Electronic records. Meeting outpatient needs first.
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Biomedical subjects
Publications and source records attributed to F Bazzoli.
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Frustrated by high costs, many organizers of community health information networks are tuning to low-cost, easy-to-implement Internet technologies and protocols. Of the 22 broad network initiatives still under way, about half are either planning to build intranets or incorporating Internet technologies on some form.
To manage the change that confronts Harris Methodist Health System, Larry Blevins uses his technical knowledge, management and interpersonal skills, and business savvy. In 14 years with the Arlington, Texas-based health care system, Blevins has unified its information systems approach and given in the automation infrastructure to thrive. "If you're not changing, then you're either dead or stagnant," Blevins says. "While that is the challenge, that's part of the fun. Change should be fun."
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A simple, safe and effective 1 week low dose triple therapy, omeprazole 20 mg u.i.d. clarithromycin 250 b.i.d. tinidazole 500 mg b.i.d. (OCT) was developed in response to the problems seen with standard triple and dual therapies. Standard triple therapy, bismuth and two antibiotics, in fact, is effective for the eradication of H. pylori but is of limited use, because of side effects and the patients low compliance. The combination of omeprazole plus one antibiotic, either amoxycillin or clarithromycin, has resulted in various rates of eradication in different geographical areas, most of them being inconsistent and low. The short term low dose triple therapy was therefore based on the rationale that measures aiming at reducing side effects and improving patient compliance with an appropriate combination of drugs would lead to a substantial improvement in the eradication rate. This regimen initially tested in H. pylori +ve patients with gastritis, is highly effective (> 90%) for long term eradication also in duodenal ulcer patients and in patients with gastric ulcer. Consistent results have been reproduced by several investigators with the same regime, whilst increasing dosages and duration of treatment does not seem to improve success rate. In alternative, omeprazole, clarithromycin, amoxicillin (OCA) has been also suggested to overcome the problem of metronidazole resistance, however recent studies seem to indicate that resistance to metronidazole does not seem to significantly influence outcome of OCT. In conclusion, also according to the recent Maastricht Consensus Report, the short term low dose triple therapy consisting of a PPI plus antibiotics--any two among clarithromycin, tinidazole/metronidazole and amoxycillin--currently represent the most effective approach to H. pylori eradication.
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Eradication of Helicobacter pylori infection is increasingly recognized as an appropriate therapeutic option, although it may prove difficult to achieve. Variable results, possibly due to side-effects, poor patient compliance and antimicrobial resistance, have been reported with traditional bismuth triple therapy. The combination of highly effective antisecretory drugs, such as omeprazole, and antimicrobial agents are providing a useful alternative to such traditional triple therapy.
Many providers are launching disease management programs to improve the cost-efficiency and quality of health care. The hot new buzzword encompasses many components, including utilization management, patient education and treatment protocols. Savvy health care organizations are devising ways to take full advantage of information technology when implementing disease management programs.
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