Care System (care + system)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Care System

  • current health care system
  • foster care system
  • health care system
  • medical care system
  • primary care system

  • Selected Abstracts

    Long-Term Effectiveness of Screening for Hearing Loss: The Screening for Auditory Impairment,Which Hearing Assessment Test (SAI-WHAT) Randomized Trial

    Bevan Yueh MD
    OBJECTIVES: To evaluate the effect of hearing screening on long-term hearing outcomes in a general population of older veterans. DESIGN: Hearing loss in the elderly is underdetected and undertreated. Routine hearing screening has been proposed, but it is not clear whether screening identifies patients who are sufficiently motivated to adhere to treatment. A four-arm randomized clinical trial was conducted to compare three screening strategies with no screening in 2,305 older veterans seeking general medical care. SETTING: Veterans Affairs Puget Sound Health Care System. INTERVENTIONS: The screening strategies were a tone-emitting otoscope, a widely used questionnaire about hearing handicap, and a combination of both tools. MEASUREMENTS: Hearing aid use 1 year after screening. RESULTS: Of participants who underwent screening with the tone-emitting otoscope, questionnaire, and combined testing, 18.6%, 59.2%, and 63.6%, respectively, screened positive for hearing loss (P<.01 for test of equality across three arms). Patients proceeded to formal audiology evaluation 14.7%, 23.0%, and 26.6% of the time in the same screening arms, compared with 10.8% in the control arm (P<.01 for test of equality across four arms). Hearing aid use 1 year after screening was 6.3%, 4.1%, and 7.4% in the same arms, compared with 3.3% in the control arm (P<.01). Hearing aid users experienced significant improvements in hearing-related function and communication ability. CONCLUSION: In older veterans, screening for hearing loss led to significantly more hearing aid use. Screening with the tone-emitting otoscope was more efficient. The results are most applicable to older populations with few cost barriers to hearing aids. [source]

    Older Persons in the Emergency Medical Care System

    Jane McCusker
    No abstract is available for this article. [source]

    Economic crisis and challenges for the Greek healthcare system: the emergent role of nursing management

    notara v., koupidis s.a., vaga e. & grammatikopoulos i.a. (2010) Journal of Nursing Management18, 501,504 Economic crisis and challenges for the Greek healthcare system: the emergent role of nursing management Background, Despite several reform efforts, the Greek health care system still faces problems related to misdistribution of trained health staff and finance between geographical areas. Aim, The objectives of the present study were to describe the current situation of the delivery of the healthcare service in Greece, to explore the basic implications of the economic crisis from a nursing management perspective and to examine future practices opening a debate in policy developments. Key issue, The principal finding of this study was the serious shortage of trained nurses, the imbalances in nursing personnel, an excess of doctors and the complete absence of a Primary Healthcare System in civil areas provided by general doctors. Conclusion, It is important that health care policy makers become aware and seriously consider rearranging the Health Care System to become more effective and efficient for the population (client). Special attention should be paid to strengthening areas such as primary health care, public health and health promotion in the direction of minimizing the demand of hospital services. Implications for nursing management, Any implementation of major health care reforms should consider seriously the role of the nursing management which formulates the substantial link between the health services and the patient. [source]

    Introducing a Standardized Oxytocin-Dosing Protocol in a Multifacility Health Care System

    Professional Issues
    No abstract is available for this article. [source]

    Accountability in the Health Care System

    Barbara Peterson Sinclair MN
    No abstract is available for this article. [source]

    A Universal Healthcare System: Is It Right for the United States?

    NURSING FORUM, Issue 1 2007
    Marleise Rashford RN
    TOPIC.,A Universal Health Care System: Is it Right for the United States? The over 45 million Americans who are uninsured speak volumes about the problems with our present healthcare system. Many Americans do not have access to basic health care and it is time to revisit the importance of universal health care for all Americans. PURPOSE.,To gain a greater understanding of the facts, figures, and support for universal health care in America. SOURCE OF INFORMATION.,A literature review of five research studies. CONCLUSION.,The implementation of universal health care in America is a plausible feat, but the support of several facets of society is necessary for this to become a reality. [source]

    Rest Premature Ventricular Contractions on Routine ECG and Prognosis in Heart Failure Patients

    Vy-Van Le M.D.
    Background: Premature ventricular contractions (PVC) at rest are frequently seen in heart failure (HF) patients but conflicting data exist regarding their importance for cardiovascular (CV) mortality. This study aims to evaluate the prognostic value of rest PVCs on an electrocardiogram (ECG) in patients with a history of clinical HF. Methods and Results: We considered 352 patients (64 11 years; 7 females) with a history of clinical HF undergoing treadmill testing for clinical reasons at the Veterans Affairs Palo Alto Health Care System (VAPAHCS) (1987,2007). Patients with rest PVCs were defined as having ,1 PVC on the ECG prior to testing (n = 29; 8%). During a median follow-up period of 6.2 years, there were 178 deaths of which 76 (42.6%) were due to CV causes. At baseline, compared to patients without rest PVCs, those with rest PVCs had a lower ejection fraction (EF) (30% vs 45%) and the prevalence of EF , 35% was higher (75% vs 41%). They were more likely to have smoked (76% vs 55%). The all-cause and CV mortality rates were significantly higher in the rest PVCs group (72% vs 49%, P = 0.01 and 45% vs 20%, P = 0.002; respectively). After adjusting for age, beta-blocker use, rest ECG findings, resting heart rate (HR), EF, maximal systolic blood pressure, peak HR, and exercise capacity, rest PVC was associated with a 5.5-fold increased risk of CV mortality (P = 0.004). Considering the presence of PVCs during exercise and/or recovery did not affect our results. Conclusion: The presence of PVC on an ECG is a powerful predictor of CV mortality even after adjusting for confounding factors. Ann Noninvasive Electrocardiol 2010;15(1):56,62 [source]

    A Reason for Optimism in Rural Mental Health Care: Emerging Solutions and Models of Service Delivery

    Myra Elder Psychology Service
    This invited commentary responds to Jameson and Blank's literature review (2007) and utilizes different source materials, such as personal communications among clinicians and policymakers, Internet-based information, and direct professional experience. An update is provided regarding new graduate programs training clinicians for rural service. In addition, perceived barriers to treatment are challenged, because they are drawn from research results that could be interpreted in different ways, given the cultural heritage of southern and central Appalachian people. Lastly, the efforts of the Veterans Affairs Health Care System to reach rural citizens for mental health treatment are summarized. Some of these federal processes could be replicated at the state level, if sociopolitical and economic factors were more directly addressed. The commentary concludes, from the perspective of a professional providing clinical services in a rural setting, that a more optimistic outlook on the state of rural mental health care may be warranted. [source]

    Surge Capacity for Health Care Systems: Early Detection, Methodologies, and Process

    Peter L. Estacio PhD
    Excessive demand on hospital services from large-scale emergencies is something that every emergency department health care provider and hospital administrator knows could happen at any time. Nowhere in this country have we recently faced a disaster of the magnitude of concern we now face involving agents of mass destruction or social disruption, especially those in the area of infectious diseases and radiological materials. The war on terrorism is not a conventional war, and terrorists may use any means of convenience to carry out their objectives in an unpredictable time line. Have we adequately prepared for the potentially excessive surge in demand for medical services that a large-scale event could bring to our medical care system? Are our emergency departments ready for such events? Surveillance systems, such as BioWatch, BioSense, the National Biosurveillance Integration System, and the countermeasure program BioShield, offer hope that we will be able to meet these new challenges. [source]

    Community Accountability among Hospitals Affiliated with Health Care Systems

    Jeffrey A. Alexander
    The shift from local, community-based hospitals to more complex, multilevel delivery systems raises questions about the community accountability exercised by hospitals. A national sample of community hospitals is the basis of this study, which examines the ways that community accountability is exercised by the governing boards of hospitals affiliated with health care systems and how such institutions compare with hospitals not affiliated with a health care system. Results indicate that hospitals display community accountability in a variety of ways. Boards of system-affiliated hospitals exercise community accountability most strongly in their information monitoring and reporting activities, whereas free-standing hospitals exercise community accountability through the structural and compositional attributes of their boards. Further, hospitals affiliated with different types of systems vary in the style and degree of accountability they demonstrate. [source]

    The Art and Science of Surge: Experience from Israel and the U.S. Military

    Boaz Tadmor MD
    In a disaster or mass casualty incident, health care resources may be exceeded and systems may be challenged by unusual requirements. These resources may include pharmaceuticals, supplies, and equipment as well as certain types of academic and administrative expertise. New agencies and decision makers may need to work together in an unfamiliar environment. Furthermore, large numbers of casualties needing treatment, newer therapies required to care for these casualties, and increased workforce and space available for these casualties all contribute to what is often referred to as "surge." Surge capacity in emergency care can be described in technical, scientific terms that are measured by numbers and benchmarks (e.g., beds, patients, and medications) or can take on a more conceptual and abstract form (e.g., decisions, authority, and responsibility). The former may be referred to as the "science" of surge, whereas the latter, an equal if not more important component of surge systems that is more conceptual and abstract, can be considered the "art" of surge. The experiences from Israel and the U.S. military may serve to educate colleagues who may be required to respond or react to an event that taxes the current health care system. This report presents concrete examples of surge capacity strategies used by both Israel and the U.S. military and provides solutions that may be applied to other health care systems when faced with similar situations. [source]

    Surge Capacity for Health Care Systems: Early Detection, Methodologies, and Process

    Peter L. Estacio PhD
    Excessive demand on hospital services from large-scale emergencies is something that every emergency department health care provider and hospital administrator knows could happen at any time. Nowhere in this country have we recently faced a disaster of the magnitude of concern we now face involving agents of mass destruction or social disruption, especially those in the area of infectious diseases and radiological materials. The war on terrorism is not a conventional war, and terrorists may use any means of convenience to carry out their objectives in an unpredictable time line. Have we adequately prepared for the potentially excessive surge in demand for medical services that a large-scale event could bring to our medical care system? Are our emergency departments ready for such events? Surveillance systems, such as BioWatch, BioSense, the National Biosurveillance Integration System, and the countermeasure program BioShield, offer hope that we will be able to meet these new challenges. [source]


    ABSTRACT Despite recent advances in ways to prevent transmission of HIV from a mother to her child during pregnancy, infants continue to be born and become infected with HIV, particularly in southern Africa where HIV prevalence is the highest in the world. In this region, emphasis has shifted from voluntary HIV counselling and testing to routine testing of women during pregnancy. There have also been proposals for mandatory testing. Could mandatory testing ever be an option, even in high-prevalence settings? Many previous examinations of mandatory testing have dealt with it in the context of low HIV prevalence and a well-resourced health care system. In this discussion, different assumptions are made. Within this context, where mandatory testing may be a strategy of last resort, the objections to it are reviewed. Special attention is paid in the discussion to the entrenched vulnerability of women in much of southern Africa and how this contributes to both HIV prevalence and ongoing challenges for preventing HIV transmission during pregnancy. While mandatory testing is ethically plausible, particularly when coupled with guaranteed access to treatment and care, the discussion argues that the moment to employ this strategy has not yet come. Many barriers remain for pregnant women in terms of access to testing, treatment and care, most acutely in the southern African setting, despite the presence of national and international human rights instruments aimed at empowering women and removing such barriers. While this situation persists, mandatory HIV testing during pregnancy cannot be justified. [source]

    Type 2 diabetes mellitus and obesity in sub-Saharan Africa

    Vivian C. Tuei
    Abstract While communicable diseases such as human immunodeficiency virus/acquired immune deficiency syndrome, malaria, and tuberculosis have continued to pose greater threats to the public health system in sub-Saharan Africa (SSA), it is now apparent that non-communicable diseases such as diabetes mellitus are undoubtedly adding to the multiple burdens the peoples in this region suffer. Type 2 diabetes mellitus (T2DM) is the most common form of diabetes (90,95%), exhibiting an alarming prevalence among peoples of this region. Its main risk factors include obesity, rapid urbanization, physical inactivity, ageing, nutrition transitions, and socioeconomic changes. Patients in sub-Saharan Africa also show manifestations of ,-cell dysfunction and insulin resistance. However, because of strained economic resources and a poor health care system, most of the patients are diagnosed only after they have overt symptoms and complications. Microvascular complications are the most prevalent, but metabolic disorders and acute infections cause significant mortality. The high cost of treatment of T2DM and its comorbidities, the increasing prevalence of its risk factors, and the gaps in health care system necessitate that solutions be planned and implemented urgently. Aggressive actions and positive responses from well-informed governments appear to be needed for the conducive interplay of all forces required to curb the threat of T2DM in sub-Saharan Africa. Despite the varied ethnic and transitional factors and the limited population data on T2DM in sub-Saharan Africa, this review provides an extensive discussion of the literature on the epidemiology, risk factors, pathogenesis, complications, treatment, and care challenges of T2DM in this region. Copyright 2010 John Wiley & Sons, Ltd. [source]

    On the justification for civil commitment

    G. Hyer
    This paper explores some of the controversies in the debate regarding the justification of civil commitment. The sometimes conflicting values reflected in the mental health legislation, human rights principles, moral philosophy and psychiatric professional standards are discussed. In spite of the often substantial use of civil commitment in many countries, there are almost no scientifically sound studies addressing the outcome of coercive treatment. The paper establishes that the traditional arguments in favour of civil commitment, like lack of insight and competence as well as the effectiveness of civil commitment, are poorly founded. The paper concludes that there seems to be a general agreement that civil commitment of patients who are dangerous to themselves or others should be the responsibility of the mental health care system, while civil commitment for treatment purposes is more controversial and hard to justify. [source]

    Vaccines, Viagra, and Vioxx: medicines, markets, and money,when life-saving meets life-style,

    David J. Triggle
    Abstract In this Commentary, life-style drugs will be termed as "those drugs for which there is a definable and real, but limited, therapeutic need, but a need that has been significantly stimulated by the cycle of pharmaceutical company advertising and pressure and public demand." The key to the continuing expansion of the life-style drug market is a progressive narrowing of the definition of "normal" coupled with campaigns launched by the pharmaceutical industry that persuade both patients and clinicians that a major and treatable disease does exist and that drug treatment, rather than acceptance of hair loss or occasional lack of sexual interest, and so on, is both necessary and appropriate. The expansion of the market for prescription drugs in this manner is now an integral part of the business model of the pharmaceutical industry. For society, the expanding role of these drugs, particularly those directed at "desires rather than diseases," raises ethical issues of our increasing obsession with a medically directed quest for perfection, and financial issues of the cost of this quest on the health care system and its priorities. For the pharmaceutical industry, there are questions of whether its role is life-saving or life-styling for a Huxleyan "Brave New World." Drug Dev Res 64:90,98, 2005. 2005 Wiley-Liss, Inc. [source]

    Impact of injecting drug use on mortality in Danish HIV-infected patients: a nation-wide population-based cohort study

    ADDICTION, Issue 3 2010
    Mette V. Larsen
    ABSTRACT Objectives To estimate the impact of injecting drug use (IDU) on mortality in HIV-infected patients in the highly active antiretroviral therapy (HAART) era. Design Population-based, nation-wide prospective cohort study in Denmark (the Danish HIV Cohort Study). Methods A total of 4578 HIV-infected patients were followed from 1 January 1997 or date of HIV diagnosis. We calculated mortality rates stratified on IDU. One-, 5- and 10-year survival probabilities were estimated by Kaplan,Meier methods, and Cox regression analyses were used to estimate mortality rate ratios (MRR). Results Of the patients, 484 (10.6%) were categorized as IDUs and 4094 (89.4%) as non-IDUs. IDUs were more likely to be women, Caucasian, hepatitis C virus (HCV) co-infected and younger at baseline; 753 patients died during observation (206 IDUs and 547 non-IDUs). The estimated 10-year survival probabilities were 53.2% [95% confidence interval (CI): 48.1,58.3] in the IDU group and 82.1% (95% CI: 80.7,83.6) in the non-IDU group. IDU as route of HIV infection more than tripled the mortality in HIV-infected patients (MRR: 3.2; 95% CI: 2.7,3.8). Adjusting for potential confounders did not change this estimate substantially. The risk of HIV-related death was not increased in IDUs compared to non-IDUs (MRR 1.1; 95% CI 0.7,1.7). Conclusions Although Denmark's health care system is tax paid and antiretroviral therapy is provided free of charge, HIV-infected IDUs still suffer from substantially increased mortality in the HAART era. The increased risk of death seems to be non-HIV-related and is due probably to the well-known risk factors associated with intravenous drug abuse. [source]

    5.2 Ethics, equity and global responsibilities in oral health and disease

    Martin Hobdell
    The charge of this Section is ethics and global responsibilities in oral health and disease. Oral health is determined by the same factors as those for general health. To a limited extent, the level of oral health care and dental education. The philosophy and organization of the health care system and dental education, therefore, are key determinants of oral health. Dental education has expanded in many countries where there has been an increase in wealth. Unfortunately, there has been no concomitant increase in the number of dental educators. This is a problem throughout the world. This present situation raises certain ethical issues with regard to professional responsibilities. It also raises some important questions for dental education. This Section has chosen to focus its efforts on examining two issues: , ,What can be done within dental schools? , ,What can be done external to dental schools , either individually or collectively? The best practices identified are more akin to goals, as it is recognized that, in a world in which there are enormous variations in economic, environmental, social, and cultural features, a single uniform set of practices is impracticable. The central core value identified is the realization by students, and faculty/teaching staff of the quest of life-long learning against a background of the social and ethical responsibilities of health professionals. The conclusion of the group is that biology is not the sole determinant of health. Understanding the role of social, economic, environmental and other factors in determining health status is critical if greater equity in dental education and care are to be achieved. [source]

    America's Health Care Safety Net Intact or Unraveling?

    Lynne D. Richardson MD
    Abstract In virtually every community in this nation, the emergency department (ED) is an integral part of the health care safety net, often serving as the only available point of access to the health care system for many vulnerable and disenfranchised individuals. The authors present a brief overview of the March 2000 report released by the Institute of Medicine that described and assessed the current status of the nation's health care safety net. The authors discuss the role of the ED as a safety net provider and as a window onto the status of the rest of the health care system. The authors describe the Andersen behavioral model of health services use and suggest it as a useful theoretical framework for emergency medicine researchers who are interested in studying these issues. [source]

    The Emergency Medical Treatment and Labor Act as a Federal Health Care Safety Net Program

    W. Wesley Fields MD
    Abstract Despite the greatest economic expansion in history during the 1990s, the number of uninsured U.S. residents surpassed 44 million in 1998. Although this number declined for the first time in recent years in 1999, to 42.6 million, the current economic slow-down threatens once again to increase the ranks of the uninsured. Many uninsured patients use hospital emergency departments as a vital portal of entry into an access-improverished health care system. In 1986, Congress mandated access to emergency care when it passed the Emergency Medical Treatment and Labor Act (EMTALA). The EMTALA statute has prevented the unethical denial of emergency care based on inability to pay; however, the financial implications of EMTALA have not yet been adequately appreciated or addressed by Congress or the American public. Cuts in payments from public and private payers, as well as increasing demands from a larger uninsured population, have placed unprecedented financial strains on safety net providers. This paper reviews the financial implications of EMTALA, illustrating how the statute has evolved into a federal health care safety net program. Future actions are proposed, including the pressing need for greater public safety net funding and additional actions to preserve health care access for vulnerable populations. [source]


    FAMILY COURT REVIEW, Issue 2 2010
    Miriam Aroni Krinsky
    Every year close to 25,000 youth age out of our foster care system; without the anchor of a family, former foster youth disproportionately join the ranks of the homeless, incarcerated, and unemployed. While the average age of financial independence in America is twenty-six years of age, we presume that foster youth can somehow attain financial and emotional independence by age eighteen. Instead, these adolescents are woefully unprepared for independent adult life, and when they falter, too often no one is there to provide support or guidance. As a result, former foster youth are ten times more likely to be arrested than youth of the same age, race, and sex and one in four youth who age out of foster care will end up in jail within the first two years after leaving care. This article will discuss strategies for changing these disheartening outcomes for transitioning foster youth, including breaking down our silos and collectively taking charge of the lives of children in our care; keeping a watchful eye on data and outcomes and using that information to guide our actions; ensuring that the voices of youth are an ever-present part of decisions and processes that will chart their future; and educating ourselves about best practices and new approaches. This article also discusses new opportunities that now exist to support foster youth as they move into adulthood, including new federal legislation that,for the first time,will allow states to support foster youth beyond age eighteen. Finally, this article provides a backdrop for this Special Issue and summarizes the insightful articles and innovative thinking contained herein. [source]


    FAMILY COURT REVIEW, Issue 4 2007
    Miriam Aroni Krinsky
    There are more than half a million children in our nation's foster care system. While foster care is intended to provide a temporary safe harbor for abused and neglected children, too many of these youth spend years in foster care limbo,experiencing a turbulent life in motion as they move from placement to placement, community to community, and school to school. Youth in foster care commonly fail to receive basic health and psychological care, and nearly 20,000 youth age out of foster care every year to an adult path of homelessness, unemployment, and despair. Our entire community must work together to more responsibly parent these youth. This article will address how lawyers and child advocates can advocate for new approaches and enhanced support on behalf of the voiceless and most vulnerable members of our community. It will address existing hurdles and systemic challenges that have helped to create the current disheartening status quo. The article will then discuss strategies that advocates can employ to turn the corner on behalf of these youth at risk. [source]


    FAMILY COURT REVIEW, Issue 3 2007
    Karen J. Mathis
    During the 2006,2007 American Bar Association (ABA) year, a special ABA Presidential Youth at Risk Initiative has addressed several important topics: addressing the needs of juvenile status offenders and their families; foster children aging out of the foster care system; increases in girls, especially girls of color, in the juvenile justice system; the need to better hear the voices of youth in court proceedings affecting them; and improving how laws can better address youth crossing over between juvenile justice and child welfare systems. Lawyers are encouraged to use their skills to improve the systems addressing at-risk youth and their families and to help facilitate coordination of youth-related community efforts. Learning how to effectively communicate with youth is an important skill attorneys must learn. Through the Youth at Risk Initiative, the ABA has held continuing legal education programs, hosted community roundtables among youth-serving stakeholders, and developed projects on: juvenile status offenders; lawyer assistance to youth transitioning from foster care; educating young girls on violence prevention, conflict resolution, and careers in law and justice; and provision of useful information to youth awaiting juvenile court hearings. New ABA policy has addressed services and programs to at-risk youth, assuring licensing, regulation, and monitoring of residential facilities serving at-risk youth, enhanced support for sexual minority foster and homeless youth, juvenile status offenders, and improving laws and policies related to youth exiting the foster care system. [source]

    The Financial Accountability of Australia's Medicare System: A Generational Accounting Analysis

    Paul J. M. Klumpes
    The financial sustainability of publicly funded health care systems is sensitive to the demographics of ageing populations, which have a significant bearing on their financial management, accountability and reporting of their financial performance. This paper examines historical and current trends in demographic structure of Australia's population that are likely to impact on the financial management and accountability practices affecting Australia'suniversal public health care system (,Medicare'). The pay-as-you-go financed funding status of Medicare as represented under both currently required, cash-based accounting principles and proposed accrual-based accounting principles are criticised for not recognising the obligations of the Australian government under Medicare. An alternative system of generational accounting is proposed that projects the financial management costs of Medicare. Data are taken from both historical trends in expenditure and ageing as well as projected demographics. The analysis implies that there is significant intergenerational-inequity in the funding of Medicare, which is not recognised under accrual-based accounting principles that are now being used to evaluate the financial accountability and performance of government entities. [source]

    Understanding the ,epidemic' of complete tooth loss among older New Zealanders

    GERODONTOLOGY, Issue 2 2010
    Philip V. Sussex
    doi:10.1111/j.1741-2358.2009.00306.x Understanding the ,epidemic' of complete tooth loss among older New Zealanders Objective:, The aim of this study was to obtain a deeper understanding of the social factors driving New Zealand's historic ,epidemic of edentulism' and how they operated. Method:, In-depth, semi-structured interviews with 31 older New Zealanders were analysed using applied grounded theory. Results:, Universal factors present in the data were: (a) the way in which New Zealand society accepted and indeed encouraged edentulism without stigma for those who had a ,sub-optimal' natural dentition; (b) how the predominant patterns of dental care utilisation (symptomatic and extraction-based) were often strongly influenced by economic and social disadvantage; and (c) the way in which lay and professional worldviews relating to ,calcium theory' and dental caries were fundamental in decisions relating to the transition to edentulism. Major influences were rural isolation, the importance of professional authority and how patient-initiated transitions to edentulism were ultimately facilitated by an accommodating profession. Conclusion:, The combined effects of geography, economics, the dental care system and the professional culture of the day, in the context of contemporary (flawed) understandings of oral disease, appear to have been the key drivers. These were supported (in turn) by a widespread acceptance by the profession and society alike of the extraction/denture philosophy in dealing with oral disease. [source]

    The role of prophylaxis in bleeding disorders

    HAEMOPHILIA, Issue 2010
    Summary., The rationale for long-term prophylaxis in more severe forms of von Willebrand's disease (VWD) is obvious, as mucosal bleeding and haemophilia-like joint bleeds resulting in chronic morbidity may occur. However, the experience with prophylactic treatment in this group is scanty. An international VWD Prophylaxis Network (VWD PN) was established in 2006. The VWD PN will investigate prophylaxis with retrospective and prospective studies. Eighteen centres in Europe and North America are recruiting patients and an additional 40 centres are preparing for or evaluating participation. In the absence of randomized prospective studies for most rare bleeding disorders, guidelines for prophylaxis are a subject of controversy. In situations where there is a strong family history of bleeding, long-term prophylaxis is administered in selected cases. Short intervals of prophylaxis can also be given before some surgeries or during pregnancy. The benefits of prophylaxis must be balanced by the risk of side effects. Therefore, it is essential to delineate its management in a specialized comprehensive care environment. In haemophilia, decades of clinical experience and numerous retrospective and, recently, prospective studies clearly demonstrate that prophylactic treatment is superior to on-demand treatment, regardless of whether the outcome is the number of joint- or life-threatening bleeds, arthropathy evaluated by X-ray or MRI, or quality of life measured by generic or haemophilia-specific instruments. Optimal prophylactic treatment should be started early in life (primary prophylaxis) but various options exist for the dose and dose interval. These depend on the objective of treatment in the individual patient, which, in turn, is dependent on resources in the health care system. [source]

    Can a publicly funded home care system successfully allocate service based on perceived need rather than socioeconomic status?

    A Canadian experience
    Abstract The present quantitative study evaluates the degree to which socioeconomic status (SES), as opposed to perceived need, determines utilisation of publicly funded home care in Ontario, Canada. The Registered Persons Data Base of the Ontario Health Insurance Plan was used to identify the age, sex and place of residence for all Ontarians who had coverage for the complete calendar year 1998. Utilisation was characterised in two dimensions: (1) propensity , the probability that an individual received service, which was estimated using a multinomial logit equation; and (2) intensity , the amount of service received, conditional on receipt. Short- and long-term service intensity were modelled separately using ordinary least squares regression. Age, sex and co-morbidity were the best predictors (P < 0.0001) of whether or not an individual received publicly funded home care as well as how much care was received, with sicker individuals having increased utilisation. The propensity and intensity of service receipt increased with lower SES (P < 0.0001), and decreased with the proportion of recent immigrants in the region (P < 0.0001), after controlling for age, sex and co-morbidity. Although the allocation of publicly funded home care service was primarily based on perceived need rather than ability to pay, barriers to utilisation for those from areas with a high proportion of recent immigrants were identified. Future research is needed to assess whether the current mix and level of publicly funded resources are indeed sufficient to offset the added costs associated with the provision of high-quality home care. [source]

    Young adults' (16,25 years) suggestions for providing developmentally appropriate diabetes services: a qualitative study

    Gail Dovey-Pearce BA (Hons) D Clin Psychol
    Abstract Managing the multiple demands of a chronic condition whilst negotiating the developmental tasks of adolescence and young adulthood is a process that is neither well described nor understood, particularly in relation to providing developmentally appropriate health care for young people. The importance of this issue is starting to be reflected within the literature, and although research into models of service delivery is emerging, a lack of user involvement in service development is apparent. This qualitative, user involvement study aimed to describe and understand the considered opinions of 19 young adults with diabetes who were receiving secondary care services about the provision of diabetes services for young people. The findings, gathered using semistructured interview and focus group methods, have potentially wide-reaching implications across primary and secondary health care, and across agencies providing services to children and young people, in terms of facilitating a person's transition through adolescence and into young adult life. Participants suggested key issues to address when developing services for young people, including staff consistency, civility, clinic structures which help a person navigate the health care system, provision of age-specific information, and support in relation to a range of health, emotional, social and developmental needs. Health care professionals can help young people to meet the expectations upon them as autonomous service users by modelling appropriate relationships, helping them to acquire skills and knowledge, and overcome barriers to them becoming active participants in their health care and achieving social participation in a fuller sense. It is somewhat arbitrary to delineate between adolescence and young adulthood in terms of age alone, but in this paper, ,adolescence' refers to the period between 11 and 15 years of age, and ,young adulthood' between 16 and 25 years of age. The phrase ,young people' will also be used to refer to people between 11 and 25 years. [source]

    Being a parent of an adult son or daughter with severe mental illness receiving professional care: parents' narratives

    Anita Pejlert RNT PhD
    Abstract The aim of this study was to illuminate the meaning of parental care-giving with reference to having an adult son or daughter with severe mental illness living in a care setting. The parents were asked to narrate their relationship to offspring in the past, in the present, and their thoughts and feelings concerning the future. The study was guided by a phenomenological hermeneutic perspective. The meaning of parental care was illuminated in the themes ,living with sorrow, anguish and constant worry', ,living with guilt and shame', ,relating with carer/care; comfort and hardships',coming to terms with difficulties' and ,hoping for a better life for the adult child'. Parental care-giving emerged as a life-long effort. The narratives revealed ongoing grief, sorrow and losses interpreted as chronic sorrow. The narratives disclosed a cultural conflict between the family system and the care system, which was interpreted as a threat to the parental role, but also experiences of receiving comfort and having confidence in the care given. Experiences of stigma were interpreted from the way of labelling illness, narrated experiences of shame and relations with the public and mental health professionals. Parents' persisting in the care-giving role, striving to look after themselves and expressing hopes for the future were interpreted as a process of coming to terms with difficulties. Results suggest that mental health professionals need to be aware of their own attitudes and treatment of families, improve their cooperation with, and support to families, and provide opportunities for family members to meet one another. [source]

    Economic analysis of China's health care system: turning a new page

    HEALTH ECONOMICS, Issue S2 2009
    Winnie Yip
    First page of article [source]