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Selected AbstractsNurse Practitioner, Nurse Midwife and Physician Assistant Attitudes and Care Practices Related to Persons with HIV/AIDSJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 2 2000Jane E. Martin RN ABSTRACT Although multiple studies of nurses' attitudes toward people living with HIV/AIDS (PLWAs) can be found in the literature, little is known about the attitudes, beliefs and practices of nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs). A survey including a 21-item AIDS Attitude Scale measuring the constructs of Avoidance and Empathy was sent to 1,291 NPs, CNMs and PAs in Louisiana, Arkansas and Mississippi to describe their attitudes and care practices related to PLWAs. Respondents who were more comfortable treating PLWAs had significantly lower avoidance scores and significantly higher empathy scores than respondents with lower comfort levels in providing care. Greater than 80% of respondents indicated that they would provide health care to HIV-infected individuals. Respondents who referred HIV/AIDS patients for all care did so primarily due to lack of experience with HIV and the availability of more experienced providers. Avoidance and empathy scores were not found to be significantly associated with referral for care. This study suggests that this group of providers has relatively low avoidance and high empathy toward PLWAs and is willing to care for HIV-infected individuals. This study was supported by Grant No. 5U69PE00112-06 from the Department of Health & Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, National AIDS Education and Training Center. [source] The Evolution and Direction of OPTN Oversight of Live Organ Donation and Transplantation in the United StatesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2009R. S. Brown For more than 20 years, the Organ Procurement and Transplantation Network (OPTN) has developed policies and bylaws relating to equitable allocation of deceased donor organs for transplantation. United Network for Organ Sharing (UNOS) operates the OPTN under contract with the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS). Until recent years, the OPTN had little defined authority regarding living donor organ for transplantation except for the collection of data relating to living donor transplants. Beginning with the implementation of the OPTN Final Rule in 2000, and continuing with more recent announcements, the OPTN's role in living donation has grown. Its responsibilities now include monitoring of living donor outcomes, promoting equity in nondirected living donor transplantation and ensuring that transplant programs have expertise and established protocols to promote the safety of living donors and recipients. The purpose of this article is to describe the evolving mandates for the OPTN in living donation, as well as the network's recent activities and ongoing efforts. [source] Development of the New Lung Allocation System in the United StatesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 5p2 2006T. M. Egan This article reviews the development of the new U.S. lung allocation system that took effect in spring 2005. In 1998, the Health Resources and Services Administration of the U.S. Department of Health and Human Services published the Organ Procurement and Transplantation Network (OPTN) Final Rule. Under the rule, which became effective in 2000, the OPTN had to demonstrate that existing allocation policies met certain conditions or change the policies to meet a range of criteria, including broader geographic sharing of organs, reducing the use of waiting time as an allocation criterion and creating equitable organ allocation systems using objective medical criteria and medical urgency to allocate donor organs for transplant. This mandate resulted in reviews of all organ allocation policies, and led to the creation of the Lung Allocation Subcommittee of the OPTN Thoracic Organ Transplantation Committee. This paper reviews the deliberations of the Subcommittee in identifying priorities for a new lung allocation system, the analyses undertaken by the OPTN and the Scientific Registry for Transplant Recipients and the evolution of a new lung allocation system that ranks candidates for lungs based on a Lung Allocation Score, incorporating waiting list and posttransplant survival probabilities. [source] National Study of the Relation of Primary Care Shortages to Emergency Department UtilizationACADEMIC EMERGENCY MEDICINE, Issue 3 2007Ilana B. Richman BA Background: Emergency department (ED) visit volumes are increasing nationwide. Objectives: To determine whether states with primary care shortages have higher rates of ED use. Methods: Populations residing in primary care shortage areas were abstracted from the Health Resources and Services Administration Geospatial Database. Annual ED visit volumes were available from the 2001 National ED Inventory. Population data and potential confounders were abstracted from federal data sets. All analyses were conducted at the state level. Results: Primary care shortage densities varied greatly across states, ranging from 3 (New Jersey) to 28 (Mississippi) medically underserved individuals per 100 people. States also varied in their annual ED visit densities, ranging from 23 visits (Hawaii) to 65 visits (Washington, DC) per 100 people. Of the 17 states in the top tertile for primary care shortage, 7 also were in the top tertile for ED visits. Primary care shortage density was positively associated with ED visit density. An increase of 10 medically underserved individuals per 100 people was associated with an annual increase of 4.2 ED visits per 100 people (p = 0.04). The association remained after controlling for six factors, with an increase of 10 medically underserved individuals per 100 people associated with an annual increase of 3.3 ED visits per 100 people (p = 0.04). Nevertheless, five states had high ED visit densities despite comparatively low primary care shortage densities (Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont), whereas five others had low ED visit densities despite high primary care shortage densities (Arizona, Idaho, Montana, New Mexico, and South Dakota). Conclusions: A positive association between primary care shortage densities and ED visit densities was found. Although most states adhere to this pattern, some states do not. Further investigation of this dissociation may yield additional explanations for rising ED visit volumes. [source] Hospitalists and intensivists: Partners in caring for the critically ill,The time has come,JOURNAL OF HOSPITAL MEDICINE, Issue 1 2010Michael Heisler MD Abstract A report by the Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS), published in 2000, predicted that beginning in 2007 a gap between the demand and availability of intensivists in the United States would become apparent and steadily increase to 22% by 2020 and to 35% by 2030. Subsequent reports have reiterated those projections including a report to congress in 2006 by the U.S. Department of Health and Human Services/Health Resources and Services Administration. This "gap" has been called a health system "crisis" by multiple authors. Two important documents have published specific recommendations for how to resolve this crisis: the Framing Options for Critical Care in the United States (FOCCUS) Task Force Report in 2004 and the Prioritizing the Organization and Management of Intensive Care Services in the Unites States (PrOMIS) Conference Report in 2007. Since the initial COMPACCS report and since these 2 additional reports were published, a new opportunity to take a major step in resolving this crisis has emerged: the growing number of hospitalists providing critical care services at secondary and tertiary care facilities. According to the 2005/2006 Society of Hospital Medicine (SHM) National Survey, that number has increased to 75%. Since the number of intensivists is unlikely to change significantly over the next 25 years, the question is no longer "if" hospitalists should be in the intensive care unit (ICU); rather the question is how to assure quality and improved clinical outcomes through enhanced collaboration between hospital medicine and critical care medicine. Journal of Hospital Medicine 2010;5:1,3. © 2010 Society of Hospital Medicine. [source] Disaster mental health training programmes in New York City following September 11, 2001DISASTERS, Issue 3 2010Kimberly B. Gill The need for mental health resources to provide care to the community following large-scale disasters is well documented. In the aftermath of the World Trade Center (WTC) disaster on September 11, 2001, many local agencies and organizations responded by providing informal mental health services, including disaster mental health training for practitioners. The quality of these programmes has not been assessed, however. The National Center for Disaster Preparedness at Columbia University's School of Public Health reviewed disaster mental health training programmes administered by community-based organizations, professional associations, hospitals, and government agencies after September 11. Results indicate that the quality and the effectiveness of programmes are difficult to assess. A wide range of curricula and a widespread lack of recordkeeping and credentialing of trainers were noted. Most of the training programmes provided are no longer available. Recommendations for improving the quality of disaster mental health training programmes are provided. [source] Does Deinstitutionalization Increase Suicide?HEALTH SERVICES RESEARCH, Issue 4 2009Jangho Yoon Objectives. (1) To test whether public psychiatric bed reduction may increase suicide rates; (2) to investigate whether the supply of private hospital psychiatric beds,separately for not-for-profit and for-profit,can substitute for public bed reduction without increasing suicides; and (3) to examine whether the level of community mental health resources moderates the relationship between public bed reduction and suicide rates. Methods. We examined state-level variation in suicide rates in relation to psychiatric beds and community mental health spending in the United States for the years 1982,1998. We categorize psychiatric beds separately for public, not-for-profit, and for-profit hospitals. Principal Findings. Reduced public psychiatric bed supply was found to increase suicide rates. We found no evidence that not-for-profit or for-profit bed supply compensates for public bed reductions. However, greater community mental health spending buffers the adverse effect of public bed reductions on suicide. We estimate that in 2008, an additional decline in public psychiatric hospital beds would raise suicide rates for almost all states. Conclusions. Downsizing of public inpatient mental health services may increase suicide rates. Nevertheless, an increase in community mental health funding may be promising. [source] There and back again: the impact of adult HIV prevalence on national life expectanciesHIV MEDICINE, Issue 2 2005AL McGuire Worldwide we have seen dramatic increases in HIV prevalence and decreases in life expectancy over the last decade. The aim of this study was to determine the association between HIV prevalence and life expectancy. A strong negative association between adult HIV prevalence and life expectancy was observed for 137 countries. Because high adult HIV prevalence poses the greatest threat to countries with limited health resources, our study supports increased efforts to provide antiretrovirals in these countries. [source] Costs of maternal health care services in three anglophone African countriesINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 1 2003Ann Levin Abstract This paper is a synthesis of a case study of provider and consumer costs, along with selected quality indicators, for six maternal health services provided at one public hospital, one mission hospital, one public health centre and one mission centre, in Uganda, Malawi and Ghana. The study examines the costs of providing the services in a selected number of facilities in order to examine the reasons behind cost differences, assess the efficiency of service delivery, and determine whether management improvements might achieve cost savings without hurting quality. This assessment is important to African countries with ambitious goals for improving maternal health but scarce public health resources and limited government budgets. The study also evaluates the costs that consumers pay to use the maternal health services, along with the contribution that revenues from fees for services make to recovering health facility costs. The authors find that costs differ between hospitals and health centres as well as among mission and public facilities in the study sample. The variation is explained by differences in the role of the facility, use and availability of materials and equipment, number and level of personnel delivering services, and utilization levels of services. The report concludes with several policy implications for improvements in efficiency, financing options and consumer costs. Copyright © 2003 John Wiley & Sons, Ltd. [source] Socioeconomic instability and the availability of health resources: their effects on infant mortality rates in Macau from 1957,2006JOURNAL OF CLINICAL NURSING, Issue 5-6 2010Moon Fai Chan Aim., To investigate the effects of socioeconomic instability and the availability of health resources on infant mortality rate. Background., In 1960, the infant mortality rate was 46·3 infants per 1000 live births in Macau but by 2006 it had declined to 2·7 infants per 1000 live births. Design., A retrospective design collecting yearly data for the Macau covering the period from 1957,2006. The infant mortality rate was the dependent variable and demographics, socioeconomic status and health resources are three main explanatory variables to determine the mortality rate. Methods., Regression modelling. Results., Results show that higher birth (Beta = 0·029, p = 0·004) and unemployment rates (Beta = ,0·120, p = 0·036) and more public expenditure on health (Beta = ,0·282, p < 0·001) were significantly more likely to reduce the infant mortality rate. Conclusions., These results indicate that the socioeconomically disadvantaged are at a significantly higher risk for infant mortality. In contrast, more public expenditure on health resources significantly reduces the risk for infant mortality. This study provides further international evidence that suggests that improving aspects of the healthcare system may be one way to compensate for the negative effects of social inequalities on health outcomes. Relevance to clinical practice., The implication of these results is that more effort, particularly during economic downturns, should be put into removing the barriers that impede access to healthcare services and increasing preventive care for the population that currently has less access to health care in communities where there is a scarcity of medical resources. In addition, efforts should be made to expand and improve the coverage of prenatal and infant healthcare programmes to alleviate regional differences in the use of health care and improve the overall health status of infants in Macau. [source] Internet-Based Interactive Support for Cancer Patients: Are Integrated Systems Better?JOURNAL OF COMMUNICATION, Issue 2 2008David H. Gustafson To compare the benefits of the Internet generally versus a focused system of services, 257 breast cancer patients were randomly assigned to a control group, access to the Internet with links to high-quality breast cancer sites, or access to an eHealth system (Comprehensive Health Enhancement Support System, CHESS) that integrated information, support, and decision and analysis tools. The intervention lasted 5 months, and self-report data on quality of life, health-care competence, and social support were collected at pretest and at 2-, 4-, and 9-month posttests. CHESS subjects logged on more overall than Internet subjects and accessed more health resources, but the latter used non health-related sites more. Subjects with access to the Internet alone experienced no better outcomes than controls at any of the 3 time points, compared to pretest levels. Subjects with CHESS experienced greater social support during the intervention period and had higher scores on all 3 outcomes at 9 months, 4 months after the intervention ended. CHESS subjects also scored higher than those with Internet access during the intervention period but not significantly after the intervention ended. Thus, CHESS (with one simple interface and integrated information, communication, and skills services) helped newly diagnosed breast cancer patients even after computers were removed. In contrast, patients received little benefit from Internet access, despite having links to a variety of high-quality sites. Résumé Le soutien interactif sur Internet des patients atteints du cancer : les systèmes intégrés sont-ils meilleurs? Afin de comparer les bénéfices de l'Internet en général par rapport à un système concentré de services, 257 patientes atteintes du cancer du sein furent assignées au hasard à l'un de trois groupes : un groupe témoin, un groupe ayant accès à Internet avec des liens vers des sites de haute qualité concernant le cancer du sein, ou un groupe ayant accès à un système eHealth (CHESS) qui intègre information, soutien et outils de décision et d'analyse. L'intervention a duré cinq mois et une collecte de données auto-évaluées (à propos de la qualité de vie, de la compétence en ce qui a trait aux soins de santé et du soutien social) fut faite avant le test et deux, quatre et neuf mois après le début du test. Les participantes ayant accès au CHESS se sont globalement connectées plus souvent que les participantes ayant accès à Internet et elles ont accédéà plus de ressources liées à la santé, mais les participantes ayant accès à Internet ont visité plus de sites non liés à la santé. Les participantes ayant seulement accès à Internet n'ont pas présenté de meilleurs résultats que le groupe témoin à aucun des trois moments de cueillette, en comparaison avec les niveaux pré-test. Les participantes ayant accès au CHESS ont reçu un meilleur soutien social pendant la période d'intervention et eurent des résultats plus élevés quant aux trois thèmes à l'évaluation de neuf mois, soit quatre mois après la fin de l'intervention. Les participantes CHESS ont également enregistré des résultats plus élevés que ceux avec Internet pendant la période d'intervention, mais pas de manière significative une fois que l'intervention s'est terminée. Ainsi, CHESS (avec une interface unique et simple et de l'information intégrée, des services de communication et de compétences) a aidé les patientes nouvellement diagnostiquées avec le cancer du sein, même lorsque les ordinateurs furent retirés. De façon constrastée, les patientes n'ont pas beaucoup bénéficié de l'accès à Internet, bien qu'elles aient été orientées vers une variété de sites de haute qualité. Abstract Internetbasierte interaktive Unterstützung für Krebspatienten: Sind integrierte Systeme besser? Um die Vorteile des Internets im allgemeinen mit den Vorteilen eines fokussierten Systems von Angeboten zu vergleichen wurden 257 Brustkrebspatienten zufällig auf eine von drei Gruppen verteilt: eine Kontrollgruppe, eine Versuchsgruppe mit Zugang zum Internet mit Links zu hochqualitativen Seiten zum Thema Krebs und eine zweite Versuchgruppe mit Zugang zu einem eHealth System (CHESS), welches Informationen, Betreuung und Entscheidungs- und Analysewerkzeuge integriert. Die Intervention dauerte 5 Monate. Selbstauskunftsdaten zur Lebensqualität, Gesundheitsfürsorgekompetenz und sozialer Unterstützung wurden vorher, und als 2-, 4- und 9-Monate Nachhermessung erhoben. CHESS-Nutzer griffen generell häufiger auf das Angebot zu als Internetnutzer und nutzten mehr Gesundheitsressourcen; allerdings griffen Internetnutzer häufiger auf Seiten ohne Gesundheitsbezug zu. Teilnehmer mit Internetzugang zeigten bezogen auf die Vorhermessung keine besseren Ergebnisse im Vergleich zur Kontrollgruppe. CHESS-Nutzer erlebten eine größere soziale Unterstützung während der Intervention und hatten höhere Werte für alle drei Ergebnismessungen zum Zeitpunkt 9 Monate, also 4 Monate nach Ende der Intervention. CHESS-Teilnehmer punkteten während aber nicht nach Ende der Intervention höher als jene mit Internet-Zugang. CHESS (mit einem einfachen Interface und integrierter Information, Kommunikation und Services) half neu diagnostizierten Brustkrebspatienten sogar nachdem die Computer entfernt wurden. Im Gegensatz dazu bekamen Patienten wenig Unterstützung vom Internet-Zugang, obwohl sie Links zu eine Vielzahl hochqualitativer Seiten hatten. Resumen Apoyo Interactivo a través del Internet para Pacientes con Cáncer: ¿Son Mejores los Sistemas Integrados? Para comparar los beneficios del Internet generalmente versus un sistema de servicios focalizados, 257 pacientes con cáncer de mama fueron asignados aleatoriamente a un grupo de control, acceso al Internet con conexiones a sitios de cáncer de mama de alta calidad, ó acceso a un sistema de Salud (CHESS) que integraba información, apoyo, y herramientas de decisión y análisis. La intervención que duró cinco meses, reportó datos individuales sobre la calidad de vida, la competencia de la asistencia médica y el apoyo social coleccionados a través de una prueba inicial y pruebas a los 2, 4, y 9 meses después. Los participantes de CHESS entablaron sesiones con más frecuencia que los sujetos de Internet y accedieron a más recursos sobre la salud, pero éstos últimos usaron más sitios no relacionados con la salud. Los sujetos que solamente accedieron al Internet no experimentaron mejores resultados que los grupos de control durante los tres puntos, comparados con los niveles de pruebas iniciales. Los sujetos con CHESS experimentaron un apoyo social mayor durante el período de intervención y tuvieron puntajes más altos en los 3 resultados a los 9 meses, 4 meses después que la intervención finalizara. Los sujetos de CHESS obtuvieron mayores puntajes que los participantes con acceso al Internet durante el período de la intervención, pero no significativamente después de que la intervención finalizara. Así, CHESS (con una interfase simple e información integrada, comunicación y servicios de habilidades) ayudaron a los pacientes recientemente diagnosticados con cáncer de mama aún después de que las computadoras fueron removidas. En contraste, los pacientes recibieron poco beneficio del acceso al Internet, a pesar de tener acceso a conexiones con una variedad de sitios de alta calidad. ZhaiYao Yo yak [source] Impacts of national surveillance for uncommon conditions in childhoodJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 11 2007Yvonne A Zurynski Abstract: The Australian Paediatric Surveillance Unit (APSU) facilitates the conduct of national collaborative research that is consistent with national health priorities, has potential to impact on public health, and addresses gaps in knowledge. Since 1993 paediatricians and other child health specialists have contributed monthly data on rare childhood conditions to the APSU. Over 40 conditions, including infectious diseases, injuries, vaccine-preventable diseases and genetic disorders have been studied. Information on epidemiology, frequency, diagnosis, management and short-term outcomes of these conditions is collected and provides evidence to support changes to clinical practice, prevention policy and allocation of health resources. In this review we give examples of the value of information gathered through the APSU surveillance system in the last 14 years. [source] The drug epidemic: Effects on newborn infants and health resource consumption at a tertiary perinatal centreJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2000J J Kelly Objectives: Illicit drug taking in Australia, with its attendant social and medical consequences, is increasing and the effects extend to maternity hospitals where infants born to addicted mothers have more health problems in the neonatal period. The aims of this study were to evaluate (1) the patterns of illness of such infants and (2) the burden imposed on the neonatal department of a large tertiary maternity centre. Methodology: An audit was conducted of all Chemical Dependency Unit (CDU) mothers and babies delivered at the Royal Women's Hospital, Melbourne, Australia during 1997. Data were compared with those from a concurrent control group of mothers and babies randomly generated from the hospital's obstetric database. Results: Ninety-six infants born to CDU mothers were compared with a control group of 200 infant/mother pairs. The majority of women in the CDU clinic were treated for narcotic addiction with methadone (90%) but most continued to use heroin during pregnancy (68%). Infants born to CDU mothers were significantly less mature and lighter than control infants. Fifty-three (55%) CDU infants required admission to the Special Care Nursery either because of neonatal abstinence syndrome (n = 29) or other medical reasons (n = 24). The median length of hospital stay was significantly longer in CDU compared with control infants (8 vs 3 days, P < 0.01). Conclusions: Infants born to drug dependent mothers have more neonatal problems requiring specialized medical and nursing expertise, compared with control infants. These infants are large consumers of scarce health resources. [source] Remote, Wireless, Ambulatory Monitoring of Implantable Pacemakers, Cardioverter Defibrillators, and Cardiac Resynchronization Therapy Systems: Analysis of a Worldwide DatabasePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2007ARNAUD LAZARUS M.D. Study Objective: To describe the daily routine application of a new telemonitoring system in a large population of cardiac device recipients. Methods: Data transmitted daily and automatically by a remote, wireless Home MonitoringÔ system (HM) were analyzed. The average time gained in the detection of events using HM versus standard practice and the impact of HM on physician workload were examined. The mean interval between device interrogations was used to compare the rates of follow-up visits versus that recommended in guidelines. Results: 3,004,763 transmissions were made by 11,624 recipients of pacemakers (n = 4,631), defibrillators (ICD; n = 6,548), and combined ICD + cardiac resynchronization therapy (CRT-D) systems (n = 445) worldwide. The duration of monitoring/patient ranged from 1 to 49 months, representing 10,057 years. The vast majority (86%) of events were disease-related. The mean interval between last follow-up and occurrence of events notified by HM was 26 days, representing a putative temporal gain of 154 and 64 days in patients usually followed at 6- and 3-month intervals, respectively. The mean numbers of events per patient per month reported to the caregivers for the overall population was 0.6. On average, 47.6% of the patients were event-free. The mean interval between follow-up visits in patients with pacemakers, single-chamber ICDs, dual chamber ICDs, and CRT-D systems were 5.9 ± 2.1, 3.6 ± 3.3, 3.3 ± 3.5, and 1.9 ± 2.9 months, respectively. Conclusions: This broad clinical application of a new monitoring system strongly supports its capability to improve the care of cardiac device recipients, enhance their safety, and optimize the allocation of health resources. [source] A cost effectiveness analysis of omitting radiography in diagnosis of acute bronchiolitis,PEDIATRIC PULMONOLOGY, Issue 2 2009Jean Hai Ein Yong MASc Abstract Objective To carry out a cost-effectiveness analysis of omitting chest radiography in the diagnosis of infant bronchiolitis. Hypothesis Omitting chest radiographs in the diagnosis of typical bronchiolitis was expected to reduce costs without adversely affecting the detection rate of alternate diseases. Study Design An economic evaluation was conducted using clinical and health resources. Emergency department (ED) physicians provided diagnoses pre- and post-radiography as well as a management plan. The primary outcome was the diagnostic accuracy (false-negative rate) of alternate diagnoses with and without X-ray. The incremental costs of omitting radiography in comparison to routine radiography per patient were assessed from a health system perspective. Patient Selection We studied 265 infants, 2,23 months old, presenting at the ED with typical bronchiolitis. Patients with pre-existing conditions or radiographs were omitted from the study. Methodology Expected costs to the health care system of including and excluding chest radiographs were compared, including costs associated with misdiagnosis. Results All alternate diagnoses (two cases) were missed by ED physicians pre- and post-radiography, resulting in a 100% false negative rate. The specificity in detecting alternate diseases was 96.6% pre-radiography and 88.6% post-radiography. Of the 17 cases of coexistent pneumonia, 88% were missed pre-radiography and 59% post-radiography, with respective false positive rates of 10.5% and 16.1%. Omission of routine chest radiograph saved CDN $59 per patient, primarily due to savings in radiography and hospitalization costs. The economic benefit persisted after the inpatient length of stay, ED overhead and radiograph costs were varied. Conclusion For infants with typical bronchiolitis, omitting radiography is cost saving without compromising diagnostic accuracy of alternate diagnoses and of associated pneumonia. Pediatr Pulmonol. 2009; 44:122,127. © 2009 Wiley-Liss, Inc. [source] BODE score is a useful predictor of hospital admission in rural patients with chronic obstructive pulmonary diseaseRESPIROLOGY, Issue 3 2008Alice MCKELLAR Background and objective: COPD is a chronic illness with frequent episodic exacerbations that require admission to hospital. The aim of this study was to identify risk factors (or predictors) for hospital admission in a sample of rural COPD patients. Methods: COPD patients from the Goulburn and Crookwell areas of New South Wales, Australia, were included in the study. Patients were divided into two groups: those with two or fewer admissions, and those with three or more admissions in the last year. Patient interviews were conducted, and data were collected on demographics, consumption of health resources, COPD severity measures (BODE score) and quality of life. Results: There were 32 patients recruited with a median age of 68 years, and 21 (65.6%) were male. There were no significant differences in risk factors (or predictors) identified between the two groups. A statistical difference was found between the two groups, with patients with three or more hospital admissions having a higher BODE score (P = 0.004), poorer quality-of-life score (P = 0.015) and reduced exercise tolerance (P = 0.001). Conclusions: In this small sample of COPD patients, there were no clear differences in terms of risk factors for COPD admission between the two groups. The BODE score was found to be a useful predictor of disease severity and likelihood of hospital admission. [source] Unmet need in inadequately controlled asthmaRESPIROLOGY, Issue 2007Richard BEASLEY Abstract: Over the last 20 years in Australia, outcomes have improved for patients with asthma. With the advent of inhaled corticosteroids and long-acting beta agonists, and improvements in management including implementation of the guided self-management plan system of care, the mortality rate for asthma has fallen by almost half. However, despite huge improvements, there remains a small but significant cohort of patients with inadequately controlled severe persistent asthma. This group of patients consumes a substantial proportion of public health resources. Patients who have poorly controlled asthma, despite receiving ,optimal' treatment, are the ones most likely to benefit from new therapies such as those that target IgE. This presentation provides an overview of severe asthma in terms of prevalence and morbidity, mortality, economic costs and then considers a way forward in terms of identifying patients in greatest need of novel treatment such as omalizumab. [source] Culture and mental health education: Implications for mental health resources in the Pacific RimASIA-PACIFIC PSYCHIATRY, Issue 2 2009P.C. Tor [source] Predictors of early rescreening in the National Cervical Screening Program, AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2001Heather Mitchell Objective: To identify variables that predict early rescreening after a negative Pap smear report. Methods: Cohort study using the records of a statewide Cervical Cytology Registry in Victoria, Australia. The cohort comprised 31,082 women who had a negative Pap smear report during the first half of 1996 and who were rescreened within the subsequent 36 months. Early rescreening was defined as a further Pap smear within 21 months. Results: The strongest predictor of early rescreening was a recommendation at the time of issuing the negative Pap smear report by the laboratory for retesting before two years (adjusted odds ratio = 3.81, 95% confidence interval (Cl) 3.58,4.05). Mention of reactive or inflammatory change as part of the negative Pap smear report was also a powerful predictor (adjusted odds ratio = 1.67, 95% Cl 1.50,1.85). Significant predictors associated with the women were young age, high socio-economic status and residence in the capital city. Significant predictors associated with the practitioner were if either the index or subsequent smear was collected by an obstetrician/gynaecologist or a hospital-based clinic, or if the practitioner collecting the index smear was a female. The population-attributable risk per cent associated with the laboratory recommendation was 27%. Conclusions: This data suggests that a multi-faceted strategy targeting pathology laboratories, practitioners and women may be needed to reduce early rescreening. Implications: Early rescreening is wasteful of health resources. New screening programs should be designed to avoid this problem [source] Screening programmes for the early detection and prevention of oral cancerAUSTRALIAN DENTAL JOURNAL, Issue 2 2009O Kujan Background:, Screening programmes for major cancers, such as breast and cervical cancer have effectively decreased the mortality rate and helped to reduce the incidence of these cancers. Although oral cancer is a global health problem with increasing incidence and mortality rates, no national population-based screening programmes for oral cancer have been implemented. To date there is debate on whether to employ screening methods for oral cancer in the daily routine work of health providers. Objectives:, To assess the effectiveness of current screening methods in decreasing oral cancer mortality. Search strategy:, Electronic databases (MEDLINE, CANCERLIT, EMBASE (1966 to July 2005) and CENTRAL (The Cochrane Library 2005, Issue 3), bibliographies, handsearching of specific journals and contact authors were used to identify published and unpublished data. Selection criteria:, Randomized controlled trials of screening for oral cancer or precursor oral lesions using visual examination, toluidine blue, fluorescence imaging or brush biopsy. Data collection and analysis:, The search found 112 citations and these have been reviewed. One randomized controlled trial of screening strategies for oral cancer was identified as meeting the review's inclusion criteria. Validity assessment, data extraction and statistics evaluation were undertaken by two independent review authors. Main results:, One 10-year randomized controlled trial has been included (n = 13 clusters: 191 873 participants). There was no difference in the age-standardized oral cancer mortality rates for the screened group (16.4/100 000 person-years) and the control group (20.7/100 000 person-years). Interestingly, a significant 34% reduction in mortality was recorded in high-risk subjects between the intervention cohort (29.9/100 000 person-years) and the control arm (45.4/100 000). However, this study has some methodological weaknesses. Additionally, the study did not provide any information related to costs, quality of life or even harms of screening from false-positive or false-negative findings. Authors' conclusions:, Given the limitation of evidence (only one included randomized controlled trial) and the potential methodological weakness of the included study, it is valid to say that there is insufficient evidence to support or refute the use of a visual examination as a method of screening for oral cancer using a visual examination in the general population. Furthermore, no robust evidence exists to suggest that other methods of screening, toluidine blue, fluorescence imaging or brush biopsy, are either beneficial or harmful. Future high quality studies to assess the efficacy, effectiveness and costs of screening are required for the best use of public health resources. In addition, studies to elucidate the natural history of oral cancer, prevention methods and the effectiveness of opportunistic screening in high risk groups are needed. Future studies on improved treatment modalities for oral cancer and precancer are also required. Plain language summary:, Screening programmes for the early detection and prevention of oral cancer. More evidence needed to find out whether screening programmes could detect oral cancer earlier and reduce the number of deaths from this disease. Cancer of the mouth and back of the throat (oral cancer) has a low survival rate, largely because the disease is often not diagnosed until it is advanced. Screening the general population for oral cancer might make it possible to detect cases of the disease earlier. The most common method is visual inspection by a clinician, but other techniques include the use of a special blue "dye" and an imaging technique. The review found that there is not enough evidence to decide whether screening by visual inspection reduces the death rate for oral cancer, and no evidence for other screening methods. [source] Welfarism Versus ,Free Enterprise': Considerations Of Power And Justice In The Philippine Healthcare SystemBIOETHICS, Issue 5-6 2003Peter A. Sy ABSTRACT The just distribution of benefits and burdens of healthcare, at least in the contemporary Philippine context, is an issue that gravitates towards two opposing doctrines of welfarism and ,free enterprise.' Supported largely by popular opinion, welfarism maintains that social welfare and healthcare are primarily the responsibility of the government. Free enterprise (FE) doctrine, on the other hand, maintains that social welfare is basically a market function and that healthcare should be a private industry that operates under competitive conditions with minimal government control. I will examine the ethical implications of these two doctrines as they inform healthcare programmes by business and government, namely: (a) the Devolution of Health Services and (b) the Philippine Health Maintenance Organization (HMO). I will argue that these doctrines and the health programmes they inform are deficient in following respects: (1) equitable access to healthcare, (2) individual needs for premium healthcare, (3) optimal utilisation of health resources, and (4) the equitable assignment of burdens that healthcare entails. These respects, as considerations of justice, are consistent with an operational definition of ,power' proposed here as ,access to and control of resources.' [source] The Ethics of Life ExpectancyBIOETHICS, Issue 4 2002Robin Small Some ethical dilemmas in health care, such as over the use of age as a criterion of patient selection, appeal to the notion of life expectancy. However, some features of this concept have not been discussed. Here I look in turn at two aspects: one positive , our expectation of further life , and the other negative , the loss of potential life brought about by death. The most common method of determining this loss, by counting only the period of time between death and some particular age, implies that those who die at ages not far from that one are regarded as losing very little potential life, while those who die at greater ages are regarded as losing none at all. This approach has methodological advantages but ethical disadvantages, in that it fails to correspond to our strong belief that anyone who dies is losing some period of life that he or she would otherwise have had. The normative role of life expectancy expressed in the ,fair innings' attitude arises from a particular historical situation: not the increase of life expectancy in modern societies, but a related narrowing in the distribution of projected life spans. Since life expectancy is really a representation of existing patterns of mortality, which in turn are determined by many influences, including the present allocation of health resources, it should not be taken as a prediction, and still less as a statement of entitlement. [source] The future magnitude of urological symptoms in the USA: projections using the Boston Area Community Health surveyBJU INTERNATIONAL, Issue 4 2007Heather J. Litman OBJECTIVE To use the population-based data from the Boston Area Community Health (BACH) Survey to estimate the likely magnitude (prevalence) of urological symptoms in the USA population in 2025, as health-services researchers use projections of the likely magnitude of disease to inform decisions on the future allocation of health resources. METHODS Age and gender-specific prevalence rates from BACH were combined with USA population projections to estimate the likely magnitude of lower urinary tract symptoms (LUTS) and symptoms suggestive of urine leakage, painful bladder syndrome (PBlS) and prostatitis (men only). RESULTS In total and accounting for overlapping symptoms, 52 million adults in the USA will have symptoms of LUTS, urine leakage, PBlS or prostatitis in 2025. These urological symptoms have a large impact on physical and mental aspects of quality of life, that is comparable to other chronic conditions. CONCLUSIONS The future magnitude of symptoms indicative of these four urological conditions might reach the current level of cardiovascular disease in the USA, which is considered ,a modern epidemic.' Our projections have important implications for medical education, training of healthcare providers, health-services research, and policy and patient education. [source] A review of guidelines on benign prostatic hyperplasia and lower urinary tract symptoms: are all guidelines the same?BJU INTERNATIONAL, Issue 9 2003J. Irani The Clinical Practice Guidelines on BPH/LUTS are examined by authors from London and Poitiers. They found in their review of the literature that the overall and methodological quality of such guidelines varies widely. They acknowledge the difficulties in developing careful guidelines, but suggest a formal appraisal of quality and methods, as these are the ones more likely to help urologists in decision-making. There are three papers on the prevalence of symptoms relating to lower tract conditions. The first examines male urinary incontinence in four European centres, the second nocturia and its effect on quality of life and sleep in a US community sample, and a further paper describes the prevalence diagnosis and treatment of prostatitis in Italy. A study from Sydney describes the authors use of the Inflow intra-urethral device for managing acontractile bladders in female patients. They found that the device provides an effective method of bladder drainage, with an acceptable side-effect profile and a significant improvement in quality of life. OBJECTIVE To compare overall and methodological quality with content in national and supra-national Clinical Practice Guidelines (CPGs) on benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS), as the purpose of CPGs is to reduce unwanted variation in practice and improve patient care by setting agreed standards based on the best available evidence. METHODS An electronic search was used to identify Internet-based national and supra-national CPGs on BPH and LUTS available in 2001. Two independent assessors analysed the content and appraised the methodological quality of the CPGs using an existing and validated instrument (St. George's Hospital Medical School Health Care Evaluation Unit Appraisal Instrument) comprising 37 items grouped into three broad areas, i.e. rigour of development, context and content, and clinical application. RESULTS Eight CPGs were suitable for appraisal; there was much variation in overall and methodological quality. There was agreement that a patient history and physical examination (including a digital rectal examination) should be used in all symptomatic men. In addition, patients' symptoms should be assessed using a validated symptom score, e.g. the International Prostate Symptom Score. There was considerable variation in the number and type of diagnostic tests recommended for routine assessment. CPGs scoring low on the appraisal instrument (indicating poor overall and methodological quality) were more likely to recommend more diagnostic tests than those scoring high. There was general agreement between the guidelines on the treatment of BPH/LUTS and the importance of the patient's involvement in making management decisions. Guideline quality was independent of local health resources and publication year. CONCLUSION The overall and methodological quality of CPGs on BPH/LUTS varies considerably. There appears to be an inverse relationship between guideline quality and the number of diagnostic tests recommended for routine assessment. Using CPGs of high quality may prevent men with BPH/LUTS being exposed to tests of doubtful utility. Although this may reduce both resource use and exposure to potential harm, moving to a more minimalist approach to diagnosis may itself be potentially harmful to patients. [source] | |||||||||||||