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Results for “Allocation and cooperation”

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At least 307 records · Page 17Linked to original sources
PubMed1982

The Veterans Administration Cooperative Study of stable angina: current status.

The current status of the Veterans Administration Cooperative Study of the effect of surgery on survival in patients with stable angina is presented. The outcome in 686 adult males randomly allocated to medical or surgical treatment groups in 1972-1974 was studied in subgroups of patients classified by invasive (arteriographic) and noninvasive risk factors. In 91 patients with left main lesions reducing the luminal diameter 50% or more, surgery significantly improved survival in the two-thirds characterized as middle or high risk by four simple noninvasive predictors of prognosis (New York Heart Association functional classification III or IV, history of myocardial infarction, history of hypertension, and ST-segment depression on the resting baseline ECG as assessed on a centralized reading). Patients with three-vessel disease and no significant disease of the left main coronary artery also had better survival rates when treated surgically. However, this was statistically significant at 6 years only in the 10 hospitals in which the aggregate operative mortality was 3.3%. Patients without left main lesions were also categorized by four noninvasive predictors of risk. Categorizing such patients into roughly equal groups of high, middle, and low risk identified a high-risk group, in which surgery was associated with statistically improved survival, and low- and middle-risk groups in which it was not. The use of both invasive and noninvasive factors to assess risk in patients with chronic stable angina pectoris provided greater predictive power than either angiography or noninvasive factors alone.

Angina Pectoris↗
PubMed1990

["Emergency medicine"--a challenge for public health services as well].

To evaluate the efficiency of the emergency care system in Düsseldorf 6314 medical records (dating from 1987) were analysed. The result shows a well-functioning system of ambulant emergency care. The success rates a better than average in West Germany, mainly due to the specific conditions in a large city. A detailed assessment of the quality of the medical care is impossible to achieve with the current documentation systems. In contrast to other cities the physicians of the medical department in Düsseldorf take an active part in the emergency care system. Prerequisites are a specialist training (e.g. surgery, anaesthesiology or internal medicine) and several years of clinical experience in intensive care. Consequently, the task of "Coordinating Emergency Physician" has been allocated to the Public Health Office. The combination of medical and administrative experience is of great benefit in solving the organisational problems of cooperation of several medical services. The organisation of the emergency care system should be accepted as an important challenge for the public health system. This engagement may contribute to a better understanding by hospitals, physicians and the general public, of the role and the importance of the Public Health Service.

Emergency Medical Services↗
PubMed1999

Collecting information on disability in the 2000 Census: an example of interagency cooperation.

The United States Constitution requires that an enumeration (or census) of the population be conducted every 10 years to apportion seats in the House of Representatives. Census information is also used to allocate funds and to plan and manage programs. Census 2000 occurs on April 1, 2000, when one-sixth of all American households will be mailed the "long form," containing disability, demographic, economic, and housing questions. Although no short set of commonly accepted questions on disability existed, one was developed for Census 2000 by a collaborative, federal interagency work group on disability, convened by the Office of Management and Budget. The work group consisted of staff from the Social Security Administration (SSA), the Department of Health and Human Services, the U.S. Census Bureau, and other agencies. They reviewed questions initially proposed by the Census Bureau, developed an alternative proposal, tested both versions in the Census Bureau's cognitive questionnaire lab, and on the basis of testing, derived a consensus version for Census 2000. In many ways, the six questions now contained on Census 2000 are an improvement over previous efforts. Disability is ascertained for children as well as for adults, and information will be collected separately for several domains of disability (for example, sensory, mental, physical). The need for a brief set of disability measures goes beyond Census 2000. If such data were collected regularly on national surveys, critical policy and program concerns across agencies could be addressed because better information could be gathered on changes in disability prevalence and on the characteristics of persons with disabilities. Other similar efforts include the former Disability Evaluation Study, now known as the National Study of Health and Activity--a national sample survey on working-age disability to be conducted by SSA--and the President's Task Force on the Employment of Adults with Disabilities (Executive Order 13078).

Activities of Daily Living↗
PubMed1993

Generalizability of valuations on health states collected with the EuroQolc-questionnaire.

PROBLEM: Non-response and non-usable response were found in population surveys on valuation of health states. If non-response is selective regarding valuations, then generalization of the resulting values to the whole survey population is not permitted. This could limit the use of empirical utility values in resource allocation in health care. METHODS: Response behaviour of a sample of 1400 from the Dutch general population to the mailed EuroQolc-questionnaire was analyzed by four methods. I. Phoning resolute non-respondents; II. comparison of zip code characteristics of respondents and non-respondents (because individual data on background characteristics were not available for the non-respondents); III. analysis of response over time (wave-analysis); IV: comparison of background variables of successful (less than two valuations missing) and unsuccessful respondents, combined with analysis of the effect of these background variables on valuations. RESULTS: No indications for selective non-response were found, although the phenomenon appeared hard to investigate. The successful response came from a slightly younger and better educated subsample. However, a general influence of age and educational level on valuations could not be shown. This finding is consistent with the literature. CONCLUSION: Although the existence of selective non-response cannot be excluded, its relevance can be considered to be small. This finding is encouraging for the use of empirical utility values in allocative decisions.

Adult↗
PubMed2003

Myeloperoxidase response to peritonitis in an experimental model.

INTRODUCTION: Patients with peritonitis often exhibit systemic manifestations of sepsis, especially in the lungs. The aim of the present study was to evaluate the local and systemic effects of the neutrophil response to peritonitis in a rat model. METHODS: Fifty Wistar rats were randomized to either a control group or a peritonitis group (5 mg zymosan intraperitoneal). Groups of five animals were killed at 4, 18, 24, 48 and 96 h for evaluation of the morphology of the peritoneum (mesothelial imprint), the number and phenotype of cells within peritoneal fluid (flow cytometry), and myeloperoxidase activity within the peritoneal fluid and distant organs (enzyme assay). RESULTS: Zymosan produced macroscopic evidence of peritonitis and on microscopy there was disruption of peritoneal mesothelial cells. This was accompanied by an influx of neutrophils between 4 and 48 h (P < 0.001) and macrophages between 48 and 96 h (P < 0.001). There was also an increase in myeloperoxidase activity within peritoneal fluid between 4 and 48 h (P < 0.05), the lung at 4 h (P < 0.01) and the liver at 48 h (P < 0.001). CONCLUSION: The present study has confirmed the validity of using zymosan to create a low-morbidity model of peritonitis. Besides the anticipated peritoneal response, there were distant effects of neutrophil activation within the lungs and liver. In the future, strategies that modulate neutrophil activation within these organs might play a useful adjunctive role in the management of patients with peritonitis.

Animals↗
PubMed1998

Physiologic responses to primary blast.

BACKGROUND: Primary blast injuries are produced by the blast shock wave. The critical determinant of survival is pulmonary injury, but acute cardiorespiratory responses to blast exposure are not well understood. The aim of this study was to investigate these changes. METHODS: Twenty anesthetized rats were exposed to moderate blast overpressure, 10 animals receiving thoracic and 10 receiving abdominal exposure. Another 9 animals acted as controls. Respiration, heart rate, and blood pressure were recorded continuously before, during, and for 6 hours after blast exposure. RESULTS: All animals exposed to thoracic blast demonstrated apnea, bradycardia, and hypotension after blast exposure, followed by a return to preblast values. No significant cardiovascular or respiratory changes were seen in animals in the other groups. CONCLUSION: Moderate thoracic blast injury produces a reflex triad of apnea, bradycardia, and hypotension that is not present after abdominal blast. These observations may have important implications for the immediate management of patients with blast injuries.

Abdominal Injuries↗
PubMed1993

Health priorities in developing countries.

In essence then, the health sector in developing countries is weak and fragile; it is vulnerable to external financial pressures and the vagaries of national budget priorities. Throughout the world, leaders in health must seek more effective ways of impressing upon others who make national policy the long term consequences of crises which disrupt health services. Above all, the impact of disinvestment in health in creating underdevelopment and the value of investment in health in creating development must be demonstrably established. Health must be seen as an engine of national development.

Acquired Immunodeficiency Syndrome↗
PubMed1981

Analgesic effects of branding in treatment of headaches.

The effect of branding--that is, the labelling and marketing--of a well-known proprietary analgesic used to treat headaches was studied in a sample of women given a branded or unbranded form with either an inert or an active formulation. The sample was also divided according to whether the subjects were regular users of the brand or users of other brands. The findings showed that branded tablets were overall significantly more effective than unbranded tablets in relieving headaches. Differential effects were observed: the effects of branding were more noticeable one hour after the tablets were taken compared with 30 minutes; in the women given the placebo; and in the users of the brand compared with the users of other brands. It is hypothesised that these effects are due to increased confidence in obtaining relief with a well-known brand, and that branding has an analgesic effect that interacts with the analgesic effects of placebos and active ingredients.

Aspirin↗
PubMed1986

An analysis of the costs of infertility treatment.

For 597 couples receiving care at an infertility clinic in Nova Scotia, the average cost of diagnosis and treatment per successful pregnancy is $10,700. This is compared to the costs of alternatives to infertility treatment. Adoption costs generally range from $3,000 to $10,000, and surrogate mother arrangements are much higher (around $20,000). This study demonstrates the feasibility and value of a systematic analysis of the costs of infertility.

Adoption↗
PubMed2005

Taking a closer look at blood donation in Latin America.

Shortages and unsafe blood still threaten the health of millions of individuals who need blood transfusions in Latin America. There are many demographic and socio-economical factors contributing to this situation. Poverty, high prevalence of infectious diseases, fragmented blood systems, reliance on replacement donors and hospital-based systems are undermining efforts to promote and retain voluntary non-remunerated blood donors (VNRBD) and are endangering the blood supply. Some economic factors seem unsurmountable in countries such as Haiti, Guatemala and Honduras, where the cost of processing a unit of donated blood exceeds the annual per capita budget allocation to health care. However, many countries which have chosen to coordinate their efforts nationally are able to attract 15 times more vnrbd. Working cooperatively with non-governmental agencies such as the Red Cross are also yielding higher rates of voluntary blood donors and fewer paid donors.

Blood Donors↗