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Patient Demand (patient + demand)
Selected AbstractsA Bayesian Approach to Prediction Using the Gravity Model, with an Application to Patient Flow ModelingGEOGRAPHICAL ANALYSIS, Issue 3 2000Peter Congdon This paper investigates the potential for estimation and prediction by Bayesian methods of hospitalization flows classified by place of residence and hospital site. The focus is especially with respect to emergency (unplanned) admissions to hospitals. The need for strategic modeling and forecasting arises since the structure of U.K. emergency service provision is subject to changes involving site closures or changes in bed numbers. The gravity model, reflecting patient demand, hospital supply, and distance effects has been applied to patient flows, but generally in a situation of unchanged destination states. It may be modified, however, in accordance with major changes in hospital service structure, to include access effects (the interplay of supply and distance) and temporal variation in its parameters. Therefore, prediction may be applied to a "new" situation defined, for example, by closures of entire hospital sites. The modeling approach used may be adapted to other flow models where destinations may be added or eliminated (for example, trade-area models). A case study involves a sector of London subject to such a restructuring following the U.K. government's 1997,98 review of London's emergency services. [source] An overview of pharmaceutical policy in four countries: France, Germany, the Netherlands and the United KingdomINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 4 2005Elias Mossialos The regulation of pharmaceutical markets is an important policy concern in many countries, and is generally undertaken with cost containment, efficiency, quality and equity objectives in mind. This article presents an overview of the demand-side and supply-side regulatory measures that have been introduced in four European countries, namely France, Germany, the Netherlands and the United Kingdom. More specifically, after considering some of the trends in pharmaceutical expenditure in these four countries over recent decades, the article considers the policies that have been introduced to influence patient demand, health care provider behaviour and the pharmaceutical industry. Since many of the policies are concurrently applied, it is difficult to assess the isolated impact of each, particularly because the effect of particular policies may often be country specific. However, it is clear that there is no overriding perfect solution to balancing the cost containment, efficiency, quality and equity objectives in pharmaceutical policy. No one policy or policy combination is right for all countries, and different countries will need to meet their own objectives through policy approaches that reflect their own particular environment. Copyright © 2005 John Wiley & Sons, Ltd. [source] Games Hospitals Play: Entry Deterrence in Hospital Procedure MarketsJOURNAL OF ECONOMICS & MANAGEMENT STRATEGY, Issue 3 2005Leemore S. Dafny Strategic investment models, though popular in the theoretical literature, have rarely been tested empirically. This paper develops a model of strategic investment in inpatient procedure markets, which are well-suited to empirical tests of this behavior. Potential entrants are easy to identify in such markets, enabling the researcher to accurately estimate the entry threat faced by different incumbents. I derive straightforward empirical tests of entry deterrence from a model of patient demand, procedure quality, and differentiated product competition. Using hospital data on electrophysiological studies, an invasive cardiac procedure, I find evidence of entry-deterring investment. These findings suggest that competitive motivations play a role in treatment decisions. [source] Predictors of Home Healthcare Nurse RetentionJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2008Carol Hall Ellenbecker Purpose:To examine the level of job satisfaction and test a theoretical model of the direct and indirect effects of job satisfaction, and individual nurse and agency characteristics, on intent to stay and retention for home healthcare nurses. Design:A descriptive correlation study of home healthcare nurses in six New England states. Methods:Home healthcare nurse job satisfaction self-report data was collected with the HHNJS survey questionnaire & Retention Survey Questionnaire. Findings:Based on a structural equation model, job tenure and job satisfaction were the strongest predictors of nurse retention. Conclusions:Understanding the variables associated with home healthcare nurse retention can help agencies retain nurses in a time of severe nurse shortages and increased patient demand. Clinical Relevance:Predicted nursing shortages and increasing demand have made the retention of experienced, qualified nursing staff essential to assure access to high-quality home healthcare services in the future. [source] Patient-maintained propofol sedation: a follow-up safety study using a modified system in volunteersANAESTHESIA, Issue 4 2002F. Henderson Summary Patient-maintained sedation is a mode of patient-controlled sedation during which propofol is administered using a target-controlled infusion, with patient demand increasing the target concentration. A system tested previously for safety in our institution resulted in oversedation. Aiming to improve safety, we modified the system by increasing the lockout period to 4 min, reducing the starting concentration to 0.5 µg.ml,1 and the increments on demand to 0.1 µg.ml,1. As in the previous study, healthy volunteers attempted to render themselves unconscious by frequently pressing the demand button. To assess effects on memory, volunteers were given keywords to remember every 15 min. The maximum target concentration reached varied between 1.0 and 2.5 µg.ml,1. No volunteers lost consciousness, however, one volunteer had a brief period of apnoea and oxygen desaturation. The Cp50 for loss of memory for words was 1.26 µg.ml,1. Although this version represents an improvement, we conclude that the system is not yet completely suitable for use without anaesthetic supervision. [source] ROLE OF AXILLARY SURGERY IN EARLY BREAST CANCER: REVIEW OF THE CURRENT EVIDENCEANZ JOURNAL OF SURGERY, Issue 7 2000Andrew J. Spillane Background: Controversy continues to surround the best practice for management of the axilla in patients with early breast cancer (EBC), particularly the clinically negative axilla. The balance between therapeutic and staging roles of axillary surgery (with the consequent morbidity of the procedures utilized) has altered. This is due to the increasing frequency of women presenting with early stage disease, the more widespread utilization of adjuvant chemoendocrine therapy and, more recently, the advent of alternative staging procedures, principally sentinel node biopsy (SNB). The aim of the present review is to critically analyse the current literature concerning the preferred management of the axilla in early breast cancer and make evidence-based recommendations on current management. Methods: A review was undertaken of the English language medical literature, using MEDLINE database software and cross-referencing major articles on the subject, focusing on the last 10 years. The following combinations of key words have been searched: breast neoplasms, axilla, axillary dissection, survival, prognosis, and sentinel node biopsy. Results: Despite the trend to more frequent earlier stage diagnosis, levels I and II axillary dissection remain the treatment of choice in the majority of women with EBC and a clinically negative axilla. Conclusions: Sentinel node biopsy has no proven superiority over axillary dissection because no randomized controlled trials have been completed to date. Despite this, SNB will become increasingly utilized due to encouraging results from major centres responsible for its development, and patient demand. Therefore if patients are not being enrolled in clinical trials strict quality controls need to be established at a local level before SNB is allowed to replace standard treatment of the axilla. Unless this is strictly adhered to there is a significant risk of an increase in the frequency of axillary relapse and possible increased understaging and resultant inadequate treatment of patients. [source] 2241: Principles of genetic counsellingACTA OPHTHALMOLOGICA, Issue 2010G HALL Purpose To present the genetic counselling needs of families with inherited eye disease. Methods A presentation on the counselling challenges and ethical dilemmas in genetic services for inherited eye disease using case illustrations and review of research and current literature. Results Genetic counselling for families with inherited eye disease is rapidly advancing with improvements in molecular testing leading to accurate diagnosis and information for families. With increasing patient demand and expectation, families request genetic counselling to understand the inheritance pattern and the risks to themselves and their children. However, the heterogeneity, variable penetrance and overlapping phenotypes make this particularly challenging in genetic eye disease. Genetic counselling is a communication process to provide information about the genetic condition, its inheritance and to facilitate decision-making around genetic testing and reproduction. Genetic counsellors have experience in helping individuals decide and come to terms with results from genetic testing such as pre-symptomatic testing, childhood testing and pre-natal diagnosis. In addition, families are often coping with the psychological burden of progressive blindness and the impact of vision loss and risk to other family members. Recent publications highlight the disparity in specialist service provision for families with inherited eye disease and calls for research and improvements in evidenced-based practice. Conclusion Families with inherited eye disease have complex genetic counselling needs requiring multidisciplinary co-ordination of services for accurate diagnosis, information provision, genetic testing and decision-making, and support and follow-up. [source] Would the elderly be better off if they were given more placebos?GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2 2010E Paul Cherniack Placebos are useful in the medical care of the elderly, although the exact definition of a "placebo" or "placebo effect" is difficult to define precisely. They have an important role as control treatments in research trials, but a non-specific "placebo effect" may also be beneficial part of many physician,patient interactions. Physicians also give them deliberately according to several studies worldwide to satisfy patient demands or because they believe in a "placebo effect" among other reasons. A significant placebo effect has been observed among older patients in clinical trials of antidepressants (12,15%), and in treatments of Parkinson's disease (16%). Placebos activate serotonergic pathways in the brain used by antidepressants. In Parkinson's disease, the administration of a placebo stimulates dopamine release in the dorsal (resulting in motor effects) and ventral striatum (which influences expectation of reward). Much of our understanding of the placebo effect comes from studies of placebo analgesia which is influenced by conditioning, expectation, meaning and context of the treatment for the patient, and patient,physician interaction. It is anatomically medicated by brain opioid pathways. Response to "sham" acupuncture in osteoarthritis may be an example of its use in the elderly. Placebos have often been considered a deception and thus unethical. On the other hand, some physicians and ethicists have suggested conditions for appropriate uses for placebos. A placebo might offer the theoretical advantage of an inexpensive treatment that would not cause adverse drug reactions or interactions with other medications, potentially avoiding complications of polypharmacy. [source] Bilaminar techniques for the treatment of recession-type defects.JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 10 2003A comparative clinical study Abstract Objectives: Complete root coverage is the primary objective to be accomplished when treating gingival recessions in patients with aesthetic demands. Furthermore, in order to satisfy patient demands fully, root coverage should be accomplished by soft tissue, the thickness and colour of which should not be distinguishable from those of adjacent soft tissue. The aim of the present split-mouth study was to compare the treatment outcome of two surgical approaches of the bilaminar procedure in terms of (i) root coverage and (ii) aesthetic appearance of the surgically treated sites. Material and Methods: Fifteen young systemically and periodontally healthy subjects with two recession-type defects of similar depth affecting contralateral teeth in the aesthetic zone of the maxilla were enrolled in the study. All recessions fall into Miller class I or II. Randomization for test and control treatment was performed by coin toss immediately prior to surgery. All defects were treated with a bilaminar surgical technique: differences between test and control sites resided in the size, thickness and positioning of the connective tissue graft. The clinical re-evaluation was made 1 year after surgery. Results: The two bilaminar techniques resulted in a high percentage of root coverage (97.3% in the test and 94.7% in the control group) and complete root coverage (gingival margin at the cemento-enamel junction (CEJ)) (86.7% in the test and 80% in the control teeth), with no statistically significant difference between them. Conversely, better aesthetic outcome and post-operative course were indicated by the patients for test compared to control sites. Conclusions: The proposed modification of the bilaminar technique improved the aesthetic outcome. The reduced size and minimal thickness of connective tissue graft, together with its positioning apical to the CEJ, facilitated graft coverage by means of the coronally advanced flap. Zusammenfassung Hintergrund: Die vollständige Deckung der Wurzeloberfläche ist das primäre Ziel, das bei der Therapie von fazialen Rezessionen bei Patienten mit ästhetischen Ansprüchen erreicht werden soll. Weiterhin sollte die Rezessionsdeckung, wenn sie den Ansprüchen des Patienten vollends entsprechen soll, mit einer Dicke und Farbe der Gingiva erreicht werden, die nicht vom benachbarten Gewebe zu unterscheiden sind. Zielsetzung: Vergleich der Therapieergebnisse von 2 chirurgischen Varianten der zweischichtigen Technik im Halbseitenversuch hinsichtlich (1) Rezessionsdeckung und (2) ästhetischer Erscheinung der chirurgisch behandelten Stellen. Material und Methoden: 15 junge und parodontal gesunde Personen mit jeweils 2 Rezessionsdefekten ähnlicher Größe an kontralateralen Zähnen im ästhetischen Bereich des Oberkiefers wurden in die Studie aufgenommen. Alle Rezessionen gehörten in die Miller-Klassen I oder II. Die Randomisierung für die Test- und Kontrollbehandlung erfolgte unmittelbar präoperativ durch Münzwurf. Alle Defekte wurden nach einer zweischichtigen chirurgischen Technik behandelt: Die Unterschiede zwischen Test- und Kontrollstellen bestanden in Größe, Dicke und Positionierung des Bindegewebstransplantates. Die klinische Nachuntersuchung erfolgte 1 Jahr postoperativ. Ergebnisse: Beide zweischichtigen Techniken führten zu einem hohen Prozentsatz von Wurzeldeckung (Test: 97,3%; Kontrolle: 94,7%) und kompletter Wurzeldeckung (Gingivarand an der Schmelz-Zement-Grenze [SZG]) (Test: 86,7%; Kontrolle: 80%) ohne statistisch signifikante Unterschiede zwischen beiden Gruppen. Allerdings wurden mit der Testtherapie bessere ästhetische Ergebnisse erzielt als mit der Kontrollbehandlung. Schlussfolgerung: Die vorgestellte Modifikation der zweischichtigen Technik verbesserte die ästhetischen Ergebnisse. Die reduzierte Größe und minimale Dicke des Bindegewebstransplantates zusammen mit seiner Positionierung apikal der SZG erleichterten eine Deckung mittels eines koronalen Verschiebelappens. Résumé Objectif: Un recouvrement complet de la racine est le premier objectif lorsque l'on traite des récessions gingivales chez les patients ayant une demande esthétique. De plus, afin de satisfaire totalement la demande du patient, cette couverture radiculaire doit aussi être réalisé par des tissus mous de couleur et d'épaisseur qui ne se distinguent pas des tissus mous adjacents. Le but de cette étude en bouche séparée était de comparer le devenir de deux approches chirurgicales de la technique bilaminaire pour (i) le recouvrement de la racine et (ii) l'apparence esthétique des sites traités chirurgicalement. Matériel et Méthodes: 15 sujets jeunes et indemnes de maladie parodontale et systèmique présentant deux récessions de profondeur similaires sur des dents contralatérales dans des zones esthétiques du maxillaire furent enrollés dans cette étude. Toutes les récessions étaient des classes I ou II de Miller. La répartition pour les traitements test ou contrôle fut tirée à pile ou face juste avant la chirurgie. Toutes les lésions furent traitées par la technique bilaminaire, la différence entre les groupes résidant dans la taille, l'épaisseur et le positionnement du greffon de tissus conjonctif. La réévaluation clinique fut faite un an après la chirurgie. Résultats: Les deux techniques bilaminaires ont entrainé un fort pourcentage de recouvrement radiculaire (97.3% pour le groupe test et 94.7% pour le groupe contrôle) et le recouvrement complet (gencive marginale au niveau de la CEJ) (86.7% dans le groupe test et 80% pour le groupe contrôle) sans différence statistiquement significative entre elles. Par contre, un meilleur rendu esthétique et suites post opératoires furent rapportés par les patients pour le traitement test. Conclusions: La modification proposée de cette technique bilaminaire améliore le devenir esthétique. La taille réduite et l'épaisseur minimale greffon conjonctif et son positionnement apical au CEJ, ont facilité le recouvrement du greffon par le lambeau déplacé coronairement. [source] A case of discoid lupus erythematosus of the eyelidTHE JOURNAL OF DERMATOLOGY, Issue 5 2006Monji KOGA ABSTRACT A 39-year-old man was first evaluated 12 years ago for erosive erythema of the left lower eyelid. The response to topical therapy was poor. The eyelid lesion was excised on the patient's demand 6 years ago and blepharoplasty was performed. However, recurrence of erythematous plaques at the same site prompted referral to our department. Examination clinically revealed atrophic erythematous plaques and several white papules on the left lower eyelid, in addition to an atrophic erythema of the upper back. The histopathological findings of both plaques and papules were typical of discoid lupus erythematosus. Immunoserological findings suggestive of systemic lupus erythematosus were absent. The lesions improved with administration of low-dose corticosteroids. Discoid lupus erythematosus involving the eyelid is rare, and definitive diagnosis often takes considerable period of time. In patients with lesions of the eyelid such as erythema or papules that are refractory to treatment, skin biopsy and careful physical examination of the entire body for similar lesions are important. [source] Computer-assisted implantology: historical background and potential outcomes,a reviewTHE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 2 2008Abbas Azari Abstract Background The accurate transfer of preoperatively determined implant positions to the patient mouth is very beneficial to the dental practitioner as well as patients. The objective of this paper was to review the gradual development of computer-assisted implant surgery. Methods All of the major data sources including unpublished data in the internet are considered Results and Conclusions Computer-assisted/-guided/-aided implantology has been founded to overcome the errors encountered during implant osteotomies and to position the implants more precisely. The protocols followed by this sophisticated technique are based upon the advocated concept of prosthetic-driven implantology and CT-scan analysis recently approved. Although several attempts have been made to improve this approach more and more, little has been done regarding the patient's demands, including cost. The inherent complexity of the techniques and materials utilized necessitates several degrees of training before attempting treatment and must be taken into account. Copyright © 2008 John Wiley & Sons, Ltd. [source] | ||||||||||