The Norwegian "Campaign Against Home Accidents" was launched nationwide during 1988 to 1991, with the goal of reducing the incidence of home accidents by 20%. The aim of the campaign was to urge primarily the municipal health services to form local accident prevention groups and to implement local measures for prevention of home accidents. On the basis of two surveys, after one year and at the end of the national campaign, an evaluation was carried out concerning the participation of the municipal health services in the campaign and the impact of the campaign on local accident prevention activities. The results indicate that the national campaign engaged the majority of the municipalities and stimulated local accident prevention work to some extent. Most local activities were health education measures, whereas environmental intervention were less commonly reported. Involvement in the campaign was the variable most related to level of accident prevention activities at the end of the campaign period. However, the relationship was only modest. Restricted economical resources, too little emphasis on environmental change, lack of political involvement and insufficient use of coalition partners at the community level are suggested as the major explanations for the limited effect of the campaign.
OBJECTIVE: Streptococcus pneumoniae (S. pneumoniae) causes significant mortality throughout the United States and greater mortality among American Indian/Alaska Natives. Vaccination reduces S. pneumoniae illness. We describe the methods used to achieve the Healthy People 2010 coverage rate goals for adult pneumococcal vaccine among those at high risk for severe disease in this population. METHODS: We implemented a pneumococcal vaccination project to bolster coverage followed by an ongoing multidisciplinary program. We used community, home, inpatient, and outpatient vaccinations without financial barriers together with data improvement, staff and patient education, standing orders, and electronic and printed vaccination reminders. We reviewed local and national coverage rates and queried our electronic database to determine coverage rates. RESULTS: In 2007, pneumococcal vaccination coverage rates among people > or = 65 years of age and among high-risk people aged 18-64 years were 96.0% and 61.2%, respectively, exceeding Healthy People 2010 goals. Government Performance and Results Act analyses reports revealed a 2.7-fold increase (36.0% to 98.0%) of coverage from 2000 to 2007 among people > or = 65 years of age at Whiteriver Service Unit in Whiteriver, Arizona. CONCLUSIONS: We achieved pneumococcal vaccination rates in targeted groups of an American Indian population that reached Healthy People 2010 goals and were higher than rates in other U.S. populations. Our program may be a useful model for other communities attempting to meet Healthy People 2010 goals.
Department of Social and Preventive Medicine, Centre de recherche Léa-Roback sur les inégalités sociales de santé de Montréal & IRSPUM, Université de Montréal Public Health Research Institute, Québec, Canada. Sherri.Bisset@criucpq.ulaval.ca
To describe how and why nutritionists implement and strategize particular program operations across school contexts.
Instrumental case study with empirical propositions from Actor-Network Theory (ANT). Data derived from interviews with interventionists and observations of their practices.
Seven primary schools from disadvantaged Montreal neighborhoods.
Six nutritionists implementing the nutrition intervention in grades 4 and 5. From 133 nutrition workshops held in 2005/06, 31 workshops were observed with audio-recordings.
Little Cooks--Parental Networks aims to promote healthy eating behaviors through engagement in food preparation and promotion of nutrition knowledge.
The program-context interface where interventionists' practices form interactively within a given social context.
Coding inspired by ANT. Interview analysis involved construction of collective implementation strategies. Observations and audio-recordings were used to qualify and quantify nutritionists' practices against variations in implementation.
Nutritionists privileged intervention strategies according to particularities of the setting. Some such variation was accounted for by school-level social conditions, individual preferences and nutritionists' past experiences.
Implementation practices are strategic and aim to engage educational actors to achieve intervention goals. These results challenge implementation frameworks centered on purely technical considerations that exclude the social and interpretive nature of practice.
Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, MS F-10, 4770 Buford Highway, Atlanta, Ga. 30341, USA. JLCleveland@cdc.gov
The authors set out to identify factors associated with implementation by U.S. dentists of four practices first recommended in the Centers for Disease Control and Prevention's Guidelines for Infection Control in Dental Health-Care Settings-2003.
In 2008, the authors surveyed a stratified random sample of 6,825 U.S. dentists. The response rate was 49 percent. The authors gathered data regarding dentists' demographic and practice characteristics, attitudes toward infection control, sources of instruction regarding the guidelines and knowledge about the need to use sterile water for surgical procedures. Then they assessed the impact of those factors on the implementation of four recommendations: having an infection control coordinator, maintaining dental unit water quality, documenting percutaneous injuries and using safer medical devices, such as safer syringes and scalpels. The authors conducted bivariate analyses and proportional odds modeling.
Responding dentists in 34 percent of practices had implemented none or one of the four recommendations, 40 percent had implemented two of the recommendations and 26 percent had implemented three or four of the recommendations. The likelihood of implementation was higher among dentists who acknowledged the importance of infection control, had practiced dentistry for less than 30 years, had received more continuing dental education credits in infection control, correctly identified more surgical procedures that require the use of sterile water, worked in larger practices and had at least three sources of instruction regarding the guidelines. Dentists with practices in the South Atlantic, Middle Atlantic or East South Central U.S. Census divisions were less likely to have complied.
Implementation of the four recommendations varied among U.S. dentists. Strategies targeted at raising awareness of the importance of infection control, increasing continuing education requirements and developing multiple modes of instruction may increase implementation of current and future Centers for Disease Control and Prevention guidelines.
Erratum In: J Am Dent Assoc. 2012 Dec;143(12):1289
The Alberta Cardiac Access Collaborative (ACAC) is a joint initiative of Alberta's health system to improve access to adult cardiac services across the patient journey. ACAC has created new care delivery models and implemented best practices across Alberta in four streams across the continuum: heart attack, patient navigation, heart failure and arrhythmia. Emergency medical providers, nurses, primary care physicians, hospitals, cardiac specialists and clinicians are all working together to integrate services, bridge jurisdictions and geography with one aim--improving the patient journey for adults in need of cardiac care.
This paper describes the development and characteristics of a comprehensive, integrated and sustained program for the education, recruitment and retention of physicians for rural practice in Alberta--the Rural Physician Action Plan. The participation of key stakeholders (including government, the provincial medical association, the licensing authority, faculties of medicine, practising rural physicians and regional health authorities) and a sustained program budget have been key organizational issues for success. Critical to the effectiveness of this program has been the focus on professional and lifestyle issues targeting 3 distinct groups: physicians in training, physicians in practice, and rural communities and health authorities. Substantial program funding since 1991-92 of up to $3 million per year has increased rural-based activities significantly. For example, 87% of medical students and 91% of residents in family medicine in Alberta now experience 4 weeks or more of rural practice. The authors believe that the historic issues and recent trends militating against recruitment and retention of rural physicians will continue unchecked without comprehensive and sustained approaches such as Alberta's Rural Physician Action Plan.
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Comment In: CMAJ. 1998 May 19;158(10):1269; author reply 1269-709614816
Comment In: CMAJ. 1998 May 19;158(10):1269; author reply 1269-709614817
Increasingly, nurses are expected to systematically improve their practice according to principles of evidence-based practice (EBP). In 2009, the Norwegian Radium Hospital, inspired by the EBP nursing model at its sister institution, The University of Texas MD Anderson Cancer Center, began transitioning its oncology nurses to an EBP model. Norwegian Radium Hospital nursing leaders selected an EBP expert to design an EBP educational program. The program consisted of a 1-semester, 15-credit-hour postgraduate EBP course followed by a clinical practicum during which selected nurses worked in groups to apply principles of EBP to challenging clinical questions. As of this writing, 60 staff nurses have completed the program. Nurses participating in the EBP program have developed 13 evidence-based clinical guidelines, evidence-based clinical procedures, and patient information documents, 9 of which have been adopted as national standards. Participants have demonstrated increased confidence in providing the best available patient care, deeper reflection about their practice, and a sense of being valued by their nurse and physician colleagues. At the institutional level, the EBP project has resulted in higher confidence that patients are receiving patient-centered care based on the best scientific evidence. The project has also resulted in increased collaboration between nurses and other practitioners within multidisciplinary clinical problem-solving teams. This successful EBP program could serve as a model for other cancer hospitals desiring to move to an EBP patient-care model, not only for nursing practice but also, more broadly, for delivery of cancer care by diverse multidisciplinary teams.
Anterior uveitis can be the result of a number of underlying etiologies and is commonly seen in ophthalmology practice. The clinician must choose from a battery of potential investigations. A nonselective approach to testing is costly and inefficient and can lead to misinterpretation of false positive results. The purpose of this study was to identify investigation patterns of ophthalmologists in Canada for anterior uveitis and to make evidence-based recommendations for appropriate tests that could lead to improved patient care and more cost-effective use of health care resources.
A cross-sectional survey of practicing ophthalmologists, fellows, and residents in Canada was conducted in September 2004. The survey instrument was an 11-item questionnaire mailed to 1196 physicians in Canada.
A total of 498 (42%) physicians responded to the survey. A wide range of tests were chosen when respondents were presented with 5 scenarios for anterior uveitis and asked what investigations they would order. Many of these tests have low diagnostic yields because they lack the sensitivity and specificity to be used as routine investigations in the setting of anterior uveitis.
Increased education and awareness could lead to more cost-effective and efficient investigations in the setting of anterior uveitis. On the basis of evidence from a review of the literature, we make recommendations for investigations that should be considered in patients with anterior uveitis.