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At least 325 records · Page 18Linked to original sources
PubMed1998

Community-based medical systems advancement in a hospital-primary health care centre in Crete, Greece: concepts, methods, and the new role of the general practitioner.

Modern health systems research and development emphasize the transition from hospital to primary health care. Importantly, this transition is projected to be coordinated and interactive, as facilitated, e.g., by improved information systems and collaboration between the involved parties, including Universities and health authorities. An ideal combination of this might accordingly be offered by a synthesis of a basic hospital and primary health care center in an area of suitable site, size, and structure. We believe that our institution, Nosokomion Neapolis, in; the moderate-size Cretan township of Neapolis (New-city) offers an interesting model example of this, because of its affiliation with the University of Heraklion and its international and EU-supported project status. In the present report we want to emphasize the elements that are particularly well suited and manageable and in many ways both opportunistic and conscientious "back to the future" instances of a successful Hospital/Primary Health Care integration. Specifically, we think that the advantages in local area epidemiology, prevention, and quality assurance are apparent, and nurture a--rather renewed that new-role of the general practitioner as both a holistic population doctor and a health systems researcher for the year 2,000 and beyond.

Academic Medical Centers↗
PubMed1990

[The methodological basis for a medical system in extreme situations].

The nature and society are suffering great losses from various cataclysms, accidents and catastrophes. We can see that there are objective and subjective reasons of intensification that tragic losses. From practical experience we can conclude that the necessity system of emergency medicine creation have been emerged. It can be organized as flexible, mobile, highly autonomous formation in the structure of the armed forces. In the proposed model medicine of catastrophes should consist of organization-methodological centres, regional organs of management and various functional elements, possessed of flexible structure of coordination and subordination.

Accidents↗
PubMedDate not supplied

Software validation: requirements for programmable electronic medical systems, how to comply with the essential requirements of the EC Directives, part II.

In the second part of this two-part article, the author reviews existing standards and current international and European standardization work, which serves to highlight the need for harmonized standards for medical devices that incorporate software. The new concepts of essential performance, and safety integrity, severity, and risk levels are examined, and these present a new basis for the revision of safety standards to make them relevant to the EC Directives.

Electronics, Medical↗
PubMed1998

Race, treatment, and survival among colorectal carcinoma patients in an equal-access medical system.

BACKGROUND: The aim of this study was to assess the influence of race on the treatment and survival of patients with colorectal carcinoma. METHODS: This retrospective cohort study included all white or black male veterans given a new diagnosis of colorectal carcinoma in 1989 at Veterans Affairs Medical Centers nationwide. After adjusting for patient demographics, comorbidity, distant metastases, and tumor location, the authors determined the likelihood of surgical resection, chemotherapy, radiation therapy, and death in each case. RESULTS: Of the 3176 veterans identified, 569 (17.9%) were black. Bivariate analyses and logistic regression revealed no significant differences in the proportions of patients undergoing surgical resection (70% vs. 73%, odds ratio 0.92, 95% confidence interval 0.74-1.15), chemotherapy (23% vs. 23%, odds ratio 0.99, 95% confidence interval 0.78-1.24), or radiation therapy (17% vs. 16%, odds ratio 1.10, 95% confidence interval 0.85-1.43) for black versus white patients. Five-year relative survival rates were similar for black and white patients (42% vs. 39%, respectively; P=0.16), though the adjusted mortality risk ratio was modestly increased (risk ratio 1.13, 95% confidence interval 1.01-1.28). CONCLUSIONS: Overall, race was not associated with the use of surgery, chemotherapy, or radiation therapy in the treatment of colorectal carcinoma among veterans seeking health care at Veterans Affairs Medical Centers. Although mortality from all causes was higher among black veterans with colorectal carcinoma, this finding may be attributed to underlying racial differences associated with survival. This study suggests that when there is equal access to care, there are no differences with regard to race.

Adult↗
PubMed1998

A survey of sedation protocols used for emergency endotracheal intubation in poisoned patients in the French prehospital medical system.

The purpose of this study was to evaluate prehospital sedation protocols used by several French mobile intensive care units for difficult intubations in poisoned patients. This prospective, descriptive study was performed within the toxicological intensive care unit in a university hospital. Consecutive poisoned patients intubated during their airway management by prehospital medical teams were included. Intubating physicians completed a one-page checklist concerning the circumstances of endotracheal intubation. Intubation difficulty was significantly related to the nature of sedation protocols. The use of etomidate alone as an intubation sedative agent was associated with significantly poorer intubating conditions (47.2% difficult) than other sedative agents or neuromuscular blockade). Neuromuscular blockade with sedation in our series was associated with the lowest incidence of difficult intubations in poisoned patients. Sedation alone for intubation appears to be inadequate to achieve good intubating conditions in a significant proportion of patients.

Adult↗
PubMedDate not supplied

David R. Boyd lecture in trauma care and emergency medical systems: "The surgical complications of toxins.".

Toxins have had major roles in our societies for thousands of years. Interactions between surgeons, both generalists and subspecialists, and those caring for poisoned patients have been extensive throughout history. The advancement of the science of toxicology, the development of regional poison control centers, the development of emergency medicine, and the development of the subspecialty of medical toxicology have led to more appropriate and creative interactions between medical toxicologists, emergency physicians, and surgeons. This article will review the diverse interfaces between the medical toxicologist and the surgeon.

Emergency Medical Services↗
PubMed1977

An evaluation model for medical system change.

An evaluation model was developed and used to monitor the impact of a new mode for entering patients into an existing health care delivery system, and it compared the new mode to two alternate entry methods. In accordance with specified eligibility criteria, 6285 patients were selected and then randomly assigned to the three entry modes. The model employed a health status classification which divided patients into four groups depending upon the concurrence of medical care provider and patient as to whether the patient was well or sick. It then measured the utilization of care resources for each patient health status group. All data were then age-sex-adjusted and analyzed for each of the three entry modes for a standard mix of health status groups.

Ambulatory Care↗