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PubMed2002

A national study of efficiency for dialysis centers: an examination of market competition and facility characteristics for production of multiple dialysis outputs.

OBJECTIVE: To examine market competition and facility characteristics that can be related to technical efficiency in the production of multiple dialysis outputs from the perspective of the industrial organization model. STUDY SETTING: Freestanding dialysis facilities that operated in 1997 submitted cost report fonns to the Health Care Financing Administration (HCFA), and offered all three outputs--outpatient dialysis, dialysis training, and home program dialysis. DATA SOURCES: The Independent Renal Facility Cost Report Data file (IRFCRD) from HCFA was utilized to obtain information on output and input variables and market and facility features for 791 multiple-output facilities. Information regarding population characteristics was obtained from the Area Resources File. STUDY DESIGN: Cross-sectional data for the year 1997 were utilized to obtain facility-specific technical efficiency scores estimated through Data Envelopment Analysis (DEA). A binary variable of efficiency status was then regressed against its market and facility characteristics and control factors in a multivariate logistic regression analysis. PRINCIPAL FINDINGS: The majority of the facilities in the sample are functioning technically inefficiently. Neither the intensity of market competition nor a policy of dialyzer reuse has a significant effect on the facilities' efficiency. Technical efficiency is significantly associated, however, with type of ownership, with the interaction between the market concentration of for-profits and ownership type, and with affiliations with chains of different sizes. Nonprofit and government-owned Facilities are more likely than their for-profit counterparts to become inefficient producers of renal dialysis outputs. On the other hand, that relationship between ownership form and efficiency is reversed as the market concentration of for-profits in a given market increases. Facilities that are members of large chains are more likely to be technically inefficient. CONCLUSIONS: Facilities do not appear to benefit from joint production of a variety of dialysis outputs, which may explain the ongoing tendency toward single-output production. Ownership form does make a positive difference in production efficiency, but only in local markets where competition exists between nonprofit and for-profit facilities. The increasing inefficiency associated with membership in large chains suggests that the growing consolidation in the dialysis industry may not, in fact, be the strategy for attaining more technical efficiency in the production of multiple dialysis outputs.

Ambulatory Care Facilities↗

PubMed2001

Online orthodontic advice: a protocol for a pilot teledentistry system.

A prototype teledentistry service was established that incorporated a PC-based expert system designed to assist in orthodontic cases. It guided the general dental practitioner (GDP) through the assessment of a patient's malocclusion and helped ensure that all relevant clinical observations were made and details recorded. The resulting data file, containing radiographic images and clinical data, was then transferred via the Internet to a dental specialist. The specialist's recommendations were returned by the same route or, where appropriate, a realtime videoconference was conducted. During an eight-month trial, six GDPs referred 158 cases through the teledentistry system; another 24 cases were referred directly to a local consultant. The protocol used during the trial worked satisfactorily. The GDPs found that it was straightforward and covered all aspects of the cases they submitted.

Child↗

PubMed2001

Why we need more psychology programmers/EL Knife, a data utility for transforming spreadsheets.

The software needs of psychology researchers are sufficiently diverse that they cannot be met by the commercial sector. The field needs more psychologists who publish software, and individual researchers need to be able to write their own. To support this view, the author offers EL Knife, a data utility for reconfiguring multifactor spreadsheet files. Data may be divided by up to four factors, each of which may have an unlimited number of levels. The interface makes it easy to specify a wide variety of different configurations (different ways of packing multiple data dimensions into a two-dimensional spreadsheet). Many other possibilities for useful research software remain to be invented.

Computers↗

PubMed2003

A computer-aided digital audio recording and encoding system for improving the encoding of verbal reports.

The increasing use of verbal reports in psychological research requires tools for improving the ease and reliability of collecting and coding verbal report data. An approach is described that maintains the verbal report data in digitally recorded audio form throughout the collecting and encoding processes. A new computer-aided encoding tool, CAPAS, is described, which randomly selects and plays individual protocol segments and stores computer keyboard-entered codes in an SPSS-formatted data file.

Data Collection↗

PubMedDate not supplied

[A computer program for the support of the treatment-diagnosis process for patients with benign prostatic hyperplasia].

The computer program "Prostate" (Windows, 1.0 version) is designed to assist the urologist in: objective assessment of the lower urinary tract in benign prostatic hyperplasia (BPH), accumulation and storage of information on the patients (data file), comparison (text, graphics) with previous data to control the course of the disease, treatment efficacy, to refer to international recommendations and recent advances in the treatment of both BPH and its complications. The status of the lower urinary tract is to be described basing on the IPSS and QOL tables, PSA findings, rhythm of spontaneous uresis, uroflowmetry, residual urine, prostate size, laboratory and microbiological urinalysis. The program "Prostate" is a new step in medical recording and efficacy of BPH treatment assessment in urology.

Diagnosis, Computer-Assisted↗

PubMed1998

Defining competition in markets: why and how?

OBJECTIVE: To examine the variety of perspectives from which to study the measurement of competition in the healthcare marketplace. Based on a meeting held by The Robert Wood Johnson Foundation in 1996, the authors discuss the complications inherent in the way markets and products are defined by key stakeholders, including economists, policymakers, federal antitrust officials, purchasers, and the competitors themselves. CONCLUSION: The consensus among those who study this issue is that the way competitors, markets, and geographic areas are currently defined, and the ways of measuring competition, are inadequate, due mainly to the fact that both the measures and the definitions have been constructed from very limited data. Confounding this is the fact that analyses of competition are undertaken for such a wide variety of uses and that creating one database to solve the problems mentioned can be extremely daunting. RECOMMENDATIONS: Future research should examine ways to develop better definitions of the new healthcare structures that are competing with each other and ways to create measures of competition that include these new structures. To remedy gaps in the ability to measure competition, the field might also benefit from a public use data file, similar to the Area Resource File (ARF), that would contain HMO data according to geographic area, as well as provider data, employer data, payer data, and sociodemographic data.

Antitrust Laws↗

PubMedDate not supplied

EPIX: an interactive computer application program for cross-sectional epidemiological, periodontal investigations from X-ray films.

This article introduces the interactive computer application program EPIX and the associated personal computer/digitizer system. The system is used to measure marginal alveolar bone height and to record angular alveolar bone defects, defective margins of dental restorations and dental calculus from 5 X-magnified periapical radiographs in cross-sectional epidemiological investigations. The 134-kBytes compiled BASIC program provides 17 menu options. A complete recording of interproximal tooth surfaces takes on average 20 minutes per subject. Data from 200 subjects can be stored on one 5.25" floppy disk. EPIX transforms data files into text files to enable transfer to main-frame computer for statistical analyses. Data displays on VDU or paper are available. Routines for data location and processing, file processing and visual display of an operator's manual provide additional facilities. EPIX has been used to process an epidemiological material of 912 subjects and has proved to be useful.

Cross-Sectional Studies↗

PubMed2005

How much is postacute care use affected by its availability?

OBJECTIVE: To assess the relative impact of clinical factors versus nonclinical factors-such as postacute care (PAC) supply-in determining whether patients receive care from skilled nursing facilities (SNFs) or inpatient rehabilitation facilities (IRFs) after discharge from acute care. DATA SOURCES AND STUDY SETTING: Medicare acute hospital, IRF, and SNF claims provided data on PAC choices; predictors of site of PAC chosen were generated from Medicare claims, provider of services, enrollment file, and Area Resource File data. STUDY DESIGN: We used multinomial logit models to predict PAC use by elderly patients after hospitalizations for stroke, hip fractures, or lower extremity joint replacements. DATA COLLECTION/EXTRACTION METHODS: A file was constructed linking acute and postacute utilization data for all medicare patients hospitalized in 1999. PRINCIPAL FINDINGS: PAC availability is a more powerful predictor of PAC use than the clinical characteristics in many of our models. The effects of distance to providers and supply of providers are particularly clear in the choice between IRF and SNF care. The farther away the nearest IRF is, and the closer the nearest SNF is, the less likely a patient is to go to an IRF. Similarly, the fewer IRFs, and the more SNFs, there are in the patient's area the less likely the patient is to go to an IRF. In addition, if the hospital from which the patient is discharged has a related IRF or a related SNF the patient is more likely to go there. CONCLUSIONS: We find that the availability of PAC is a major determinant of whether patients use such care and which type of PAC facility they use. Further research is needed in order to evaluate whether these findings indicate that a greater supply of PAC leads to both higher use of institutional care and better outcomes-or whether it leads to unwarranted expenditures of resources and delays in returning patients to their homes.

Aftercare↗

PubMed2002

Effect of smoking on tear proteins.

PURPOSE: Cigarette smoking is a serious risk factor for many diseases, e.g., cardiovascular and pulmonary diseases. It is also a risk factor in several eye diseases, including macula degeneration, glaucoma, and cataract. Ischemic, toxic, and oxidative effects of cigarettes are thought to play an important role in damaging ocular tissue. Furthermore, smoking can cause symptoms of dry-eye disease. The aim of this study was to analyze and compare electrophoretic patterns in tears of smokers (SP), severs smokers (SSP), and nonsmokers (CTRL). METHODS: We examined 105 eyes (SP: n=29, SSP: n=26, CTRL: n=50). Each patient was asked for subjective symptoms such as burning, itching, and foreign-body sensation. Tear proteins were separated by Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Digital image analysis was performed by BioDocAnalyze (Biometra, Göttingen, Germany), with densitometric data files being created for each electrophoretic lane. Data was analyzed by multivariate statistical techniques. RESULTS: Tear protein patterns in SP ( P<0.05) and SSP ( P<0.05) were different from those of CTRL. There were significantly more protein peaks in the SSP group ( P<0.005) than in CTRL. CONCLUSION: Electrophoretic analysis of tear protein patterns could detect changes in tear proteins of smokers in comparison to nonsmokers. These changes were correlated with an increase of dry-eye-related subjective symptoms in smokers. Thus, electrophoretic analysis of tear proteins provided greater insight into the pathogenesis of smoking-induced ocular surface diseases.

Control Groups↗

PubMed2004

Occupational exposure to air pollution and cancer risk among Danish urban mail carriers.

OBJECTIVES: Our objective was to study the risk of cancer associated with exposure to air pollution among mail carriers. METHODS: We carried out a retrospective cohort study of 17,233 persons who had been mail carriers during the period 1898-1996. Data on employment was obtained from company files. Data on cancer was obtained from the Danish Cancer Registry. RESULTS: Male mail carriers employed for more than 3 months had a low incidence of cancer, standardised incidence ratio (SIR) 0.92. For cancers related to air pollution the risk estimates were 0.96 for lung cancer, 0.91 for laryngeal cancer and 0.98 for bladder cancer. A significant low risk for cancer of the oesophagus (SIR 0.50), kidney (SIR 0.73), prostate (SIR 0.81) and skin (melanoma) (SIR 0.87) was seen. Among female mail carriers the risk pattern showed a significant excess of cancer of the cervix uteri (SIR 2.24). CONCLUSION: In our study of mail carriers who had spent most of their day doing physical hard work outside in the general air pollution we saw no excess in cancers related to air pollution compared with the general population of Copenhagen. This might be due to the protective effect of physical activity.

Aged↗

PubMed2003

Delivery of preventive services for low-income persons over age 50: a comparison of community health clinics to private doctors' offices.

This study focused on the use of 14 evidence-based preventive services for the low-income population over age 50: colorectal, breast and cervical cancer screening, cholesterol screening, counseling around diet, exercise, tobacco, alcohol and illicit drugs, and immunizations for influenza, tetanus and pneumonia. Population characteristics and rates of delivery of these preventive services are compared for low-income users of community health clinics vs private doctors' offices/HMOs. Three nationally representative data-files from the National Health Interview Survey--the Person-Level File, Sample Adult File, and Sample Adult Prevention File--were linked to obtain the necessary data on preventive services use in the 12,024 persons over age 50. Among the population of persons over age 50 living below 200% of the poverty threshold, those using community clinics were more likely to be younger, a racial or ethnic minority, less formally educated, in poorer health, uninsured, and more likely to face time, transportation or cost barriers to obtaining health care (p < .01 for all comparisons), than their counterparts using private doctors' offices/HMOs. Community health clinics performed as well as private doctors/HMOs in the delivery of cancer screening, cholesterol screening and immunizations to lower income persons over 50 years. Rates of counseling about diet and exercise were higher among users of private doctor's offices than among users of community health clinics users (40% vs. 31% respectively, p = .02). Despite the severe resource constraints under which they operate, and the greater vulnerability of the population they serve, community clinics deliver preventive services at rates comparable to private doctors' offices and HMOs.

Community Health Centers↗

PubMed2003

Application of Monte Carlo calculations to calibration of anthropomorphic phantoms used for activity assessment of actinides in lungs.

This paper reports on a new utility for development of computational phantoms for Monte Carlo calculations and data analysis for in vivo measurements of radionuclides deposited in tissues. The individual parameters of each worker can be acquired for an exact geometric representation of his or her anatomy, which is particularly important for low-energy gamma ray emitting sources such as thorium, uranium, plutonium and other actinides. The software discussed here enables automatic creation of an MCNP input data file based on computed tomography (CT) scanning data. The utility was first tested for low- and medium-energy actinide emitters on Livermore phantoms, the mannequins generally used for lung counting, in order to compare the results of simulation and measurement. From these results, the utility's ability to study uncertainties in in vivo calibration were investigated. Calculations and comparison with the experimental data are presented and discussed in this paper.

Actinoid Series Elements↗

PubMedDate not supplied

ABO incompatible kidney transplantation - an analysis of UNOS Registry data.

BACKGROUND: The ABO incompatible kidney transplants have been performed successfully from large numbers of living donors and some blood type A2 deceased donors. However, there are few reports to support the feasibility of ABO incompatible transplants from non-A2 deceased donors. This problem was examined in the United Network for Organ Sharing (UNOS) data file. PATIENTS AND METHODS: The UNOS Registry data of kidney transplants performed between 1995 and 2003 from 256 centers was utilized for Kaplan-Meier curves and log-rank tests to compare graft and functional graft survival rates. RESULTS: Deceased donor transplants from all ABO incompatible donors had the same graft survival rates, as that from ABO compatible donors regardless of whether the blood group incompatibility was A (A1), A2 or B. Graft survival from 201 ABO incompatible donors was 66.9% at 5 yr, compared with 66.7% for ABO compatible donors (p = 0.83). Non-A2 incompatible donors also yielded comparable survival rates to ABO compatible donors. From living donors, ABO incompatible donors yielded significantly lower graft survival rates than the ABO compatible group, although long-term graft survival rates of those who survived >1 yr did not differ significantly. CONCLUSION: Except higher initial graft loss possibility because of insufficient removal of antibodies, non-A2 kidneys yielded equivalent graft survival rates to ABO compatible transplants. In addition to A2 incompatibilities, Blood group A1 and B incompatibilities can also be considered in ABO incompatible transplants.

ABO Blood-Group System↗

PubMed1989

Health care expenditure and other data.

This international compendium from the Organization for Economic Cooperation and Development Secretariat contains available data for the 24 Member countries for 1960 through 1987. The Federal Republic of Germany is listed as Germany. Tables are presented for expenditure on health, health care pricing trends, social protection and public participation, utilization of medical services and available personnel resources, selected variations in common medical care practice, selected health status indicators, and demographic and general economic background data. There may be some inconsistencies between the data presented in the articles in this issue and those in this data compendium. The articles were based on earlier versions of the Health Data File. As a result, revisions to the data in a number of countries, including Canada, France, Germany, and Italy, are not reflected in the articles. However, the changes are relatively minor and do not affect the results presented in the articles in any substantive way.

Canada↗

PubMed1994

Computerized documentation of pharmacists' interventions.

A computerized system for documenting interventions, developed by the pharmacy department at a 695-bed tertiary care university teaching hospital, is described. A computerized system was developed to better gain the needed details on pharmacists' recommendations, to capture a greater number of such recommendations, and to prepare for recent changes in standards of the Joint Commission on Accreditation of Healthcare Organizations. Only clinically important recommendations or those that involve cost savings are documented. Data can be entered and retrieved from any medical information system terminal in the hospital, and each entry becomes part of the patient's permanent record. A hard copy of all recommendations and a data file are generated daily. Analysis of the data has provided numerous opportunities for improving both patient care and the quality of pharmaceutical services. The system has been well received by pharmacists and has resulted in physician support of pharmacists' recommendations, as well as substantial cost savings. A convenient, easy-to-use computerized program for reporting interventions has helped a pharmacy department conduct departmental and institutional quality assurance activities and decrease costs.

Clinical Pharmacy Information Systems↗

PubMed1991

The basic health care system for the lunar base crew.

A plan of the health care system for the crew on the lunar base is described in this study. The health care system consists of two subsystems. The first is the daily health care system. The system contains health care menus, similar to those on Earth, and some biochemical and ordinary medical examinations. The second system is a periodic medical inspection for the crew's bones and the determination of natural radioisotopes in the body. These care systems are automatically treated with the examination and data filing. Usually these examinations are carried out without the presence of a medical doctor. Examinations and files of the whole results are controlled by a computer. The daily results of examinations are compared with data in the file. If any abnormal values are found in the results, an appropriate message is sent advising whether he must receive an in-depth examination by a medical doctor, or be reexamined by the same submenu. The automatic health care system also records transactions with the life support monitoring system.

Aerospace Medicine↗

PubMed1982

Sexuality in aging: a study of 106 cultures.

Human Relations Area Files data relating to sexual activity among older individuals in 106 traditional societies were studied to identify cross-cultural patterns of variability in sexual behavior occurring with age. In 70% of the societies for which data were available relating to the sexual behavior of older males, a continuation of sexual activity of various kinds was found to occur with aging. These groups were seen to have expectations for continued sexual activity for older men that implied little, if any, loss of their sexual powers until very late in life. Among females, reports of continued sexual activity and interest were found to occur in 84% of the files containing data on the sexual behavior of this age group. Reports of expressions of strong sexual interest by older women were common in these societies. In addition, 50% of the references to sexual activity of older females were found to relate to changes in the women's role as procreant. A lessening of inhibition in regard to sexual conversation, sexual humor, and sexual gestures was noted in 22% of these 106 societies. This diminution of restraint in regard to sexual conversation was reported more frequently among older women, 74% of the reports of such behavior referring to females. The continuance of sexuality in many societies during aging and the limitation of sexuality in other societies suggests that cultural as well as biological factors may be key determinants in sexual behavior in the later part of life.

Aged↗

PubMed1994

Motorcycle crashes in New Zealand resulting in death and hospitalisation. I: Introduction methods and overview.

Relative to car crashes motorcycle crashes have received relatively little attention by the research community. This is the first in a series of three papers describing the epidemiology of motorcycle crashes resulting in death and hospitalisation in New Zealand. This paper describes the methods used for the study, provides an overview of all crashes, and, in particular, compares traffic crashes with nontraffic crashes. The source of the fatality data was national mortality data files for the years 1978 to 1987 inclusive. The source of the hospitalisation data was a national morbidity file, which records all public hospital discharges in New Zealand. A total of 1,175 motorcyclist fatalities were identified for the period 1978-1987, resulting in a mortality rate of 3.6 per 100,000 persons per year. A total of 2,623 motorcycle crash victims were hospitalised in 1988 resulting in a hospitalisation rate of 80.4 per 100,000 persons per year. Males, especially those 15-24 years of age had very high mortality (26-27) and morbidity rates (464-462). Motor vehicle traffic crashes represented 96% of the fatalities and 85% of the hospitalisations. Drivers were the victims in 88% of fatalities and 86% of hospitalisations. For hospitalised victims the leading injuries were to the lower limb (43%) and head (24%). Whereas 29% of the traffic crashes were AIS-3 or higher the comparable figure for nontraffic crashes was 19%. There has been a significant linear increase in the fatality rate between 1978 and 1988 but no comparable trend in hospitalisations.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗