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Biomedical subjects

S Houston

Publications and source records attributed to S Houston.

At least 109 records · Page 6Linked to original sources
PubMedDate not supplied

Schistosomal periportal fibrosis in Zimbabwe: use of ultrasound in patients with oesophageal varices.

Ultrasound (U/S) imaging of liver was used in a prospective study of 62 consecutive patients with oesophageal varices in the central hospitals in Harare; 50 had haematemesis. U/S changes of Symmers's periportal fibrosis (PPF) were graded from mild (grade 1) to gross (grade 4). 46 patients (74%) had U/S features of PPF: 7 were grade 1, 7 grade 2, 29 grade 3, and 3 grade 4. Patients with PPF were more likely to have bled (P less than 0.05) and were less likely to have ascites (P less than 0.05) than those without PPF. Spleen or liver size or grade of varices did not correlate with the U/S grade of PPF. Rectal snips were positive for schistosome ova in 19 of 28 cases with PPF and 2 of 7 cases without PPF. Patients with PPF were more likely than those without PPF (P less than 0.005) or controls (P less than 0.0001) to have spent their childhood in an area of Zimbabwe with a high prevalence of Schistosoma mansoni. Schistosomal PPF appears to be a common cause of portal hypertension in Zimbabwe. It is strongly associated with childhood spent in areas of high S. mansoni prevalence.

Adult↗
PubMedDate not supplied

Human T cell lymphotropic virus type 1 in Zimbabwe.

Human T cell lymphotrophic virus type 1 (HTLV-1) causes myelopathy and adult T cell leukaemia. Knowledge of its distribution in Africa is limited. We performed HTLV-1 testing by enzyme immunoassay, with immunofluorescence assay confirmation, on 931 blood donors, 88 human immunodeficiency virus (HIV) seronegative patients with clinical features of acquired immune deficiency syndrome, 23 multi-transfused haemophiliacs, 8 patients with haematological malignancies, and 32 patients with neurological disease. One blood donor and 3 neurological patients, all 3 with spinal cord syndromes, were HTLV-1-seropositive. Two of the 3 HTLV-1-positive myelopathy patients were co-infected with HIV and both experienced unusually rapid progression of neurological disease. HTLV-1 is uncommon but can be associated with myelopathy in Zimbabwe.

Adult↗
PubMedDate not supplied

Outcomes management in women's health.

Outcomes management uses a quality and research approach to reducing costs in health care. Populations may be targeted for high volumes or their potential for cost savings. Outcomes are identified and measured through data collection and analysis. System and care processes that drive these outcomes are analyzed. Tenets related to outcomes management include questioning practice, administrative and physician involvement; recognizing that change is necessary; accepting uncontrollable factors; and valuing the outcomes management process. Resources necessary for managing outcomes include the use of collaborative practice teams, outcomes assessment, information systems, and educational support services. The women's health population can benefit from an outcomes management effort by improving and standardizing care for mothers and infants across the continuum. There is the opportunity to affect the wellness of this population even before the pregnancy occurs.

Cost Savings↗
PubMedDate not supplied

Cost effectiveness of Streetworks' needle exchange program of Edmonton.

OBJECTIVE: To conduct a cost-effectiveness analysis of the Edmonton Streetworks needle exchange program, in terms of the additional cost per HIV infection averted. The main outcome measures were needle use with and without Streetworks, HIV cases averted, and program costs. METHODS: We conducted interviews and HIV saliva tests on a sample of street-involved intravenous drug users (IDU) who are regular Streetworks' clients. Outcomes were used in a cost-effectiveness model. RESULTS: It is projected that the program has a cost-effectiveness of $9,500 (Canadian) per HIV infection delayed for one year. CONCLUSIONS: The discounted cost per case averted is less than the cost of a case of AIDS. Continuing the program is a dominant strategy.

Adult↗
PubMedDate not supplied

Linking outcomes management and practice improvement. Structured care methodologies: evolution and use in patient care delivery.

Structured care methodologies are tools that provide a comprehensive approach to patient care delivery. These tools have evolved in their application and purpose over the years. In many situations, multiple tools are needed to obtain the best outcomes for a patient. The presence of a SCM does not preclude clinical judgment. On the contrary, the fundamental purpose of any SCM is to assist practitioners in implementing practice patterns associated with good clinical judgment, research-based interventions, and improved patient outcomes. These tools support smooth operation and appropriate use of resources, establish a means of patient management across the continuum of care, facilitate collaboration among disciplines, reflect patient outcomes, and provide outcomes data. Data from SCMs permit benchmarking, comparison of pre-implementation and post-implementation outcomes, development of action plans for quality enhancement, identification of high-risk patients, identification of issues and problems in the system that require interventions, and the development of research protocols and studies. Structured care methodology development and implementation can be challenging, rewarding, and at times frustrating. When used appropriately, these tools can have a major impact on the standardization of care and the achievement of desired outcomes. However, individual patient needs may supersede adherence to a tool. The challenge then becomes one of balancing the unique needs of each patient and appropriate use of SCMs. Change comes slowly, but persistence pays off.

Algorithms↗
PubMedDate not supplied

Managing the outcome of infection: nosocomial infection initiative.

Outcomes management provides a mechanism to foster development of patient-driven services through revision of practice and measurement of outcomes. This article shares an outcome initiative that focused on reducing the incidence of nosocomial pneumonia in a hospital setting. Strategies used such as a case-control study, risk tool development and protocol implementation are discussed. Both process and outcome data are provided to demonstrate the positive impact of the initiative.

Aged↗
PubMedDate not supplied

Reflections on a decade of outcomes management in women's services.

Outcomes management was theorized as a strategy for redesigning and continually enhancing interdisciplinary health care processes through the use of outcomes measurements. Regardless of the rapidly changing and oftentimes turbulent health care environment, this strategy successfully facilitated positive outcomes in one women's service for 10 years. Outcomes affected during these years included reduction in cost per case, length of stay, infant prematurity, and cesarean delivery rates.

Cesarean Section↗
PubMedDate not supplied

Challenge of managing interventional cardiology patients over a decade.

Using an outcomes management approach, St. Luke's Episcopal Hospital has achieved positive outcomes in the interventional cardiology patient population. In this article the authors describe a decade of experiences related to the processes they implemented and the outcomes achieved in this patient population.

Cardiology↗
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Ethical concerns regarding cardiac retransplantation.

Health care professionals face many ethical dilemmas regarding cardiac transplantation and retransplantation. A thorough understanding of ethical theories and careful examination of each case encourages decisions reflective of the values of the health care team.

Adult↗