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Selected AbstractsThe Long Road to Better ACHD CareCONGENITAL HEART DISEASE, Issue 3 2010Gary Webb MD ABSTRACT The care of adult patients with congenital heart defects in the United States is spotty at best, and needs to improve greatly if the needs of these patients are to be met. The care of American children with congenital heart defects is generally excellent. Pediatric cardiac services are well established and well supported. The care of adults with congenital heart disease (CHD) is well established in only a few American centers. While there are an increasing number of clinics, they are generally poorly resourced with relatively few patients. If located in adult cardiology programs, they are usually minor players. If located in pediatric cardiac programs, they are usually minor players as well. Training programs for adult CHD (ACHD) caregivers are few, informal, and poorly funded. To improve the situation, we need perhaps 25 well-resourced and well-established regional ACHD centers in the United States. We need to stop the loss to care of CHD patients at risk of poor outcomes. We need to educate patients and families about the need for lifelong and skilled surveillance and care. We need to effect an orderly transfer from pediatric to adult care. We need to strengthen the human resource infrastructure of ACHD care through the training and hiring of healthcare professionals of a quality equivalent to those working in the pediatric care environment. We need to demonstrate that adult care is high quality care. We need more high-quality ACHD research. The ACHD community needs to establish its credibility with pediatric cardiac providers, adult cardiology groups, with governments, with professional organizations, and with research funding agencies. Accordingly, there is a need for strong political action on behalf of American ACHD patients. This must be led by patients and families. These efforts should be supported by pediatric cardiologists and children's hospitals, as well as by national professional organizations, governments, and health insurance companies. The goal of this political action should be to see that ACHD patients can receive high-quality lifelong surveillance, that we lose fewer patients to care, and that the staff and other services needed are available nationwide. [source] Complementary and alternative medicine: the move into mainstream health careCLINICAL AND EXPERIMENTAL OPTOMETRY, Issue 2 2004Kylie O'Brien BSc (Optometry) BAppSc (Chinese Medicine) MPH The use of complementary and alternative medicine (CAM) in Australia is extensive with over 50 per cent of the Australian population using some form of complementary medicine and almost 25 per cent of Australians visiting CAM practitioners. Expenditure on CAM by Australians is significant. The scope of CAM is extremely broad and ranges from complete medical systems such as Chinese medicine to well-known therapies, such as massage and little known therapies, such as pranic healing. There is a growing focus on CAM in Australia and worldwide by a range of stakeholders including government, the World Health Organization, western medical practitioners and private health insurance companies. CAM practices may offer the potential for substantial public health gains and challenge the way that we view human beings, health and illness. Several issues are emerging that need to be addressed. They include safety and quality control of complementary medicines, issues related to integration of CAM with western medicine and standards of practice. The evidence base of forms of CAM varies considerably: some forms of CAM have developed systematically over thousands of years while others have developed much more recently and have a less convincing evidence base. Many forms of CAM are now being investigated using scientific research methodology and there are increasing examples of good research. Certain forms of CAM, including Chinese medicine in which ophthalmology is an area of clinical speciality, view the eye in a unique way. It is important to keep an open mind about CAM and give proper scrutiny to new evidence as it emerges. [source] Dental nomograms for benchmarking based on the study of health in Pomerania data setJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 12 2004C. Schwahn Abstract Aim: Benchmarking is a means of setting goals or targets. On an oral health level, it denotes retaining more teeth and/or improving the quality of life. The goal of this pilot investigation was to assess whether the data generated by a population-based study (SHIP 0) can be used as a benchmark data set to characterize different practice profiles. Material and Methods: The data collected in the population-based study SHIP (n=4310) in eastern Germany were used to generate nomograms of tooth loss, attachment loss, and probing depth. The nomograms included twelve 5-year age strata (20,79 years) presented as quartiles, and additional percentiles of the dental parameters for each age group. Cross-sectional data from a conventional dental office (n=186) and from a periodontology unit (n=130, Greifswald) in the study region as well as longitudinal data set of a another periodontology unit (n=135, Kiel) were utilized in order to verify whether the given practice profile was accurately reflected by the nomogram. Results: In terms of tooth loss, the data from the conventional dental office agree with the median from the nomogram. For attachment loss and probing depth, some age groups yielded slight but not uniform deviations from the median. Cross-sectional data from the periodontology unit Greifswald showed attachment loss higher than the median in younger but not in older age groups. The probing depth was uniformly less than the median and tended toward the 25th percentile with increasing age. The longitudinal data of the Unit of Periodontology in Kiel showed a pronounced trend towards higher percentiles of residual teeth, meaning that the patients retained more teeth. Conclusion: The profile of the Pomeranian dental office does not deviate noticeably from the population-based nomograms. The higher attachment loss of the Unit of Periodontology in Greifswald in younger age strata clearly reflects their selection because of periodontal disease; the combination of higher attachment loss and decreased probing depth may reflect the success of the treatment. The tendency of attachment loss towards the median with increasing age may indicate that the Unit of Periodontology in Greifswald does not fulfill its function as a special care unit in the older subjects. The longitudinal data set of the Unit of Periodontology in Kiel impressively reflects the potential of population-based data sets as a means for benchmarking. Thus, nomograms can help to determine the practice profile, potentially yielding benefits for the dentist, health insurance company, or , as in the case of the special care unit , public health research. [source] Socio-demographic factors influence chronic proton pump inhibitor use by a large population in the NetherlandsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2009O. S. Van BOXEL Summary Background, Chronic proton pump inhibitor (PPI) use is common in the Western world. Socio-economic status and socio-demographic factors have been shown to influence decisions related to prescribing of various drugs, but the influence of these factors on chronic PPI use is uncertain. Aim, To study the influence of SES and socio-demographic factors on chronic PPI use. Methods, Data were collected from a database of a Dutch health insurance company. Subjects having had at least one prescription for a PPI were identified and followed up for 6 months. Patients were then subdivided into chronic PPI users. Socio-demographic status was based on neighbourhood level of residence. Logistic regression was performed to determine socio-demographic factors associated with PPI use. Results, A total of 2 001 787 insured individuals were included, 85 253 subjects were chronic users. Both low income (OR 1.55; CI 1.52,1.58) and low educational level (OR 1.33; CI 1.31,1.36) were associated with chronic PPI use. Other independent predictive variables included use of 10 or more concomitant medications (OR 5.33; CI 4.96,5.72) and the use of prokinetic drugs (OR 10.01; CI 9.22,10.88). Conclusions, Patients of a lower socio-demographic status are more likely to use PPIs on a chronic basis. The observed gradient in PPIs use may reflect differences in health, healthcare use or healthcare supply. [source] | ||||||||||