Getting physicians involved in hospital management.
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Canada↗
Biomedical subjects
O Adams
Publications and source records attributed to O Adams.
Physician resource databank: numbers, distribution and activities of Canada's physicians.
The physician resource databank, compiled and maintained by the Canadian Medical Association (CMA), contains functional information from 41 599 of Canada's licensed physicians. The information was gathered from a 20-item questionnaire sent to 47 162 physicians. Of the total, 38 653 responses came from physicians who had completed their training and these were included in the analysis to produce a profile of the supply of physicians in Canada. The data from physicians younger than 35 years indicate some changes in the structure of the supply: 27% are women (compared with only about 9% of physicians older than 45 years).The implications of these statistics are not yet clear, but within the next decade the numbers in some specialties-surgery, anesthesia, obstetrics and gynecology, and radiology-may be too few to meet the demand as more than 20% of the current practitioners reach retirement age. Other findings are that [List: see text]
Age Factors↗
Established Programs Financing-government money for medical care.
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Canada↗
Retirement and mortality.
The impact of retirement on morbidity and mortality in Canada is examined. "The mortality experience of a cohort of 15,260 men and 5,632 women, retiring in 1970 at the age of 65, is compared with corresponding age-specific death rates observed in the general Canadian population between 1970-74." The mortality differentials observed are analyzed by sex.
Americas↗
Oestrogen use and survival in endometrial cancer.
Of 860 women with endometrial cancer registered in a regional cancer treatment centre, 259 (30%) gave a history of oestrogen use for 6 months or more at some time before diagnosis, and 568 (66%) were non-users. OEstrogen use was associated with younger age, earlier stage, lower grade of tumour, less common myometrial invasion, and preferred treatment including radiation and hysterectomy. The 5-year survival of oestrogen users was 92 +/- 2% compared with 68 +/- 2% for non-users. Further analysis controlling for differences in the distribution of the variables associated with survival showed that for women who have endometrial cancer, the risk of any death for non-users is approximately 2-7 times greater than for oestrogen users, and the risk of death from endometrial cancer is 5.4 times greater for non-users. A history of oestrogen use is not associated with superior survival of women who have poorly differentiated tumours or myometrial invasion.
Adult↗
Preliminary experiences with ritonavir in children with advanced HIV infection.
The aim of this study was to obtain information on the feasibility (tolerance, safety) of antiretroviral combination therapy, including ritonavir, in children. In eight children (median age 8.9 years; range 3 to 13 years) with advanced HIV disease (median CD4+ lymphocyte count at baseline, 80 cells/microliter; range 0 to 280 cells/ microliter), drug combinations including ritonavir (approximately 300 mg/m2 b.i.d.) were administered. In seven children, previous therapy using a combination of at least two nucleoside reverse transcriptase inhibitors (NRTI) had failed. Four patients had ritonavir added to an already existing regimen of two NRTI; two patients had one NRTI replaced by a new one; and in two patients two new NRTI were initiated. The number of CD4 T cells, plasma HIV RNA concentration, CBC and blood chemistry profile were monitored. Medication had to be discontinued in two children because of severe nausea and vomiting. In the remaining six children, ritonavir was tolerated and treatment was maintained for at least 6 months. The number of CD4 cells increased in five of six patients. The median number of CD4 cells increased from 66 +/- 110 cells/microliter at baseline to 92 +/- 99 cells/microliter, 161 +/- 88 cells/microliter, and 252 +/- 25 cells/microliter after 1, 3 and 6 months of therapy, respectively. The plasma HIV RNA concentration decreased below the detection limit of 500 copies/ml in three children. In the remaining children a maximum reduction of 0.8, 1.0 and 1.8 log10 was observed. In one child the HIV RNA concentration reincreased after 6 months by 0.7 log10 above the nadir. Antiretroviral combinations including ritonavir were tolerated by six of eight children and produced substantial benefits with respect to increased numbers of CD4 cells and a decline in plasma viral RNA concentration. It can be concluded that the administration of ritonavir is possible in a significant proportion of HIV-infected children, and leads to improvement of the CD4 cell count and viral load.
Adolescent↗
Haematopoietic transplant potential of unrelated and related cord blood: the first six years of the EUROCORD/NETCORD Bank Germany.
To date, human umbilical cord blood (CB) has been employed successfully in well over 1000 allogeneic (unrelated and sibling) stem cell transplantations. Because of primary limitations in volume and cell numbers, over 90% of these transplantations were performed in children. Therefore requests for well standardised cord blood units of high quality are now increasing constantly. Examination and standardisation of unrelated and related cord blood stem cell preparations and banking as well as their biological characterisation was already initiated in Düsseldorf in 1992. Hitherto a total of 3236 CB samples with a mean volume of 89 +/- 25 ml, a mean total number of nucleated cells (NC) of 10 +/- 5 x 10(8) and a mean number of CFU-GM of 6 +/- 5 x 10(5) have also been validated by haematological, immunological and microbiological criteria. In addition to that, 97 directed CB donations of siblings with a clinical indication have been characterised and banked along the same lines. All CB units were collected from the umbilical cord vein immediately after vaginal full term delivery or caesarean section, then frozen and stored in liquid nitrogen. 1940 CB units were stored unseparated, the other 1296 were volume reduced using Hetastarch (HES) with a mean recovery of 85 +/- 13% of the nucleated cells, 86 +/- 12% and 84 +/- 13% for CFC and CD34+ cells, respectively. Only 5.0 ml of a CB sample is required for routine laboratory testing as there are HLA-class I typing, HLA-class II typing by sequence specific oligonucleotide probes (PCR-SOP), ABO typing, sterility control, assessment of progenitor and stem cells by colony forming assays, and CD34+ status as well as certain viral infections such as CMV, Hepatitis B, C, HIV, Parvo B19 by PCR technology before releasing the CB unit for transplantation. For apparent viral infections, maternal sera obtained at birth were tested for HBsAg, anti-HBc, anti-HCV, -HAV-(IgG, IgM), -HIV-1-2, -EBV- (IgG, IgM), -HTLVI-II, -CMV (IgM, IgG), toxoplasmosis and syphilis. Within the last three years a total of 4860 preliminary searches and 680 extended unit reports were submitted to the CB bank Düsseldorf by fax or World Wide Web. So far 68 unrelated and 3 related CB units were delivered. From these 70 have been transplanted in 30 different transplant centres world-wide. Until now the evaluation of the first 53 unrelated CB-transplantations was performed together with the EUROCORD transplant registry. Three patients were excluded from the analysis, since they received an unrelated CB-transplant for non-engraftment after previous allotransplants. The median patient age of these 50 patients was 5.0 years (range 0.3-44), the median weight 18 kg (range 4-70 kg). The majority of the patients transplanted for malignancies (66%) suffered from ALL (n = 19), AML (n = 7), CML (n = 4) and lymphoma (n = 2) with two third (75%) in an intermediate (2nd CR) or advanced stage of disease (> 2nd CR); 13 patients had metabolic diseases and immunodeficiencies and three had aplastic anaemia. All CB samples as well as the patients' blood samples were typed in Düsseldorf for HLA-class I by serology confirmed by PCR-SSP and by high resolution DNA typing for HLA-DRB1 and HLA-DQB1 alleles. 96% of the 50 patients receiving unrelated CB were mismatched at one or more HLA-antigens. 41 of the 50 patients transplanted with unrelated CB from Düsseldorf were evaluable for engraftment with an overall engraftment rate of 83%. According to the defined criteria of EUROCORD, 9 of the 50 patients were not evaluable for engraftment, since they died before day 60. The present median follow-up time is 14 months (1.4-38). The Kaplan-Meier estimate of survival at one year is 42 percent. The three paediatric patients after sibling CB transplantations (ALL, amegakaryocytic thrombocytopenia and CML) are alive with a follow-up time of 350, 379 days and 531 days. (ABSTRACT TRUNCATED)
Adolescent↗
Gianotti-Crosti syndrome associated with Epstein-Barr virus infection.
Gianotti-Crosti syndrome (GCS) is a distinct exanthematic, acrolocated eruption of childhood caused by a variety of infectious agents. Historically hepatitis B antigen positive (HBsAG+) papular acrodermatitis of childhood and HBsAg negative (HBsAg-) papulovesicular acrolocated syndrome have been distinguished. Here we characterize the spectrum of associated infectious agents in seven patients with confirmed GCS seen in our departments in the years 1994-1995. Where available, stored frozen serum samples were reanalyzed for antiviral antibodies. The mean age of the two girls and five boys was 22.5 months with a range of 8 to 53 months. None of the patients was HBsAG+. Four patients showed serologic evidence of an acute infection and one patient of a recent Epstein-Barr virus (EBV) infection. In two additional children vaccination preceded the appearance of GCS. In these two patients serologic investigations revealed no evidence of recent infection with most common viruses. Our results underline the role of viral infections other than hepatitis B in the etiology of GCS. EBV infection was the most commonly associated viral disease in our population. We agree with other authors that we should avoid using the terms papular acrodermatitis of childhood and papulovesicular acrolocated syndrome in describing HBsAg+ and HBsAg- forms of GCS.
Acrodermatitis↗
Reprofiling human resources: transferring care from hospital to community.
It is generally accepted that there must be a shift from expensive acute care services, which often only serve a limited population, to a method of community-based care that is supported by an appropriate mix of primary care providers and specialists. This article identifies constraints to the successful implementation of models of primary care and community-based approaches to the delivery of health services. The importance of health human resource planning and policies is emphasized and suggestions are made on approaches that tend to match human resource development with community-based delivery.
Canada↗
Is Canada's Medicare system sustainable? A review of recent policy recommendations.
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Canada↗
[The World Health Organization and the development of human resources of the health system].
Health workforce is among the main components of the health care system. The performance of the latter depends on the knowledge, competence and motivations of the various categories of health workers. The task of the World Health Organization is to analyze the main problems related to health workforce and to help member-states overcome these problems. An other task is to facilitate intercountry comparisons. To attain these objectives, WHO has developed a conceptual framework, taking into account elements such as the labour market, the health care system, the policies and macro-factors (economic, socio-demographic). Among the main issues related today to health workforce, one can quote: the numbers and distribution of health workers, their migration, their involvement into the field of public health, the contents of their training, and, finally, the increased risk factors they are challenging.
Career Mobility↗
Treatment of chronic hepatitis C with interferon-alpha in patients infected with the human immunodeficiency virus.
BACKGROUND/AIMS: The incidence of hepatitis C infection is increased in subjects with human immunodeficiency virus infection, although the relative frequency of hepatitis b infection is higher than that hepatitis c. The present study assessed the effect of IFN-a on chronic hepatitis C in HIV infected patients. MATERIAL AND METHODS: Twenty patients with chronic hepatitis C, nine positive for antibodies to the human immunodeficiency virus and eleven HIV-seronegative, were treated with interferon a-2b. RESULTS: Five HIV-positive patients responded to therapy with a complete (three) or partial (two) remission of hepatitis at the end of treatment. A sustained response was achieved in four patients. From the HIV-negative patients eight responded with a complete (six) or partial (two) remission. The response was sustained in six patients. Hepatitis C virus-RNA became at least temporarily undetectable in three HIV-positive and six HIV-negative patients. No severe toxicity of interferon treatment was seen in either the HIV-positive or the HIV-negative patients. CONCLUSION: The present results indicate that interferon treatment of chronic hepatitis C in HIV-positive patients is successful in a considerable number of individuals. However it might be inferior to the results in HIV-negative patients.
Adult↗