Primary care nurses: effects on secondary care referrals for diabetes

Background: Primary care nurses play an important role in diabetes care, and were introduced in GP-practice partly to shift care from hospital to primary care. The aim of this study was to assess whether the referral rate for hospital treatment for diabetes type II (T2DM) patients has changed with the introduction of primary care nurses, and whether these changes were related to the number of diabetes-related contacts in a general practice. Methods: Healthcare utilisation was assessed for a period of 365 days for 301 newly diagnosed and 2124 known T2DM patients in 2004 and 450 and 3226 patients in 2006 from general practices that participated in the Netherlands Information Network of General Practice (LINH). Multilevel logistic and linear regression analyses were used to analyse the effect of the introduction of primary care nurses on referrals to internists, ophthalmologists and cardiologists and diabetes-related contact rate. Separate analyses were conducted for newly diagnosed and known T2DM patients. Results: Referrals to internists for newly diagnosed T2DM patients decreased between 2004 and 2006 (OR:0.44; 95%CI:0.22-0.87) in all practices. For known T2DM patients no overall decrease in referrals to internists was found, but practices with a primary care nurse had a lower trend (OR:0.59). The number of diabetes-related contacts did not differ between practices with and without primary care nurses. Cardiologists’ and ophthalmologists’ referral rate did not change. Conclusions: The introduction of primary care nurses seems to have led to a shift of care from internists to primary care for known diabetes patients, while the diabetes-related contact rate seem to have remained unchanged.

An introduction to the collaborative methodology and its potential use for the management of heart failure

BACKGROUND: Heart failure (HF) is responsible for significant disease burden in developed countries internationally. Despite significant advances and a strong evidence base in therapies and treatment strategies for HF, access to these therapies continues to remain elusive to a significant proportion of the HF population. The reasons for this are multifactorial and range from the financial cost of treatments to the individual attitudes and beliefs of clinicians. The collaborative methodology, based upon a quality improvement philosophy, has been identified as a potentially useful tool to address this treatment gap. AIM: In this manuscript, we review the published literature on the collaborative methodology and assess the evidence for achieving improvement in the management of HF. METHODS: Searches of electronic databases, the reference lists of published materials, policy documents, and the Internet were conducted using key words including collaborative methodology, breakthrough series, quality improvement, total quality improvement, and heart failure. Because of the paucity of high-level evidence, all English-language articles were included in the review. RESULTS: On the basis of the identified search strategy, 43 articles were retrieved. Key themes that emerged from the literature included the following: (1) The collaborative methodology has a significant potential to reduce the treatment gap. (2) Leadership is an important characteristic of the collaborative method. (3) The collaborative methodology facilitates sustainability of the quality improvement process. CONCLUSION: The collaborative methodology, when implemented and conducted according to key conceptual principles, has significant potential to improve the outcomes of patients, particularly those with HF and chronic cardiovascular disease

Status reports to the Paper Properties and Uses Project Advisory Committee, April 1-2, 1986

"April 1-2, 1986."Project 3526. Internal strength enhancement / R. Stratton, J. Becher, K. Hardacker -- Project 3571. Board properties and performance / W. J. Whitsitt, R. A. Halcomb -- Project 3469. Strength improvement and failure mechanisms / J. Waterhouse, W. Whitsitt -- Project 3467. Process, properties and product relationships / G. A. Baum, C. C. Habeger -- Project 3332. On-line measurement of paper mechanical properties / C. C. Habeger, G. A. Baum

Status report to the Paper Properties and Uses Project Advisory Committee, March 22-23, 1984.

"March 22-23, 1984."Copy 2 includes slide book.Project 3467. Process, properties, product relationships / G. A. Baum -- Project 3332. On-line measurement of paper mechanical properties / G. A. Baum, C. C. Habeger -- Project 3500. Shear deformation and failure / J. F. Waterhouse -- Project 3470. Fundamentals of drying / Fred Ahrens -- Project 3527. Measurement of fiber properties and fiber-to-fiber bonding / K. W. Hardacker, G. A. Baum -- Project 3526. Fundamentals of internal strength enhancement / R. A. Stratton, J. J. Becher -- Project 3396. Mechanics of fluting / W. J. Whitsitt -- Project 3469. Compressive strength / W. J. Whitsitt, J. F. Waterhouse -- Project 3272. Analysis of board structures / R. A. Halcomb, W. J. Whitsitt

Status reports to the Paper Properties and Uses Project Advisory Committee, October 25-26, 1984

"October 25-26, 1984."Project 3467. Process, properties, product relationships -- Project 3332. On-line measurement of paper mechanical properties -- Project 3500. Shear deformation and failure -- Project 3527. Measurement of fiber properties and fiber-to-fiber bonding -- Project 3501. Development of analytical techniques for characterizing wood and fiber and related exploratory research -- Project 3526. Fundamentals of internal strength enhancement -- Project 3469. Compressive strength -- Project 3571. Board properties and performance

Status reports to the Paper Properties and Uses Project Advisory Committee

"October 21-22, 1987."Board properties and performance: project 3571 / W. J. Whitsitt , R. A. Halcomb , J. Dess ; Process, properties, product relationships: project 3467 / G. A. Baum , C. C. Habeger ; Internal strength enhancement: project 3526 / R. Stratton , K. Hardacker ; Strength improvement and failure mechanisms / J. Waterhouse , W. Whitsitt ; On-line measurement of paper mechanical properties: project 3332 / C. C. Habeger , G. A. Baum , M. S. Hall

Status reports to the Paper Properties and Uses Project Advisory Committee

"April 2-3, 1985."Measurement of fiber properties and fiber-to-fiber bonding: project 3527 / K. W. Hardacker , G. A. Baum ; Fundamentals of internal strength enhancement: project 3526 / R. A. Stratton , J. J. Becher ; Compressive strength: project 3469 / W. J. Whitsitt , J. F. Waterhouse ; Board properties and performance: project 3571 / W. J. Whitsitt / R. A. Halcomb ; Combined stress and failure processes (formerly shear deformation and failure): project 3500 / J. F. Waterhouse ; Process, properties, product relationships: project 3467 / G. A. Baum / C. C. Habeger ; On-line measurements of paper mechanical properties: project 3332 / G. A. Baum , C. C. Habeger

Status reports to the Paper Properties and Uses Project Advisory Committee

"October 19-20, 1988."Copy 2 includes slide material.Strength improvement and failure mechanisms: project 3469 / J. Waterhouse ; Internal strength enhancement: project 3526 / R. Stratton, K. Hardacker ; Fundamentals of paper surface wettability: project 3646 / F. Etzler, R. Stratton ; Board properties and performance: project 3571 / W.J. Whitsitt, R.A. Halcomb, J. Dees ; Process, properties, product relationships: project 3467 / C. Habeger, K. Hardacker, Y. Pan ; On-line measurement of paper mechanical properties: project 3332/3613 / C. C. Habeger, M. S. Hall -- Slide material

Socioeconomic status and heart failure in Sydney

Background: Socioeconomic disadvantage is associated with an increased risk of developing heart failure and with inferior health outcomes following diagnosis. Methods: Data for hospitalisations and deaths due to heart failure in the Sydney metropolitan region were extracted from New South Wales hospital records and Australian Bureau of Statistics databases for 1999–2003. Standardised rates were analysed according to patients’ residential local government area and correlated with an index of socioeconomic disadvantage. Results: Eight of the 13 local government areas with standardised separation rate ratios significantly higher than all NSW, and those with the six highest standardised separation rate ratios, were in Greater Western Sydney. Rates of heart failure hospitalisations per local government area were inversely correlated with level of socioeconomic status. Conclusions: Higher rates of heart failure hospitalisations among residents of socioeconomically disadvantaged regions within Sydney highlight the need for strategies to lessen the impact of disadvantage and strategies to improve cardiovascular health

Status reports to the Paper Properties and Uses Project Advisory Committee

"October 21-22, 1986."Strength improvement and failure mechanisms: project 3469 / J. Waterhouse , W. Whitsitt ; Process, properties and product relationships: project 3467 ; G. A. Baum , C. C. Habeger ; Internal Strength enhancement: project 3526 / R. Stratton , J. Becher , K. Hardacker ; Board properties and performance: project 3571 ; W. J. Whitsitt , R. A. Halcomb ; On-line measurement of paper mechanical properties: project 3332 / C. Habeger , G. Baum -- Slide Material