Directory of health care facilities and approved schools of nursing.

Prepared 1968-69 by Illinois Division of Health Care Facilities and Chronic Illness; 1970- by Illinois Division of Health Facilities.

The Illinois state survey and plan for the construction of hospitals and medical facilities (P.L. 725 and P.L. 482) /

Description based on: 16th annual revision (1964)

Evaluation of a Post Discharge Intervention on 30-Day Re-admission and Emergency Room Use in Patients with Diabetes A Pilot Program

Thesis (Master's)--University of Washington, 2016-06

HIV Status Disclosure among Older African American Men Who Have Sex with Men and Women

Thesis (Ph.D.)--University of Washington, 2016-06

Achieving better in-hospital and after-hospital care of patients with acute cardiac disease

In patients hospitalised with acute coronary syndromes (ACS) and congestive heart failure (CHF), evidence suggests opportunities for improving in-hospital and after hospital care, patient self-care, and hospital-community integration. A multidisciplinary quality improvement program was designed and instigated in Brisbane in October 2000 involving 250 clinicians at three teaching hospitals, 1080 general practitioners (GPs) from five Divisions of General Practice, 1594 patients with ACS and 904 patients with CHF. Quality improvement interventions were implemented over 17 months after a 6-month baseline period and included: clinical decision support (clinical practice guidelines, reminders, checklists, clinical pathways); educational interventions (seminars, academic detailing); regular performance feedback; patient self-management strategies; and hospital-community integration (discharge referral summaries; community pharmacist liaison; patient prompts to attend GPs). Using a before-after study design to assess program impact, significantly more program patients compared with historical controls received: ACS: Angiotensin-converting enzyme (ACE) inhibitors and lipid-lowering agents at discharge, aspirin and beta-blockers at 3 months after discharge, inpatient cardiac counselling, and referral to outpatient cardiac rehabilitation. CHF. Assessment for reversible precipitants, use of prophylaxis for deep-venous thrombosis, beta-blockers at discharge, ACE inhibitors at 6 months after discharge, imaging of left ventricular function, and optimal management of blood pressure levels. Risk-adjusted mortality rates at 6 and 12 months decreased, respectively, from 9.8% to 7.4% (P=0.06) and from 13.4% to 10.1% (P= 0.06) for patients with ACS and from 22.8% to 15.2% (P < 0.001) and from 32.8% to 22.4% (P= 0.005) for patients with CHF. Quality improvement programs that feature multifaceted interventions across the continuum of care can change clinical culture, optimise care and improve clinical outcomes.

Physical enhancement of transdermal drug application: is delivery technology keeping up with pharmaceutical development?

Advances in molecular biology have given us a wide range of protein and peptide-based drugs that are unsuitable for oral delivery because of their high degree of first-pass metabolism. Though parenteral delivery is the obvious answer, for the successful development of commercial chronic and self-administration usage formulations it is not the ideal choice. Transdermal delivery is emerging as the biggest application target for these agents, however, the skin is extremely efficient at keeping out such large molecular weight compounds and therapeutic levels are never going to be realistically achieved by passive absorption. Physical enhancement mechanisms including: iontophoresis, electroporation, ultrasound, photomechanical waves, microneedles and jet-propelled particles are emerging as solutions to this topical delivery dilemma. Adding proteins and peptides to the list of other large molecular weight drugs with insufficient passive transdermal fluxes to be therapeutically useful, we have a collection of pharmacological agents waiting for efficient delivery methods to be introduced. This article reviews the current state of physical transdermal delivery technology, assesses the pros and cons of each technique and summarises the evidence-base of their drug delivery capabilities.

Economic Impact of E.coli 0111 Outbreak in 1995 in Australia

Increased incidence of food-borne illnesses is a matter of significant concern for the community and the government alike. An outbreak of E.coli O111 that occurred in Australia in 1995 affected 200 people of whom 22 developed HUS while one person died. This study analyses the economic costs of the outbreak. The total cost of the outbreak is estimated to be A$5.61 million. Productivity loss represented the highest percentage of outbreak costs (66%) due to death, disability and chronic illness. The direct medical costs contributed 33%. The estimated loss could be even higher if all costs could be quantified. Nevertheless, the findings provide an idea to the policy maker regarding the extent and nature of the damage that could result from an outbreak. The severity of the damage warrants allocation of necessary resources to prevent such occurrences.

Diabetes, my constant companion

Forty-five years as a doctor with diabetes has given Alan Stocks personal insight into how to manage life and practice when living with a chronic illness. Diabetes has proved beneficial to his career, rather than a disadvantage.

Investigation of the coping antecedents to positive outcomes and distress in multiple sclerosis (MS)

This study examined relations between stress and coping predictors and distress and positive outcomes in multiple sclerosis (MS). A total of 502 people with MS completed a questionnaire at Time 1 and, 3 months later, Time 2 (n= 404). Predictors included Time 1 illness (duration, number of symptoms, course), number of problems, appraisal and coping (acceptance, problem solving, emotional release, avoidance, personal health control, energy conservation). Dependent variables were Time 2 distress (anxiety, depression) and positive outcomes (life satisfaction, positive affect, benefits). Results indicated that as hypothesised, personal health control, emotional release and physical assistance were related to the positive outcomes, whereas avoidance was related to distress, and acceptance was associated with the positive outcomes and distress. Findings highlight the differential relations between coping strategies and positive and negative outcomes and the role of appraisal and coping in regulating distress and promoting positive psychological states while managing a chronic illness.

MODELOS DE AÇÕES SOLIDÁRIAS: UM EXAME MULTICASO

O presente trabalho, busca compreender como ocorre este processo, denominado Desenvolvimento Comunitário (SOUZA, 1991), percebendo-se seu processo histórico, bem como, sua contemporalidade, nas quais contemplam atributos sociais e coletivos, favoráveis à compreensão e aplicabilidade dos conceitos de solidariedade, no qual fazem parte desta categoria social econômica. Para tanto, propõe um diálogo, entre o referencial teórico abordado no presente trabalho, com os relatos das Histórias de Vidas , desenvolvidos na pesquisa de campo, propiciando uma leitura das práticas solidárias, que possam despertar um novo sentido a comunidade, por meios culturais e da participação coletiva. O método de Pesquisa, utilizado foi a Qualitativa , de caráter Exploratório , e a análise dos dados levantados, se procedeu com inspiração Fenomenológica . A técnica de pesquisa utilizada foi a vivencial, por meio da abordagem de histórias de vida , visando compreender como os sujeitos da pesquisa, representados pela Olho Vivo Cooperativa de Confecções e Costura, da cidade de Santo André e da Associação de Promoção Humana e Resgate da Cidadania Padre Léo Comissari, na cidade de São Bernardo do Campo, em São Paulo, percebem o conceito sobre economia solidária, e qual a existência prática da solidariedade, que facilitam, interferem ou propiciam a geração de trabalho e renda, dentro destas comunidades. A análise dos relatos de vida, destes sujeitos da pesquisa, mostrou que a prática da solidariedade ocorre somente entre moradores em situações de extrema necessidade de sobrevivência, mas precisamente na comunidade da Sacadura Cabral. Percebe-se que esta ajuda mútua, dentro desta comunidade, ocorre de forma voluntária, desagregada da compreensão do termo solidariedade. A responsabilidade social das instituições de ensino Superior da região do ABC Paulista incentivou a criação do Corredor Cultural da Economia Solidária do ABC Paulista, cujo comprometimento com a pesquisa, a responsabilidade social e as práticas pedagógicas de ensino superior, apontam para a necessidade de apoio às comunidades locai, visando principalmente o seu desenvolvimento, por meio de instrumentos de capacitação, que visam à geração de trabalho e renda.(AU)

DINÂMICA PSÍQUICA E EFICÁCIA ADAPTATIVA DE PACIENTES COM DIABETES MELLITUS TIPO 2

O diabetes é uma doença crônica conhecida há aproximadamente 3.500 anos e que atinge, atualmente, cerca de 18,8 milhões de pessoas no mundo, sendo, portanto, de grande interesse a diversos pesquisadores das mais variadas áreas. Esta doença é resultante de uma insuficiência de insulina, que desempenha papel fundamental nos processos metabólicos do organismo. A incidência do Diabetes Mellitus tipo 2 tem apresentado um considerável crescimento nas últimas décadas, principalmente decorrente da elevada expectativa de vida e, também, pelo resultado de comportamentos destrutivos a saúde, como o abuso de substâncias, dieta inadequada e um estilo de vida sedentário. O presente estudo teve por objetivos avaliar a Qualidade de Vida, a dinâmica psíquica, a eficácia adaptativa e verificar os níveis glicêmicos de pessoas com Diabetes Mellitus tipo 2 participantes de um grupo psicoeducativo. Participaram deste estudo 14 pessoas com Diabetes Mellitus tipo 2. Os instrumentos utilizados foram: 1. Escala da Associação Brasileira de Institutos de Pesquisa de Mercado (ABIPEME); 2. Escala Diagnóstica Adaptativa Operacionalizada (EDAO); 3. Teste das Relações Objetais de Phillipson (TRO); e, 4. WHOQOL-bref. Os resultados mostraram que alguns pacientes apresentaram uma melhora significativa em seus níveis glicêmicos após a realização do grupo psicoeducativo, mesmo verificando que alguns não atingiram ainda bom controle de sua glicemia. A qualidade de vida destes participantes apresentou-se com níveis muito bons. Ao avaliar a eficácia adaptativa e a dinâmica psíquica destes participantes, verificou-se o quanto é difícil aceitar que se tem uma doença crônica e ter atitudes para realizar o tratamento adequado. Concluímos que para estas pessoas com diabetes poderem aderir ao tratamento é necessário que ele apresente uma boa capacidade de solucionar conflitos, e, apresente seu mundo interno ligado à posição depressiva. Se estes fatores estiverem equilibrados o estilo de vida e o bem-estar desses pacientes serão positivos, de modo que eles possam apresentar consequentemente um bom prognóstico com menos complicações da doença durante mais tempo de vida.

Men det är väl bara mensvärk? : En studie om hur det är att leva med endometrios

Endometrios är en kronisk sjukdom som drabbar en av tio kvinnor världen över. Vanliga symptom är menstruationssmärta, samlagssmärta och en nedsatt fertilitet. Diagnosen endometrios ställs oftast i samband med en titthålsoperation och kan i många fall dröja upp till flera år. Tidigare forskning på området har funnit att individer som lever med endometrios kan uppleva en minskad livskvalité, komplikationer med sociala relationer samt emotionella besvär. Syftet med föreliggande studie var att studera kvinnors upplevelse av endometrios. Åtta kvinnor intervjuades, samtliga bosatta i Stockholmsområdet. Resultatet visar på flera olika psykologiska aspekter som sjukdomen för med sig. En minskad livskvalité, komplikationer med sociala relationer och en nedsatt arbetsförmåga är aspekter som påverkas av de upplevda symptomen. En nedsatt fertilitet kan vidare skapa en reducering av individens självkänsla. Slutsatsen är att en tidigare diagnos och ökad forskning skulle kunna bidra till underlättande av endometriosdrabbades vardag och därmed förbättra deras livskvalité.

Attitudes of young people with diabetes to an Internet-based virtual clinic

We assessed the feasibility of developing a virtual diabetes clinic for young people, using the Internet. The proposed content of the site would be based on self-efficacy theory, aiming to develop confidence in self-management of diabetes. A questionnaire about the proposed Website was delivered to 72 patients who attended a young person’s outpatient clinic in a district hospital. Thirty-nine replies were received, a response rate of 54%. The mean age of the respondents was 13 years. A positive attitude to the potential clinic was reported by 95% of respondents. The items rated as most useful were: quick and easy access to up-todate information about diabetes; the opportunity to ask an expert; good graphics; easy navigation; interactivity. Responses to open questions indicated that 24-hour access and anonymity in asking questions were also valued. A virtual clinic appears to be a possible method of health-care delivery to young people with diabetes.

Reducing medicines waste in the community

There is increasing concern at the amount and cost of prescribed medicines that are unused or wasted and then have to be disposed of. Previous studies have used health promotion and Dispose Unwanted Medicines Properly campaigns targeted at the patient to describe and quantify the annual cost of waste. The reasons patients return unused drugs to pharmacies have also been explored. The paper focuses on patient explanations for not needing medication; categorized as: over-collection in the past, self-management strategies, changes in medical condition, other changes in patient circumstances, or the repeat medicines policy at the surgery. The aim of the original study was to make a measurable change in prescribed medicines with a reduction in medicines wastage, whilst at the same time achieving improved standards of pharmaceutical care. Information on patient needs and behaviour came from consultation in the pharmacy monitoring forms and interview. The study was based on two medical practices in the West Midlands, UK, comparing an outer city and an inner city population. The participants were general practitioners, pharmacists and 350 repeat prescription patients. Prescriptions were issued for two three-month periods. The outcome was that 23.8% of the prescribed items were not dispensed, at a value of £13.1K, 58% of the medications that would be expected to be regularly supplied were collected. The study suggests that closer professional management at the point of dispensing and an understanding of patient experiences can help reduce the amount of unwanted medication collected by patients.

An investigation of managerial skills:Implications for personnel policy

This research explores the conceptual basis in adopting a skills approach to management development. The literature reveals a number of development approaches but only a limited appreciation of how the manager does his job i.e. of the skills that he needs. An investigation of managerial skills was conducted with 10 manager s mainly occupying middle and senior positions. The principal source of evidence was the manager's thoughts on what he did and how he did it, although the interviews were supplemented by formal and informal observation. There was also a dialectic value from discussions with other analysts/managers and empathy between analyst and practitioner also played a part. Each manager was invited to comment upon his own skills analysis as a check upon validity. The study supports the view that the manager similar to other skilled practitioners, is conceptually a model builder and operationally a navigator (Singleton 1978b) . The manager variously holds enactive, pictorial, symbolic and hybrid models that enable him to understand his world and act in it. The universal managerial function is decision making and the study presents a preliminary nomenclature in classifying decision processes or perceptual skills. Managerial skills are also reflected in interpersonal interaction where the hallmark is mutual construction and attribution and in 'self-management’ where the requirement is to cope with the inner rather than the outer world. Differences between the managers are most evident in perceptual skills, the more senior manager requiring increasing ability to process abstract information and take account of environmental uncertainty. He will also make greater use of 'off- line’ information. The practical purpose in studying managerial skills is to facilitate the improvement of managerial performance and the implications of the research for training, selection and appraisal are explored.