1000 resultados para HRM Tertiary Programs
Resumo:
Background Chronic heart-failure management programmes (CHF-MPs) have become part of standard care for patients with chronic heart failure (CHF). Objective To investigate whether programmes had applied evidence-based expert clinical guidelines to optimise patient outcomes. Design A prospective cross-sectional survey was used to conduct a national audit. Setting Community setting of CHF-MPs for patients postdischarge. Sample All CHF-MPs operating during 2005–2006 (n=55). Also 10–50 consecutive patients from 48 programmes were recruited (n=1157). Main outcome measures (1) Characteristics and interventions used within each CHF-MP; and (2) characteristics of patients enrolled into these programmes. Results Overall, there was a disproportionate distribution of CHF-MPs across Australia. Only 6.3% of hospitals nationally provided a CHF-MP. A total of 8000 postdischarge CHF patients (median: 126; IQR: 26–260) were managed via CHF-MPs, representing only 20% of the potential national case load. Significantly, 16% of the caseload comprised patients in functional New York Heart Association Class I with no evidence of these patients having had previous echocardiography to confirm a diagnosis of CHF. Heterogeneity of CHF-MPs in applied models of care was evident, with 70% of CHF-MPs offering a hybrid model (a combination of heart-failure outpatient clinics and home visits), 20% conducting home visits and 16% conducting an extended rehabilitation model of care. Less than half (44%) allowed heart-failure nurses to titrate medications. The main medications that were titrated in these programmes were diuretics (n=23, 96%), β-blockers (n=17, 71%), ACE inhibitors (ACEIs) (n=14, 58%) and spironolactone (n=9, 38%). Conclusion CHF-MPs are being implemented rapidly throughout Australia. However, many of these programmes do not adhere to expert clinical guidelines for the management of patients with CHF. This poor translation of evidence into practice highlights the inconsistency and questions the quality of health-related outcomes for these patients.
Resumo:
Objectives:
Design and Methods:
This study involved a cross-sectional survey of 304 public health practitioners and policy-makers from government, non-government, and community organizations across Victoria, Australia. Participants reported their organizations' current obesity prevention programs and policies, their own perceptions of the feasibility and effectiveness of strategies to prevent obesity and their preferred settings for obesity prevention.
Results:
Thirty-nine percent had an obesity prevention policy, and 92% were implementing obesity prevention programs. The most common programs focused on education, skill-building, and increasing access to healthy eating/physical activity opportunities. School curriculum-based initiatives, social support for physical activity, and family-based programs were considered the most effective strategies, whereas curriculum-based initiatives, active after-school programs, and providing access to and information about physical activity facilities were deemed the most feasible strategies. Schools were generally perceived as the most preferred setting for obesity prevention.
Conclusion:
Many organizations had obesity prevention programs, but far fewer had obesity prevention policies. Current strategies and those considered feasible and effective are often mismatched with the empirical literature. Systems to ensure better alignment between researchers, practitioners, and policy-makers, and identifying effective methods of translating empirical evidence into practice and policy are required.
Resumo:
There is now a substantial amount of published literature describing the range of programs and interventions that have been implemented in an attempt to improve aspects of community safety. Only a small body of this work, however, has examined the outcomes of those programs delivered to Indigenous Australians or, indeed, the communities in which they live. This Issues paper provides an overview of those programs that were identified in a systematic search of relevant research databases.
Although a wide range of programs have been described, the diversity of these programs—combined with the limited published data available that documents their outcomes—makes it difficult to articulate what constitutes effective practice in this area.
It is concluded that an evidence-based approach to practice in this area is essential if the long-term aim of the Closing the Gap initiative is to be achieved. To generate this evidence, however, more attention is needed to develop evaluation methods that assess the impact of program activities on medium and longer term outcomes.
In addition, information about program outcomes needs to be integrated with what is known about the mechanisms by which effective programs are delivered, as well as with knowledge about how they might be most effectively implemented in different communities.
Resumo:
Issue addressed:
Methods:
Semistructured telephone or face-to-face interviews with 25 key informants from stakeholder organisations were conducted. Key informants discussed strategies used by their organisation to effectively recruit and retain participants into community-based healthy eating and/or physical activity programs. Transcribed data were analysed with NVivo software.
Results:
Effective recruitment strategies included word of mouth, links with organisations, dissemination of printed materials, media, referrals, cross-promotion of programs and face-to-face methods. Effective retention strategies included encouraging a sense of community ownership, social opportunities, recruiting a suitable leader and offering flexibility and support. Fees and support for recruiting and retaining participants was also identified.
Conclusion:
This study provides novel insights to a greatly under researched topic in the field of health promotion. There are two key take-home messages from the present study that are applicable to health practitioners as well as developers and deliverers of community health-promotion programs: (1) it is imperative that all community health organisations report on the effectiveness of their recruitment and retention, both successes and failures; and (2) there is a clear need to tailor the recruitment and retention approach to the target population and the setting the program is occurring in.
So what?
These findings provide important insights for the development of future community-based healthy eating and physical activity programs.
Resumo:
The challenges of nation building in Melanesia and Timor-Leste have often been neglected in the regional focus on state-building challenges. High levels of ethno-linguistic diversity, combined with an array of regional, historical and cultural divisions, continue to present obstacles to the creation of a cohesive sense of national political community leading these nations to be labelled ‘fragile’. This paper presents the findings of a comparative study on the attitudes of tertiary students in Melanesia and Timor-Leste to national identity and nation building. A strong pan-Melanesian pattern of group identification was identified, common to Papua New Guinea, Solomon Islands and Vanuatu. The ongoing importance of traditional authority and custom in informing conceptions of political community and identity was evident in all four case study sites, but was in each case matched by indicators of respect for modern state authority. The survey also reveals some significant gender differences in key attitudes towards national identity, including the role of traditional authorities. Most importantly, the study reveals high degrees of national pride, and faith in democratic principles and citizenship; but conversely, low levels of pride in contemporary democratic performance and inter-group tolerance.
Resumo:
Nation-building remains a key challenge in Vanuatu. From the origins of this new nation in 1980, it was clear that creating a unifying sense of national identity and political community from multiple languages and diverse traditional cultures would be difficult. This paper presents new survey and focus group data on attitudes to national identity among tertiary students in Vanuatu. The survey identifies areas of common attitudes towards nationalism and national identity, shared by both Anglophone and Francophone Ni-Vanuatu. However, despite the weakening ties between language of education and political affiliation over recent years, the findings suggest that there remain some key areas of strong association between socio-linguistic background, and attitudes to the nation, and national identity. These findings cast new light on the attitudes of likely future elites towards regional, ethnic, intergenerational and linguistic fault lines in Vanuatu and the challenges of building a cohesive sense of political community and national identity.
