Community health centers and quality of care: a goal to provide effective health care to the community

The uniqueness of community health centers provides for a sound environment for total quality management (TQM). Structure, process, and outcome are valued equally under TQM. With strong management leadership and a framework for quality of care, community health care specialists (e.g., advanced practice nurses) can easily incorporate the TQM measurement criteria in their daily practice routines. By applying the principles of TQM, the community health center will advance toward its goal of enhancing the effectiveness of health care delivery to a community and its members in partnership with the community.     

Wartime military service and utilization of VA health care services

A case of an atypical thyroglossal duct cyst is described in a 9-year-old boy who presented with a lateral neck mass that was hypofunctioning on thyroid scan and clinically indistinguishable from a thyroid nodule. Preoperative fine needle aspiration biopsy results demonstrating abundant, normal appearing squamous epithelial cells and keratinaceous material was suggestive of the diagnosis. Definitive diagnosis was made only after complete mobilization of the left lobe of the thyroid gland and cyst resection. A standard Sistrunk procedure was performed, and cyst excision was accomplished without resection of the left lobe of the thyroid gland. Microscopic examination disclosed a keratinizing pseudostratified squamous epithelium that has not been previously reported with thyroglossal duct cysts.     

Cooperative health care clinics: a group approach to individual care

In cooperative health care clinics (CHCC), health care is provided to older patients in a group setting. The CHCC concept, which was developed under a research grant by Kaiser Permanente in Colorado in 1991, showed improvement in patient and provider satisfaction, as well as improved quality of care and cost effectiveness. CHCC are being replicated in other sites under a research grant from the Robert Wood Johnson Foundation. In addition to formal findings from research studies, much has been learned about factors that have promoted the success of the program.     

Ensuring health care quality: a purchaser's perspective--a health care coalition

This paper explores how one health care purchasing coalition in Minnesota, the Buyers Health Care Action Group (BHCAG), has taken an active role in restructuring its local health care market. BHCAG started with the belief that the consumer should be the motivating force in health care delivery. Unfortunately, providing consumers with the information and incentives they need to make informed, effective health care decisions has triggered numerous problems. This paper examines groups of providers who network to form care systems, and explores the roles of consumers, employers, and health plans in the current market. It identifies specific methods for gathering data and distributing information to the consumer, and discusses the problems associated with attempting to implement quality improvement, as well as the questions that arise when the market does not support those improvements.     

Helping military families through the deployment process: Strategies to support parenting.

Recent studies have highlighted the impact of deployment on military families and children and the corresponding need for interventions to support them. Historically, however, little emphasis has been placed on family-based interventions in general, and parenting interventions in particular, with returning service members. This article provides an overview of research on the associations between combat deployment, parental adjustment of service members and spouses, parenting impairments, and children's adjustment problems. We provide a social interaction learning framework for research and practice to support parenting among military families affected by a parent's deployment. We then describe the Parent Management Training-Oregon model (PMTO), a family of interventions that improves parenting practices and child adjustment in highly stressed families, and briefly present work on an adaptation of PMTO for use with military families (After Deployment: Adaptive Parenting Tools, or ADAPT). The article concludes with PMTO-based recommendations for clinicians providing parenting support to military families. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Predictors of change in postmerger identification during a merger process: A longitudinal study.

Adopting an intergroup perspective, the authors examined predictors of change in postmerger identification throughout a merger. Data were collected over 3 points of measurement from 157 students of a newly merged university. The 1st questionnaire was distributed 4 months after the implementation of the merger; the following 2 were distributed 6 months and 1 year thereafter. With its longitudinal design, this study replicates and extends past results by revealing predictors of change in organizational identification for members of the dominant and subordinate organizations throughout a merger process. As predicted, postmerger identification increased only slowly for members of both the dominant and the subordinate organizations. Multilevel models for change confirmed that the predictive effect of premerger identification on postmerger identification for members of the dominant organization dissipates over time. The effect of in-group typicality unexpectedly varied as a function of organizational membership and was stable over time. Perceived fairness in the merger process positively influenced postmerger identification across members of both organizations; over time the effect of fairness amplified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coordinated systems of community-based health care delivery: a vehicle for health care reform

The need for health care reform in this country continues to be high on the public agenda. Deficits in the access of United States citizens to needed health care services continues, despite recent efforts at health care reform. In addition, the health status of children in this country is of paramount concern. Significant threats to the health of this nation's children have spurred several proposals for reducing the cost of health care while improving the quality of outcomes. A sample of these proposals is analyzed. An example of a health care program which exemplifies one such proposal for health care reform is then discussed. Findings of a recent research project that is relative to the benefits of such a program are provided.     

Managed care: the third reorganization of health care

A 60-day-old neonate boy received hepatic portojejunostomy for biliary atresia under PFK. Pharmacokinetics of propofol and ketamine during and after PFK was also studied. Plasma levels of propofol (Cp) and ketamine (Ck) were maintained at 2 to 3 micrograms ml-1 and at 200 to 300 ng ml-1 during surgery, respectively. Both Cp and Ck decreased quickly after the end of infusions. From the pharmacokinetic point of view, PFK may be safely applied even for neonates.     

Eighteen years of home care: from assistance by phone to a complete service within the health care system

A postal questionnaire was undertaken to assess the current facilities available for adolescents in Irish hospitals. A previous survey showned that no facilities existed whereas this survey demonstrates some improvements but adolescents are still admitted to adult wards, have inappropriate waiting facilities at outpatients and a limited number of joint Paediatric-Adult clinics. The ability of paediatricians to assess risk taking behaviour and the provision of age appropriate information at ward and outpatient level was assessed. The results demonstrate there is need for improvement in all aspects of adolescent care in Irish hospital services. This needs to be addressed promptly as 66% of the paediatricians surveyed were considering the development adolescent services in their hospitals.     

Latex sensitivity: a public health care challenge

Latex sensitivity is becoming epidemic in the health care arena. Providers of health care need to be aware of the signs and symptoms, the treatments, and the consequences of latex sensitive reactions. In this article, I will provide information about latex sensitivities that will enable health care workers and their patients to have a better understanding of the phenomena. Resource information is provided for the latest information pertaining to latex sensitivities to aid in the education of health care providers and their patients.     

Beyond corporate-style downsizing: a better way for medical schools to succeed in a changing world

The previous years mean temperature of July, total solar radiation of July and August and the male flowering index were used to predict atmospheric pollen counts. We examined the adaptability of these predictions and we get following results: 1. Following good harvest years of male flower, atmospheric pollen counts predicted by previous year's mean temperature of July and the total solar radiation of July and August are higher than the actual atmospheric pollen count. 2. Prediction of atmospheric pollen counts by factors within the previous five years are more exact because matured Cryptomeria forests are increasing yearly. 3. There are few errors in prediction by the flowering index because the flower index reflects the actual harvest of male flower.