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At least 289 records · Page 16Linked to original sources
PubMed2005

Intensity-modulated radiotherapy as the boost or salvage treatment of nasopharyngeal carcinoma: the appropriate parameters in the inverse planning and the effect of patient's anatomic factors on the planning results.

The current study demonstrates that the large increase in normal tissue penalty often degrades target dose uniformity without a concomitant large improvement in normal tissue dose, especially in anatomically unfavorable patients. The excessively large normal tissue penalties do not improve treatment plans for patients having unfavorable geometry.

Carcinoma↗
PubMed2003

[New possibilities in fracture visualization by means of CT: reconstructions, 3D plannings--difficult joint fractures--modern management--improved visualization and operative planning in joint fractures].

After having been introduced in the seventies computed tomography (CT) has become an important instrument for the diagnosis of difficult joint fractures. With the evolution of the Spiral-CT with multiplanar reformations and three-dimensional (3D-) reconstructions the quality of visualization has been improved considerably. In comparison with conventional radiography the actual CT scanners give a clear image of the fracture configuration and the degree of fragment displacement in joint fractures. Additional information about sub-/luxations of the joint, impaction and comminution is also clearly visualized by the CT. This means a rise in quality of fracture classification and enables a detailed view of the fracture pattern. These findings provide the basis for gratifying treatment regimens and surgical management of the injured joint. By the use of innovative reconstruction methods the CT allows exact visualization of internal fixations/osteosynthesis and secondary angular/rotation or length deformities postoperatively. Furthermore, reconstructed 3D-views enable preoperative computer simulated plannings of internal fixations and of reduction control intraoperatively. In fact, the actual Spiral-CT scanners are nearly equivalent in costs and total radiation dose compared to the performance of special projections of conventional radiographs. Thus, we recommend to enlarge the performance of additional CT diagnostic in difficult joint fractures and special pre- or postoperative cases.

Cost-Benefit Analysis↗
PubMed2003

Developing a new faculty practice plan with a model for funds flow between the hospital and the plan.

The majority of academic health centers are experiencing significant difficulties balancing their research, teaching, and clinical missions while maintaining adequate financial performance. One of the major areas under intense scrutiny is the specific financial relationship between the hospital and the full-time faculty. A realignment of the funds flow between these two entities is becoming essential to the future viability and ultimate survival of many health systems. The authors describe a model that evolved as part of the integration of the faculty practice plans of their institutions when they merged into a single health system, and that provides a framework that specifically addresses these issues of funds flow. The model includes (1) a strong partnership between the hospital and the full-time faculty; (2) a governance model of chairmen, faculty, and administration; (3) flexibility for the department chairs to set salaries and make significant financial decisions relative to their departmental performances; (4) a specific formula for funds flow for graduate medical education dollars from the hospital to the clinical departments; (5) local front-end charge capture and back-end central collections; and (6) clear and consistent definitions of revenue and expense items for both partners.

Academic Medical Centers↗
PubMed1984

Make a plan and a pattern for this plan: a useful material.

When planning out a reconstructive problem, 3M Microfoam tape is used in layers for pattern making. It is found to be versatile in that it is handled easily, is similar in elasticity to full-thickness skin, and can be autoclaved for intraoperative use.

Humans↗
PubMed2006

The theory of planned behaviour and binge drinking: Assessing the moderating role of past behaviour within the theory of planned behaviour.

A sample of 398 undergraduate students completed questionnaires assessing the main constructs of the theory of planned behaviour (TPB) in relation to binge drinking, as well as past binge drinking behaviour. Of these, 273 were followed up at 1 week. Regression analyses revealed attitude, self-efficacy, and perceived control (negative relationship) to be predictive of binge drinking intentions. Intention and self-efficacy were, in turn, predictive of binge drinking at 1-week follow-up. Past behaviour was found to explain additional variance in intention and behaviour. In addition, past behaviour was found to moderate the attitude-intention and intention-behaviour relationships, such that weaker relationships were observed with increasing frequency of past behaviour. The results are discussed in relation to the need to develop and test alternative measures of habit. The implications of the findings for interventions to encourage more appropriate drinking behaviour are outlined.

Adult↗
PubMedDate not supplied

On being new to an insurance plan: health care use associated with the first years in a health insurance plan.

BACKGROUND: We wanted to compare health care utilization and costs in the first year of being in a health insurance plan with those of subsequent years. METHODS: We used claims data from an independent practitioner association (IPA)-style managed care organization in the Rochester, NY, metropolitan area from 1996 through 1999. Cross-sectional and panel analyses of up to 4 years of claims data were conducted, involving 335,547 adult patients assigned to the panels of 687 primary care physicians (internists and family physicians). Multivariate analyses, adjusting for age, sex, case mix, and socioeconomic status derived from ZIP codes, examined the relationship between the first year of health insurance and Papanicolaou tests, mammograms in women older than 40 years, physician use, avoidable hospitalization, and expenditures. RESULTS: After multivariate adjustment, the first year of insurance was associated with a higher risk of not getting a mammogram, a higher risk of avoidable hospitalization, greater likelihood of visiting a physician, and higher expenditures, especially for testing. There was no relationship, however, between Papanicolaou test compliance and year of enrollment. CONCLUSIONS: The findings suggest there might be adverse clinical and financial implications associated with changing insurance.

Adult↗
PubMedDate not supplied

[HIV seroprevalence in patients seen at sexually-transmitted disease and family planning centers in Spain, 1995-1996. AIDS Programs of the Autonomic Communities and Network of sexually-transmitted disease, HIV and family planning centers].

BACKGROUND: The sexually-transmitted diseases (STD's) centers are good sentinels for monitoring the sexual transmitting of HIV. This study analyzes the results of voluntary HIV tests run in 1995 and 1996 within a network of STD, HIV and family planning centers in Spain. METHODS: Starting as of 1995, a questionnaire was sent out yearly to said centers for recording the number of individuals found to have HIV the previous year and the number of those who are proven to be HIV positive. A calculation of HIV incidence was based as a function of sex and the main HIV transmission categories. RESULTS: Eighty-one centers answered the survey in 1995, 78 having done so in 1996. Ninety-five percent of these centers ran the HIV test at the request of the interested parties. At the 39 centers which provided data regarding the HIV tests conducted in 1996, a total of 15,964 individuals had been tested. Positive: 4.8% (n = 760) (CI: 4.4%-5.1%). The HIV seroprevalence was higher for males (5.9%) than for females (2.6%; p, 0001). The highest HIV seroprevalence was found among injecting drug users (IDU's) (18.7%). On comparing HIV seroprevalence in 1995 with that of 1996, drops were detected in the number of homosexual/bisexual men from 7.4% to 6.1% (p = 0.049) and in women prostitutes, from 2.0% to 1.3% (p = 0.034). The Sexual partners of IDUs went from 3.4% to 4.6% (p = 0.267). CONCLUSIONS: These results provide a nationwide reference regarding HIV incidence among populations having high-risk sexual relations. The trend therein is favorable among homosexual/bisexual men and female prostitutes.

Adult↗
PubMedDate not supplied

[Life planning--consequences of a steadily growing life span 1650-2000. Considering the longer life span, do we need a life plan?].

Recent social historical studies on the development of life expectancy over the last 300-400 years have shown that the increasing certainty that the great majority of us will be able to live relatively healthy lives until the end is more decisive for most people than the lengthening of the life span itself. A premature death is no longer--as in previous generations--the rule. Today it is the exception. In an historical and worldwide context, we are the first who will--or could--be able to live our lives from the perspective of a relatively calculable, distant end. In order to do this to a greater degree and, above all, more consciously, a "life design" or "life plan" seems to be necessary. This means developing, as early in life as possible, the types of interests that will last a whole life long and will provide fulfillment, particularly in the "Fourth Age". The period of maturity (and waning activity) should not then be one of insufferable emptiness. "Maturity of life" can mean a chance and a goal for most of us today, provided that we structure this life appropriately ourselves. Contributions to discussions in this context in the USA and in two research-related seminars at the Free University of Berlin are presented.

Aged↗
PubMed1982

Physician performance in a prepaid health plan: results of the peer review program of the Health Insurance Plan of Greater New York.

A peer review program to evaluate the quality of medical care was established by the Health Insurance Plan of Greater New York in 1973. Physician performance is assessed through application of explicit process criteria to medical care as recorded in the patient record. A total of 6,788 records were reviewed in terms of the clinical management of acute otitis media, hypertension and breast lesions. Follow-up procedures to bring about positive changes in delivery of health care were integrated into the program at the time of the initial audit. Reaudit of 715 records were used to measure change in physician compliance with medical care standards. Results of this audit/reaudit process demonstrated statistically significant improvement in quality of clinical practice as measured by the assessment parameters.

Ambulatory Care↗
PubMed1997

[Career plans of future physicians. Level of ambition and plans for specialization among medical students].

This nation-wide study inquiry concerned the intended future careers of medical students at the end of their studies and those of a cohort of first-year students. More first-year than final-year students hoped to obtain a position as a hospital physical or surgeon with management responsibility and twice as many men as women wanted such a position in both cohorts. High self esteem, having a doctor as father and successful examinations at medical school were associated with a high level of ambition. Compared with first-year students, more final-year students preferred family medicine and internal medicine, and less preferred surgery, psychiatry and social medicine. Plans for specialisation were influenced by the father's education level, successful examinations at medical school, whether they had children or not, and the university of graduation. More women preferred gynaecology, more men preferred surgery. The interest for surgery among female students is high compared with the low share of female surgeons. Assuming that these trends persist, psychiatry, laboratory medicine and social medicine risk insufficient recruitment. The share of women holding clinical professorships will probably remain low, even in a generation with more female than male medical students.

Adult↗