Achievements of Siberian cardiologists in the epidemiology, diagnosis, treatment and prophylaxis of arterial hypertension and coronary heart disease are described with reference to specific conditions of Siberia and the Far East. Research priorities, such as problems of combined prophylaxis and the development of new methods for preventive check-ups of the population in Siberia are discussed.
In August 1995, the Ontario Ministry of Health (MOH) issued a request for proposal (RFP) for the establishment of new and expanded dialysis services. London Health Sciences Centre (LHSC) was successful in expanding its integrated dialysis delivery network with satellites in Stratford, Woodstock and Owen Sound. This achievement required collaboration of LHSC and host hospital staff to meet the challenging RFP requirements. With final approval received in January 1997, efforts were required to establish an operational model supporting self-care and full-care patients, to train satellite staff and patients, and to manage the resulting clinical impact. A balanced scorecard (Kaplan & Norton, 1992) evaluation model was developed. Initial outcome data indicate that full-care patients in satellites require more fallback support to London units, experience more hypotensive episodes during dialysis and, in some cases, demonstrate lower levels of dialysis adequacy and nutritional status when compared to satellite self-care patients. Findings from these data will assist in revising patient inclusion criteria and processes to optimize community-based dialysis.
This paper presents a model of an integrated Psychiatric Emergency Service serving Hamilton, a community of 450,000 in Southern Ontario. It describes the evolution of the service and how it has integrated five separate, hospital-run Emergency Psychiatric Services into a single service. The principles of the service and ways in which it operates are outlined and the advantages and drawbacks of the model are discussed. The authors conclude that such a model leads to a more efficient use of resources and is adaptable to most urban communities with a similar, or even larger population.
To determine whether a consensus exists among experts regarding the effect of organized trauma systems on patient outcomes based on peer-reviewed, published evidence. Second, to ascertain whether experts agree on the optimal structure of trauma systems.
A multistage, longitudinal survey was administered to trauma system experts participating in a national symposium designed to assess the published evidence regarding trauma system effectiveness. Survey questions assessed published evidence by evaluating study designs, potential biases, and sample case mix. Trauma system structure was assessed by asking participants to rate the merit of previously identified key trauma system characteristics. Analyses were conducted using consensus theory.
Ninety symposium participants (99%) completed all five surveys. Respondents considered the evidence to be "moderately supportive" of trauma system effectiveness when considering severely injured patients in urban settings. Several key trauma system characteristics were identified as mandatory or highly desirable components of trauma system implementation and maintenance. Experts currently favor exclusive rather than inclusive trauma systems.
A consensus does exist among trauma system experts regarding the effectiveness of trauma systems and the optimal structure of trauma systems. Additional research is needed to determine whether trauma system benefits extend to other patient subgroups in other geographic regions. Consensus theory provides an impressive model for assessing rater agreement by controlling for response bias and providing a probability measure to determine whether a true consensus exists.
Atlantic Canada has some of the earliest, most comprehensive, well-established networks, and innovative applications for telehealth in the country. The region offers a range of models for telehealth, in terms of management structure, coordination, funding, equipment, utilization, and telehealth applications. Collectively, this diversity, experience, and wealth of knowledge can significantly contribute to the development of a knowledge base for excellence in telehealth services. There is no formal process in place for the sharing of information amongst the provinces. Information sharing primarily occurs informally through professional contacts and participation in telehealth organizations. A core group of organizations partnered to develop a process for knowledge exchange to occur. This type of collaborative approach is favored in Atlantic Canada, given the region's economy and available resources. The Atlantic Telehealth Knowledge Exchange (ATKE) project centred on the development of a collaborative structure, information sharing and dissemination, development of a knowledge repository and sustainability. The project is viewed as a first step in assisting telehealth stakeholders with sharing knowledge about telehealth in Atlantic Canada. Significant progress has been made throughout the project in increasing the profile of telehealth in Atlantic Canada. The research process has captured and synthesized baseline information on telehealth, and fostered collaboration amongst telehealth providers who might otherwise have never come together. It has also brought critical awareness to the discussion tables of governments and key committees regarding the value of telehealth in sustaining our health system, and has motivated decision makers to take action to integrate telehealth into e-health discussions.
