Survey report: Pakistan.
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Administrative Personnel↗
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Results for “Health Planning Guidelines”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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The Institute of Medicine report "Unequal Treatment": implications for academic health centers.
BACKGROUND: The United States has achieved dramatic improvements in overall health and life expectancy, largely due to initiatives in public health, health promotion and disease prevention. Academic health centers have played a major role in this effort, given their mission of engaging in research, educating health professionals, providing primary and specialty medical services, and caring for the poor and uninsured. However, national data indicate that minority Americans have poorer health outcomes (compared to whites) from preventable and treatable conditions such as cardiovascular disease, diabetes, asthma, cancer and HIV/AIDS. Two factors contribute heavily to these racial and ethnic disparities in health: minorities are subjected to adverse social determinants, and they are disproportionately represented among the uninsured. In the last twenty years, however, the literature has highlighted the fact that racial and ethnic disparities occur not only in health, but also in health care. The Institute of Medicine Report, "Unequal Treatment." The Institute of Medicine (IOM) was asked to determine the extent of racial and ethnic disparities in health care. Their report, entitled "Unequal Treatment," found that racial and ethnic disparities in health care do exist, and that many sources, including health care systems, health care providers, patients and utilization managers, are contributors. Recommendations from "Unequal Treatment": Implications for Academic Health Centers. The IOM Report, "Unequal Treatment," provides a series of recommendations to address racial and ethnic disparities in health care, targeted to a broad audience (the executive summary and full IOM Report can be found at www.nap.edu under the search heading "Unequal Treatment"). Several of the recommendations speak directly to the mission and roles of academic health centers, and have clear and direct implications for patient care, education, and research. These recommendations include collecting and reporting health care access and utilization data by patient=s race/ethnicity, encouraging the use of evidence-based guidelines and quality improvement, supporting the use of language interpretation services in the clinical setting, increasing awareness of racial/ethnic disparities in health care, increasing the proportion of underrepresented minorities in the health care workforce, integrating cross-cultural education into the training of all health care professionals, and conducting further research to identify sources of disparities and promising interventions. CONCLUSION: "Unequal Treatment" provides the first detailed, systematic examination of racial/ethnic disparities in health care, and provides a blueprint for how to address them. The report=s recommendations are broad in scope, yet have direct implications for academic health centers.
Academic Medical Centers↗
[Longitudinal data related to health. A survey of health related panel studies in Germany].
Individual longitudinal data are indispensable for studying the differential incidence of diseases and of possible chronic conditions, health care interventions and outcomes in the course of time, the effects of changing population structure on morbidity, the demand and use of health services, as well as the efficacy and efficiency of health care guidelines. Here, we present an up to date survey of panel studies in Germany, in so far as these are either still active or were completed only recently, and in so far as they are accessible via public use files or equivalent solutions for the scientific community. There are some health related items on existing general purpose national panel studies, but no health related representative national panel study. In addition to the well known unique potential of panel data, we demonstrate, for special populations (e. g. foreigners and people living in institutionalised settings), as well as for special items (salutogenetic potentials and preventive resources), the particular need for health related panel data in the German context.
Data Collection↗
North-South cooperation for survival.
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Africa↗
Relationships among and demographic predictors of dentists' self-reported adherence to national guidelines.
How dentists learn about and integrate new procedures and techniques into dental practice are major concerns in innovation research in dentistry. The purposes of this study were to: (1) develop reliable measures of self-reported adherence to different national guidelines; (2) to examine the relationships among the different measures; and (3) to determine if predictors of these adherence behaviours exist. One thousand U.S. general dentists were asked to complete a survey of adherence behaviours to established guidelines in infection control, radiation protection, and antibiotic prophylaxis. Thirty-five percent responded to the mailed survey. Reliable scales were developed in infection control and antibiotic prophylaxis behaviors. Step-wise multiple regression analysis produced several weak predictors of adherence to guidelines in these two areas. Characteristics of early adopters such as office complexity, membership in professional associations, and year of graduation, were consistent with other dental innovation literature. Significant correlations were found between adherence behaviors in infection control and antibiotic prophylaxis. These correlations do support the findings that practitioners who are early adopters of innovation are likely to do so in more than one area.
Anti-Bacterial Agents↗
Managed care and open-heart surgery facilities in California.
More than 25 percent of hospitals in California that offer open-heart surgery performed fewer than the number recommended by minimum volume guidelines in 1991. This DataWatch examines the characteristics of these hospitals and the patients they treat. The analysis suggests that the market share of these providers has remained constant over recent years, despite substantial growth in managed care. Simple explanations--for example, that these hospitals are serving isolated geographic markets or are hospitals in transition--do not explain the phenomenon. Medicare beneficiaries represent approximately half of the patient volume at these facilities. Health maintenance organizations (HMOs) are more likely to send their enrollees to high-volume facilities.
California↗
Prioritizing IVF patients according to the number of existing children--a proposed refinement to the current guideline.
The National Health Service is poised to offer at least one cycle of IVF treatment to couples free of charge in the UK, provided that certain clinical criteria are met. At a local level, therefore, funders are faced with the problem of prioritizing patients and establishing waiting lists. It is generally accepted that preference should be given to those with the 'greatest need', but it is uncertain what the criterion is for greatest need. We propose two recommendations as a modification to the current guideline that stresses the need to favour 'couples who do not have any children living with them'. First, we suggest that parental responsibility rather than shared residence be used as a criterion for eligibility. Second, we present a need-based approach that can be used coherently to distribute publicly funded treatment. In an attempt to achieve a fair way of prioritizing patients, we make distinctions between different family arrangements, based on the number of existing children. Our approach treats like cases alike, and ranks different cases relative to each other in a manner that is equitable and charitable.
Adult↗
Quality of life after multiple trauma--summary and recommendations of the consensus conference.
In October 1999, an international and interdisciplinary consensus conference was held about the assessment and application of quality of life (QoL) measures after multiple trauma. Four working groups represented the following patients: children with traumatic brain injury (TBI); adults with TBI, adults with multiple injuries (but without TBI), and adults with spinal cord injury. According to predefined questions, the groups tried to identify the relevant problems of the patients, at different time points after the traumatic event. A review of the existing instruments for quality of life assessment and the evidence of their application in trauma patients in the scientific literature was performed by each group. Based on the results of these literature reviews it was concluded that there are not enough data to establish "evidence-based" guidelines for QoL assessments in these patients. Nevertheless, the groups comprised of experts clinicians and methodologists, agreed on the Glasgow Outcome Scale and the SF-36 as generic tools for QoL assessment across all trauma patients. It was further recommended to use these generic tools in combination with condition-specific instruments to better reflect the specific problems of the patients. Finally, the whole group suggested that it was not appropriate to view this conference as a "final report" about QoL assessment in trauma patients, but rather it should be seen as a starting point for increased efforts to initiate clinical research projects using QoL as an outcome, to develop better instruments, and to include QoL assessments into daily routines.
Health Planning Guidelines↗
Organization of hospital-based acute pain management programs.
BACKGROUND: The management of acute pain is an aspect of hospital-based practice that has been neglected. Control of pain is important for ethical reasons, for compliance with new guidelines and standards, and for optimizing patient satisfaction and outcomes. METHODS: Be review the rationale for establishing priority to the control of acute pain, the importance of an institutional approach to improve pain management, and specific steps in the establishment and conduct of an acute pain program. RESULTS: Improvement in pain control depends on an institutional approach to facilitate changes in attitude and prioritization. Pain management programs should provide for patient and staff education, adequate documentation of care, institutional standards for pain control, quality assurance/continuous quality improvement (CQI) activities, and periodic review of practice and policy. CONCLUSIONS: Effective pain management can set the stage for a rehabilitational approach to postoperative care, which should lead to earlier recovery and improved outcomes.
Acute Disease↗
Bilateral environmental and occupational health program with India.
In spite of considerable economic progress in recent years, India continues to face challenges dealing with poverty, unemployment, malnutrition, disease and disability. The governments of India and the United States have formed a collaborative effort to address outstanding issues in the fields of environmental and occupational health. The Joint Statement on Indo-U.S. Collaboration in Environmental and Occupational Health, which was approved by the Minister of the Indian Union of Health and Family Welfare and the Secretary of Health and Human Services of the United State in Geneva in May of 2002, formalizes the collaborative relationship and calls for the development of Implementation Guidelines. The Implementation Guidelines establish a Joint Working Group, which is responsible for identifying and implementing the collaborative projects. The collaborating organizations have identified three broad areas for collaboration: emergency preparedness and response; training, education, and technology transfer; and research. Within the three broad areas, the organizations have identified two subject areas for initiation: arsenicosis and asbestosis. Researchers and health officials in both India and the U.S. share interest in both research and interventions efforts in these subject areas. As many as 42 million people in the West Bengal area of India may be exposed to arsenic in drinking water at concentrations of health concern. Similarly, as many as 10 million industrial or mine workers in India may be exposed to asbestos or other dusts at concentrations of health concern. The first Joint Working Group meeting is scheduled for March 2003 in New Delhi and will consider these subject areas in developing collaborative projects. Other tasks being undertaken by the signatory agencies include expanding the relationship to include academic and nongovernmental organizations and obtaining funds for the various projects from governmental and nongovernmental sources.
Arsenic Poisoning↗
The association of clinical conditions and serologic tests with CD4+ lymphocyte counts in HIV-infected subjects without AIDS.
Early intervention guidelines in HIV infection require knowledge of CD4+ lymphocyte count; however, CD4+ determinations require special laboratory procedures and may not be readily available in all situations. Using data from 207 HIV-seropositive homosexual men without AIDS, we evaluated the association of difference clinical conditions or serologic tests with CD4+ count. Men with conditions including seborrheic dermatitis, hairy leukoplakia, oral candidiasis and chronic diarrhea, and men with beta2-microglobulin levels greater than or equal to 4.0 mg/l had significantly lower CD4+ counts. However, the probability that a subject with such parameters had less than 200 x 10(6)/l CD4+ cells was limited (25-63%). Although the probability that a subject with such parameters had less than 500 x 10(6)/l CD4+ cells was better (76-88%), the probability that a person without these parameters had greater than or equal to 500 x 10(6)/l CD4+ cells was only 45-50%. Clinical and serologic parameters may provide important prognostic information, but cannot be used to reliably determine the level of CD4+ cells.
Bisexuality↗
Eye care for elderly Americans with diabetes mellitus. Failure to meet current guidelines.
PURPOSE: The purpose of the study is to understand current pattern of eye care use among people with diabetes. METHODS: Study population included 175,015 Medicare beneficiaries who had physician-diagnosed diabetes. The authors estimated overall rate of eye care visits among these beneficiaries in 1992 and 1993 using Medicare physician claims data. In combination of Area Resource File, the authors examined association of eye care use with demographic characteristics, regional socio-economic characteristics, and regional eye care provider supply. RESULTS: Fifty-three percent of the population had at least 1 eye care visit in a 1-year period and 67% in a 2-year period. Younger age (ages < 75 years), male gender, black race, high regional poverty, and fewer ophthalmologist supply were related to lower rate of eye care use. There was no association between eye care use and regional education level and optometrist supply. CONCLUSION: The findings suggest that a large portion of elderly people with diabetes is not obtaining the necessary eye care, especially blacks, men, and those residing in poor areas with fewer ophthalmologists.
Black or African American↗
Assessment and control of vitamin A deficiency disorders.
The XX International Vitamin A Consultative Group (IVACG) meeting in Hanoi, Vietnam, in February 2001 celebrated 25 y of progress in prevention and control of vitamin A deficiency disorders (VADD). Programmatic themes included the following: 1) intervention innovations, 2) integration of vitamin A interventions, 3) the increased risk to health of women who are deficient, 4) measurement of progress and impact and 5) programmatic sustainability. The history of IVACG was remembered and the growth of the group from a meeting of 30 to 40 persons in 1975 to nearly 600 delegates from 63 countries was described. Successful adaptation to new challenges and scientific advances, in moving science to practice, was noted. Guidelines for indicators and interventions were reviewed. A set of revised recommendations were made, including the following indicators for assessment (and, for some, outcome evaluation) of VADD: 1) under-five mortality rate >50 as a surrogate indicator to trigger action, 2) maternal night blindness >5%, 3) rapid dark adaptation worse than -1.11 log cd/m(2) and 4) serum retinol <0.7 micro mol/L (>15%) in young children (<6 y). Key recommendations for specific interventions were to double the existing dose of prophylactic vitamin A supplementation to 50,000 international units (IU) at the three Expanded Programme on Immunization contacts for young infants (<6 mo) and to two doses of 200,000 IU each for women within 6 wk after delivery; to support fortification as a valid and necessary strategy to combat VADD; and to recognize that food-based approaches should include promoting breast-feeding and consuming animal products, because promoting plant-based foods alone will not eliminate VADD in young children due to the low bioefficacy of dietary beta-carotene. This meeting clearly set the agenda for the twenty-first century and called for successful implementation of integrated approaches that will eliminate VADD.
Adaptation, Ocular↗
Colorectal cancer prevention: adherence patterns and correlates of tests done for screening purposes within United States populations.
BACKGROUND: Studies exploring CRC testing prevalence and correlates within US populations have provided limited and sometimes conflicting information. The most recent national-level reports have described US usage of CRC tests but none have considered only those tests done specifically for screening reasons as an outcome variable. METHODS: Using the NHIS 2000 sample of >or=50 year-old, we assessed screening behavior using an outcome variable accounting for (1) any combination of recommended tests (2) done within their respective time guidelines, and (3) specifically for screening purposes. RESULTS: Only 25.8% (95% CI: 24.9-26.7%) of the population reported getting a test done for screening purposes within the recommended time. Most (>85%) of the FOBTs and only about 60% of endoscopies were done for screening. Among those who had an endoscopy within the recommended time, Blacks were more likely than Whites to report screening as the purpose of the test. Hispanics had the lowest test usage irrespective of test time, reason or type. Hispanics were 50% (p<0.001) less likely to be adherent, and Blacks approximately 22% (p<0.01) less likely to be adherent, than Whites. After multivariate adjustment, differences between Whites and Blacks disappeared; Hispanics remained less likely. Increasing education predicted higher adherence among Whites but only undergraduate completion did so among Blacks. Male gender predicted adherence only among Blacks and insurance only among Hispanics. CONCLUSIONS: Preventive screening for CRC is lower than estimates from previous studies. Future studies should consider accounting for test purpose. Our findings need confirmation through studies based on objective data.
Black or African American↗
Overview of breast health care guidelines for countries with limited resources.
Among women around the globe, breast cancer is both the most common cancer and the leading cause of cancer-related death. Women in economically disadvantaged countries have a lower incidence of breast cancer, but poorer survival rates for the disease relative to women in affluent countries. Evidence suggests that breast cancer mortality can be reduced if resources are applied to the problem in a systematic way. The purpose of the Global Summit Consensus Conference was to begin a process to develop guidelines for improving breast health care in countries with limited resources-those with either low- or medium-level resources based on World Health Organization (WHO) criteria. Breast cancer experts and patient advocates representing 17 countries and 9 world regions participated in the conference. They reviewed the existing breast health guidelines, which generally assume unlimited resources. Individual panels then discussed and debated how limited resources can best be applied to improve three areas of breast health care--early detection, diagnosis, and treatment--and how to integrate these areas in building a breast health care program. The panelists unanimously agreed on the guiding principle that all women have the right to access to health care. They also agreed that collecting data on breast cancer is imperative for deciding how best to apply resources and for measuring progress. The panelists acknowledged the considerable challenges in implementing breast health care programs when resources are limited, as well as the need to build a program that is specific to each country's unique situation. The panelists noted that the development of centralized, specialized cancer centers may be a cost-effective way to deliver breast cancer care to some women when it is not possible to deliver such care to women nationwide. In countries with limited resources, at least half of the women have advanced or metastatic breast cancer at the time of diagnosis. Because advanced breast cancer has the poorest survival rate and is the most resource intensive to treat, measures to reduce the stage at diagnosis are likely to have the greatest overall benefit in terms of both survival and costs. Women should have access to diagnosis and treatment if efforts are undertaken to improve early detection of breast cancer. The panels' findings outline specific steps for prioritizing the use of limited resources to decrease the impact of breast cancer around the globe.
Breast Neoplasms↗
CIPIH report: main recommendations.
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Developing Countries↗
'HeartGuide' food-rating program attracts 114 applications as controversy continues.
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American Heart Association↗
Drug-eluting stent task force: final report and recommendations of the working committees on cost-effectiveness/economics, access to care, and medicolegal issues.
Coronary artery disease remains a major health problem worldwide. Since introduction of percutaneous transluminal coronary angioplasty and stents, much progress has been made. Percutaneous coronary intervention, however, has been limited by restenosis (repeat obstruction of arteries that have been previously treated. Introduction of drug-eluting stents (DESs) in April 2003 was a major breakthrough in preventing restenosis. In March 2003, The Society for Cardiovascular Angiography and Interventions (SCAI) published a position statement on the clinical implications of DESs, recommending an evidence-based adoption strategy. Subsequently, in May 2003, SCAI formed a multidisciplinary Drug Eluting Stent (DES) Task Force to address the significant nonclinical ramifications posed by DESs: medicolegal, financial, and access to care. The Task Force included representatives from physician societies, industry, academia, the reimbursement community, and health policy organizations. The resultant report presents analyses, options, and recommendations regarding those nonclinical issues based on the collective experience and knowledge of the Task Force members. The Task Force trusts that this report will be of value to the diverse constituencies involved with introduction of this important new technology.
Advisory Committees↗