcomes of pan-European postgraduate training in obstetrics & gynaecology.

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van der Aa, Jessica E; Tancredi, Annalisa; Goverde, Angelique J; Velebil, Petr; Feyereisl, Jaroslav; Benedetto, Chiara; Teunissen, Pim W; Scheele, Fedde

2017-09-01

European harmonisation of training standards in postgraduate medical education in Obstetrics and Gynaecology is needed because of the increasing mobility of medical specialists. Harmonisation of training will provide quality assurance of training and promote high quality care throughout Europe. Pan-European training standards should describe medical expertise outcomes that are required from the European gynaecologist. This paper reports on consensus development on the medical expertise outcomes of pan-European training in Obstetrics and Gynaecology. A Delphi procedure was performed amongst European gynaecologists and trainees in Obstetrics & Gynaecology, to develop consensus on outcomes of training. The consensus procedure consisted of two questionnaire rounds, followed by a consensus meeting. To ensure reasonability and feasibility for implementation of the training standards in Europe, implications of the outcomes were considered in a working group thereafter. We invited 142 gynaecologists and trainees in Obstetrics & Gynaecology for participation representing a wide range of European countries. They were selected through the European Board & College of Obstetrics and Gynaecology and the European Network of Trainees in Obstetrics & Gynaecology. Sixty people participated in round 1 and 2 of the consensus procedure, 38 (63.3%) of whom were gynaecologists and 22 (36.7%) were trainees in Obstetrics & Gynaecology. Twenty-eight European countries were represented in this response. Round 3 of the consensus procedure was performed in a consensus meeting with six experts. Implications of the training outcomes were discussed in a working group meeting, to ensure reasonability and feasibility of the material for implementation in Europe. The entire consensus procedure resulted in a core content of training standards of 188 outcomes, categorised in ten topics. European consensus was developed regarding the medical expertise outcomes of pan-European training in Obstetrics and

Implicit Consensus: Blockchain with Unbounded Throughput

OpenAIRE

Ren, Zhijie; Cong, Kelong; Pouwelse, Johan; Erkin, Zekeriya

2017-01-01

Recently, the blockchain technique was put in the spotlight as it introduced a systematic approach for multiple parties to reach consensus without needing trust. However, the application of this technique in practice is severely restricted due to its limitations in throughput. In this paper, we propose a novel consensus model, namely the implicit consensus, with a distinctive blockchain-based distributed ledger in which each node holds its individual blockchain. In our system, the consensus i...

Benefit-risk of Patients' Online Access to their Medical Records: Consensus Exercise of an International Expert Group.

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Liyanage, Harshana; Liaw, Siaw-Teng; Konstantara, Emmanouela; Mold, Freda; Schreiber, Richard; Kuziemsky, Craig; Terry, Amanda L; de Lusignan, Simon

2018-04-22

 Patients' access to their computerised medical records (CMRs) is a legal right in many countries. However, little is reported about the benefit-risk associated with patients' online access to their CMRs.  To conduct a consensus exercise to assess the impact of patients' online access to their CMRs on the quality of care as defined in six domains by the Institute of Medicine (IoM), now the National Academy of Medicine (NAM).  A five-round Delphi study was conducted. Round One explored experts' (n = 37) viewpoints on providing patients with access to their CMRs. Round Two rated the appropriateness of statements arising from Round One (n = 16). The third round was an online panel discussion of findings (n = 13) with the members of both the International Medical Informatics Association and the European Federation of Medical Informatics Primary Health Care Informatics Working Groups. Two additional rounds, a survey of the revised consensus statements and an online workshop, were carried out to further refine consensus statements.  Thirty-seven responses from Round One were used as a basis to initially develop 15 statements which were categorised using IoM's domains of care quality. The experts agreed that providing patients online access to their CMRs for bookings, results, and prescriptions increased efficiency and improved the quality of medical records. Experts also anticipated that patients would proactively use their online access to share data with different health care providers, including emergencies. However, experts differed on whether access to limited or summary data was more useful to patients than accessing their complete records. They thought online access would change recording practice, but they were unclear about the benefit-risk of high and onerous levels of security. The 5-round process, finally, produced 16 consensus statements.  Patients' online access to their CMRs should be part of all CMR systems. It improves the process

Principles for research on ethnicity and health: the Leeds Consensus Statement.

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Mir, Ghazala; Salway, Sarah; Kai, Joe; Karlsen, Saffron; Bhopal, Raj; Ellison, George Th; Sheikh, Aziz

2013-06-01

There is substantial evidence that health and health-care experiences vary along ethnic lines and the need to understand and tackle ethnic health inequalities has repeatedly been highlighted. Research into ethnicity and health raises ethical, theoretical and methodological issues and, as the volume of research in this area grows, so too do concerns regarding its scientific rigour and reporting, and its contribution to reducing inequalities. Guidance may be helpful in encouraging researchers to adopt standard practices in the design, conduct and reporting of research. However, past efforts at introducing such guidance have had limited impact on research practice, and the diversity of disciplinary perspectives on the key challenges and solutions may undermine attempts to derive and promote guiding principles. A consensus building Delphi exercise--the first of its kind in this area of research practice--was undertaken with leading academics, practitioners and policymakers from a broad range of disciplinary backgrounds to assess whether consensus on key principles could be achieved. Ten key principles for conducting research on ethnicity and health emerged, covering: the aims of research in this field; how such research should be framed and focused; key design-related considerations; and the direction of future research. Despite some areas of dispute, participants were united by a common concern that the generation and application of research evidence should contribute to better health-care experiences and health outcomes for minority ethnic people. The principles provide a strong foundation to guide future ethnicity-related research and build a broader international consensus.

Multimorbidity care model: Recommendations from the consensus meeting of the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS).

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Palmer, Katie; Marengoni, Alessandra; Forjaz, Maria João; Jureviciene, Elena; Laatikainen, Tiina; Mammarella, Federica; Muth, Christiane; Navickas, Rokas; Prados-Torres, Alexandra; Rijken, Mieke; Rothe, Ulrike; Souchet, Laurène; Valderas, Jose; Vontetsianos, Theodore; Zaletel, Jelka; Onder, Graziano