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PubMed1994

Middle ear gas exchange in rhesus monkeys.

The mechanism of gas exchange between the middle ear and tissue is fundamental to understanding middle ear physiology and pathophysiology. In this study, the middle ears of six rhesus monkeys were inflated on separate occasions with nitrogen (N2), carbon dioxide (CO2), and oxygen (O2), and middle ear pressures were recorded at defined times postinflation for up to 4 hours. From these data, rate constants governing the exchange of these gases were estimated and compared to those predicted under both diffusion and perfusion limitations. The results show that the rate constants for middle ear to tissue exchange of O2 and CO2 are consistent with a diffusion-limited process. In contrast, middle ear pressure did not decrease over the study period following introduction of N2 into the middle ear. This is interpretable as a much slower rate of N2 exchange than that predicted by either perfusion or diffusion-limited models calibrated to the O2 and CO2 rate constants. These results have significant implications for middle ear gas exchange and suggest that for relatively short observation periods, the behavior of middle ear pressure is controlled by experimentally established O2 and CO2 gradients.

Animals↗
PubMed2005

Achievements and challenges on policies for allied health professionals who use telehealth in the Canadian Arctic.

We formulated policies and procedures for allied health professionals (AHPs) who provide services using telehealth in Nunavut, Canada's newest Arctic territory. These are a supplement to the clinical policies and procedures already established for Nunavut physicians and nurses. The services were in the areas of audiology, dietetics/nutrition, midwifery, occupational therapy, ophthalmic services, pharmacy, physiotherapy, psychology, respiratory therapy, social work and speech therapy. Documents specific to each of the services were developed, drawing on information from Government of Nunavut data, Nunavut healthcare providers and links made through the Internet. Topics included the scope and limitations of telehealth services, staff responsibilities, training and reporting, professional standards and cultural considerations. We also considered generic policies covering common issues such as jurisdiction, licensing and liability. The policies and procedures for AHPs will enhance and expand the successes already achieved with telehealth in Nunavut. The challenges are to balance the preferred approaches to service provision with the realities of health care and communications in an Arctic setting.

Achievement↗
PubMed1998

[Characteristics of medical institutions visited by patients with intractable diseases--analyses of patients receiving financial aid for treatment].

The Research Committee of Epidemiology of Intractable Diseases (Ministry of Health and Welfare, Japan) conducted a nationwide survey of 34 intractable diseases. Each of 47 prefectural governments reported information on all patients with the diseases who received financial aid for the disease from April 1992 to March 1993. Information collected on each patient included the identification number, sex, age, the code of the municipality where the patient lived, and the medical institution and department where the patient was being treated. Out of 247, 726 patients whose information was reported by prefectural governments, we analysed data of 208,945 patients whose medical institutions were reported. The results can be summarized as follows: 1) Aged patients and children who were less than ten years old tended to visit medical institutions located in their neighborhoods and be treated in small hospitals or clinics. 2) The proportion of patients who visited hospitals with 200 beds or more was 77 percent. 3) Patients with the diseases resulting in physical disabilities such as SMON and malignant rheumatoid arthritis tended to visit clinics. Patients with skin diseases as pemphigus, epidermolysis bullosa and pustular psoriasis tended to be treated in university hospitals. 4) Many patients living in prefectures near large cities such as Tokyo and Ishikawa visited medical institutions in the large cities. 5) The proportion of patients who visited university hospitals decreased during the eight years from 1984 to 1992. However, a quarter of these patients visited university hospitals.

Adolescent↗
PubMedDate not supplied

Consistent standards in medication use: the need to care for patients from research to practice.

OBJECTIVE: To propose adoption of practice standards for pharmacists based on the principles of pharmaceutical care that are parallel to internationally accepted ethical precepts governing clinical research. DATA SOURCES: Relevant literature selected by the authors. SUMMARY: Pharmaceutical care practice standards can create a continuum of high quality care for patients from research through practice and are presented as a rational solution to managing the benefits and risks of medication use. By implementing these practice standards, patients are empowered to become active participants in the treatment process, knowledge of drug effectiveness and safety is increased, and the pharmaceutical care practitioner's responsibilities are delineated. More than a quarter century ago, the research community adopted the ethical principles of respect for persons, beneficence, and justice, as outlined in the Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research. Under these guidelines, research subjects are considered participants, knowledge of medication efficacy and safety has increased, and investigator responsibilities have been defined. However, these guidelines only apply to the life cycle of a drug before approval by the Food and Drug Administration. Once the product is released for general use, fewer standards are applied. Pharmacy has the opportunity to establish parallel standards for the clinical use of medications in patients by establishing patient care practices in consonance with pharmaceutical care practice. CONCLUSION: Pharmaceutical care practitioners need to apply new practice standards that allow them to contribute meaningfully to appropriate, effective, safe, and convenient drug therapy for all patients. Such pharmaceutical care practice standards could ensure consistent vigilance throughout the life cycle of the drug product and result in rational, appropriate, effective, safe, and convenient drug therapy for all patients.

Drug Therapy↗
PubMedDate not supplied

Tuberculosis in the twentieth century: time-series mortality in São Paulo, Brazil, 1900-97.

The objective of this study was to characterize tuberculosis mortality trends in the Municipality of São Paulo, Brazil, from 1900 to 1997. Standardized tuberculosis mortality rates and proportional mortality ratios were calculated and stratified by gender and age group based on data provided by government agencies. These measures were submitted to time-series analysis. We verified distinct trends: high mortality and a stationary trend from 1900 to 1945, a heavy reduction in mortality (7.41% per year) from 1945 to 1985, and a resumption of increased mortality (4.08% per year) from 1985 to 1995. In 1996 and 1997 we observed a drop in tuberculosis mortality rates, which may be indicating a new downward trend for the disease. The period from 1945 to 1985 witnessed a real reduction in tuberculosis, brought about by social improvements, the introduction of therapeutic resources, and expansion of health services. Recrudescence of tuberculosis mortality from 1985 to 1995 may reflect the increasing prevalence of Mycobacterium and HIV co-infection, besides loss of quality in specific health programs.

Adolescent↗
PubMed1985

Epidemiologic evidence and motor vehicle policy making.

After being randomly assigned to receive policy effectiveness information expressed as attributable benefit, attributable risk, or relative risk, 318 graduate students were asked to indicate their preferences for the current voluntary seat belt use policy, a mandatory seat belt policy, or mandatory passive restraints. A control group received no data. Exposure to effectiveness information (any type) was significantly associated with favoring either mandatory seat belts or passive restraints over the current policy. Those exposed to attributable benefit or risk data were more apt to make proregulatory choices than subjects exposed to relative risk data. Attitudes toward government regulation and specific views about personal freedom and policy effectiveness were also found to be significant predictors of policy preference.

Accidents, Traffic↗
PubMed2003

Cancer-related health disparities in women.

OBJECTIVES: This article synthesizes information about cancer in 9 populations of minority women: Mexican American, Puerto Rican, Cuban American, African American, Asian American, Native Hawaiian, American Samoan, American Indian, and Alaska Native. METHODS: Cancer registry data, social indicators, government sources, and published articles were searched for information on the background and cancer experience of these 9 racial/ethnic groups. RESULTS: Approximately 35 million women in these racial/ethnic groups live in the United States, and their numbers are increasing rapidly. Since 1992, incidence rates for major cancer sites have slowed or decreased among these groups, but declines in mortality have not occurred or have been smaller than for Whites. Gaps in early detection have narrowed, but minority women still lag behind Whites. Smoking and obesity remain common in these populations. CONCLUSIONS: More culturally appropriate interventions and research are needed, and these efforts must involve the community and raise the quality of health services.

Adult↗
PubMed1989

The masters degree in departments of nursing science at South African universities: types, growth and policy differences and similarities.

In this exploratory study nine masters programmes in nursing were surveyed to establish the types of programmes available, the growth of masters students over the years and the policies governing each programme. Data were collected by means of a questionnaire developed by the investigator. From the findings it could be established that considerable variation existed in the type of form of degree offered, that growth was steady but slow and that both similarities and differences existed in the policies of the departments. Several areas were identified for additional research.

Academic Dissertations as Topic↗
PubMed1997

Assessing quality using administrative data.

Administrative data result from administering health care delivery, enrolling members into health insurance plans, and reimbursing for services. The primary producers of administrative data are the federal government, state governments, and private health care insurers. Although the clinical content of administrative data includes only the demographic characteristics and diagnoses of patients and codes for procedures, these data are often used to evaluate the quality of health care. Administrative data are readily available, are inexpensive to acquire, are computer readable, and typically encompass large populations. They have identified startling practice variations across small geographic areas and-supported research about outcomes of care. Many hospital report cards (which compare patient mortality rates) and physician profiles (which compare resource consumption) are derived from administrative data. However, gaps in clinical information and the billing context compromise the ability to derive valid quality appraisals from administrative data. With some exceptions, administrative data allow limited insight into the quality of processes of care, errors of omission or commission, and the appropriateness of care. In addition, questions about the accuracy and completeness of administrative data abound. Current administrative data are probably most useful as screening tools that highlight areas in which quality should be investigated in greater depth. The growing availability of electronic clinical information will change the nature of administrative data in the future, enhancing opportunities for quality measurement.

Abstracting and Indexing↗
PubMedDate not supplied

Male identity in mental health nursing.

AIM: To explore the cultural meaning associated with male mental health nurses. METHOD: An ethnographic approach was used to discover the meaning informants attach to the cultural norms, values and rules that govern their behaviour. Data were collected through participant observation and in-depth interviews with informants. RESULTS: Data were analysed using emerging domains and taxonomies regarding male nurse issues. This involved grouping terms, words and everyday reflections collected from the male mental health nurses. These lists of data (taxonomies) enabled the researcher to identify in-depth cultural themes about the attitudes, behaviours and symbolism typically associated with male nurses. CONCLUSION: A number of cultural themes emerged, including the notion of 'soft masculinity', which provided some insight into male nurses' experiences of working in a female-dominated workplace. A recurring theme was the need for male nurses to demonstrate gentleness and caring while maintaining a balanced sense of masculine identity.

Anthropology, Cultural↗
PubMed1983

Public policies and family outcomes: empirical evidence or ideology?

Research findings and other data dealing with government policies and programs such as Social Security, supplemental security income, welfare reform, deinstitutionalization, abortion, and compensatory preschool education show that these programs have promoted family well-being and not hindered family interests.

Aid to Families with Dependent Children↗
PubMed1983

Medicare program; invalidation of the wage index in the schedule of limits on Hospital per diem inpatient general routine operating costs for cost reporting periods beginning on or after July 1, 1981 and ending with cost reporting periods beginning on or before September 30, 1982--HCFA. Notice.

This notice announces the April 29, 1983 decision of the United States District Court for the District of Columbia in the case of District of Columbia Hospital Association, et al. v. Heckler, et al. (No. 82-2520 D.D.C.). In its decision, the court ordered us to publish a notice in the Federal Register stating that the 1981 schedule of limits on hospital per diem inpatient general routine operating costs has been declared invalid with regard to the wage index for cost reporting periods beginning on or before July 1, 1981 and ending with cost reporting periods beginning on or before September 30, 1982. The District Court held that the decision to exclude Federal government hospital wage data from the computation of the wage index used in the 1981 Medicare hospital cost limits, without providing prior notice and an opportunity for comment, was in violation of the rulemaking requirements of the Administrative Procedure Act. The decision of the District Court does not apply to cost reporting periods beginning on or after October 1, 1982. The cost limits for periods beginning on or after October 1, 1982 are contained in the interim final notice with comment period published in the Federal Register on September 30, 1982 (47 FR 43296).

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

[Children of immigration: effects of their presence on the demographic situation in selected employment countries].

The author examines the impact of migrant workers in Europe on such demographic developments as declining fertility, population decrease, and demographic aging. Official government and U.N. data are used to contrast age distributions of migrant and native populations in selected receiving countries in Europe. "In his analysis of the impact of second-generation migrants on demographic development in the principal European employment countries, the author shows that in all of these countries the foreign population improves the age distribution of the population as a whole by way of reinforcing the weight of the younger age groups in relation to the older groups. The ageing of the national populations...is thus countered by the presence of second-generation migrants." (summary in ENG)

Age Distribution↗
PubMed2002

[Nationwide survey of intractable disease patients. Analyses of patients receiving public financial aid for treatment in fiscal year 1997].

OBJECTIVE: In order to clarify epidemiologic features of selected intractable diseases, an investigation of the fourth nationwide survey, in 1998, was performed. METHODS: We asked 47 prefectural governments to provide data concerning every patient receiving financial aid for treatment of 39 selected intractable diseases from April 1997 to March 1998. The items for each patient required were the beginning year of the financial aid, the disease code, sex, date of birth, residence, type of insurance, whether an in-patient or outpatient, medical institution and the clinical division where the patient was treated. We performed a detailed analysis regarding the age distribution, the prefecture, in-patient or outpatient, the clinical division, the insurance, and the disease, for both males and females. RESULTS: 1. The total number of patients who received financial aid for treatment was 399, 719 with a sex ratio of 0.66 (males 158, 766, or female 240, 953), 60.7% being between 45 and 74 years of age. Of 214, 173 patients whose status could be confirmed regarding outpatient or inpatient. 14.7% were the latter. Of 129, 685 cases, 56, 471 (43.6%) were treated in departments of internal medicine. Of 396, 187 patients, 65, 841 (16.6%) were covered by the health and medical services law for the aged. The greatest number of patients resided in Tokyo, and the least was in Yamanashi Prefecture. 2. With regard to specific intractable diseases, the largest number of patients receiving aid for treatment were suffering from ulcerative colitis at 52, 261, while the least number was for primary pulmonary hypertension at 96. The numbers for each group had increased within the 13 years from 1984 to 1997, except for SMON. As the patients' age increased, the percentage of those receiving treatment also increased and the numbers of aged individuals were especially elevated. 3. The proportion of in-patients for the Creutzfelde-Jakob disease was 76.4 percent, which was remarkably higher than for other diseases. CONCLUSION: By the present analysis of the nationwide survey in fiscal year 1997, we could clarify changes in epidemiologic features of patients receiving financial aid for treatment. This kind of analysis should be continued to obtain important information on the epidemiology of intractable diseases.

Adolescent↗
PubMed2002

Using the STS and multinational cardiac surgical databases to establish risk-adjusted benchmarks for clinical outcomes.

One of the purposes of collecting data on cardiac surgical procedures, at a national level is to enable individual surgeons to improve quality and benchmark their own practice by making more accurate prospective prediction of outcome of each individual patient by using risk stratification based on previous local and national experiences. The past decade has seen a dramatic increase in the development of national cardiac surgical initiatives in many countries around the world. The size and extent of these databases has successfully allowed their use for patient risk stratification and preoperative risk modeling in four main aspects: patient selection and informed consent, coherent analysis of the determinants of patient outcomes, rationalizing unit management, and negotiations with external agencies. Approximately 610 cardiac surgical units presently contribute their patient data, containing pre-operative risk factors, to centralized national registries. There are currently nine different datasets used throughout the world to collect patient information. To harmonize the considerable diversity among these source materials, an International Dataset has been developed by a collaborative process among more than 50 cardiac surgeons around the world. Constructed around the Society of Thoracic Surgeons (STS) data format, the International Dataset brings in key elements from all the other datasets, allowing the sharing of data and cross-analysis, thus greatly expanding the pool of patients, and national sources, from which risk-stratifed outcomes can now be analyzed and unified. Unlike the STS dataset, the International Dataset incorporates EuroSCORE, a simple-to-use, validated patient risk stratification system, which has been rapidly adopted by large numbers of centers around the world for patient risk stratification, outcomes assessment, and improving patient informed consent. There are several benefits to collecting and centralizing national and international data: (1) understanding and defining basic demographics of patients undergoing cardiac surgery; (2) patient risk stratification and risk prediction at both a national and center-by-center level; (3) unit benchmarking, and development of effective nationally oriented and center-oriented quality improvement programs; (4) understanding and rationalizing resource utilization; and (5) use of data to leverage governments and other healthcare providers to affect policy. Cardiac surgical registries will soon attempt to track patients for longer follow-up periods after discharge in order to identify surgery-related deaths for more extended periods of time following surgery, thereby improving the monitoring and prediction of patient outcomes.

Benchmarking↗
PubMed1984

DRGs and hospital case records: implications for Medicare case mix accuracy.

As Medicare moves to DRG-based prospective payment, it is not clear whether the federal government has adequate data upon which to formulate DRG prices and assess hospital case mix. This study compares the Medicare case mix of Minneapolis-St. Paul hospitals based on the historical information submitted for billing purposes on the Medicare claim with the actual case mix of hospitals as described in the medical record chart. It was found that for the same patients, the DRG based on the claim matched the DRG on the medical record approximately half of the time. These "mismatches" resulted in a statistically significant understatement of hospitals' case mix, and have obvious implications for the setting of DRG prices and equitable hospital reimbursement.

Centers for Medicare and Medicaid Services, U.S.↗