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At least 325 records · Page 18Linked to original sources
PubMed1990

Managing physician efficiency and effectiveness in providing hospital services.

Physicians control more than 80 percent of the decisions affecting health costs. Consequently, managing physician practice patterns is an important avenue to reducing health care costs. One approach to identifying inefficient practice patterns is demonstrated in this pilot study of physicians treating heart shock patients. Physicians are evaluated using data envelopment analysis (DEA), a relatively new linear-program-based efficiency evaluation tool. This approach (1) locates physicians using excess resources in treating patients, (2) estimates the amount of excess resources used, and (3) explicitly considers the quality of patient care in the overall assessment of the physician's practice patterns. Findings of physician inefficiency that are stable over time could be used to alter practice patterns and subsequently to assist in cost containment.

Data Collection↗
PubMed1975

The Denver universal microspectroradiometer (DUM). II. Computer configuration and modular programming for radiometry.

This paper describes and discusses for microscopists and spectroscopists the choice of computer equipment and the design of programs used in the Denver Universal Microspectroradiometer (DUM). This instrument is an accurate computerized photon-counting microspectrophotometer, microspectrofluorimeter and microrefractometer. The computer is used to control the operation of the system, to acquire radiometric data of various kinds, and to reduce, analyse and output the data in a readily usable form. Since the radiometer was designed to carry out many kinds of measurements in a variety of micro- and macroscopic specimens, and since different methods of microscopy or spectroscopy have to be combined in various ways fro the study of any one specimen, no single master-program could fulfill efficiently all foreseeable requirements. Therefore, the programming developed is interactive, modular, hierarchical and hybrid. Modular interactive programming makes it possible for almost any kind of main program, applicable to almost any kind of measurement, to be assembled quickly from a collection of hierarchical subroutines. Main programs are short and composed mainly of Fortran statements calling subroutines; subroutines, in turn, automatically call other subroutines over many levels. The subroutines are independently written and optimized for maximum operational efficiency in the computer system used, or for maximum ease of transfer to other systems. This approach to programming enables someone unfamiliar with computer languages to operate the radiometric system from the console of the CRT terminal. The writing of new main programs, by linking groups of existing subroutines, requires only a minimum acquaintance with Fortran; only the writing and revision of subroutines requires programming experience. Differences and similarities in the method of computer operation between the present system and other computerized radiometers are briefly discussed.

Computers↗
PubMed1983

In vivo desensitization of a severe driving phobia through radio contact with telemonitoring of neurophysiological reactions.

A 34 year-old man with a severe driving phobia was treated by in vivo desensitization. A radio transceiver was used to provide the anxiety inhibiting effects of voice contact during exposure to phobic driving experiences. Transceivers were linked to a Telemonitor apparatus programmed to broadcast heartbeat and GSR readings automatically every 15 minutes or on demand, each of 10 seconds duration. The therapist was therefore in touch with the subjective and physiological arousal of the patient from distances up to 7 miles. This allowed him to conduct more efficiently a program of in vivo graduated exposure. Treatment effects were maintained at a 9-month follow-up.

Adult↗
PubMed2001

Learning to solve planning problems efficiently by means of genetic programming.

Declarative problem solving, such as planning, poses interesting challenges for Genetic Programming (GP). There have been recent attempts to apply GP to planning that fit two approaches: (a) using GP to search in plan space or (b) to evolve a planner. In this article, we propose to evolve only the heuristics to make a particular planner more efficient. This approach is more feasible than (b) because it does not have to build a planner from scratch but can take advantage of already existing planning systems. It is also more efficient than (a) because once the heuristics have been evolved, they can be used to solve a whole class of different planning problems in a planning domain, instead of running GP for every new planning problem. Empirical results show that our approach (EvoCK) is able to evolve heuristics in two planning domains (the blocks world and the logistics domain) that improve PRODIGY4.0 performance. Additionally, we experiment with a new genetic operator --Instance-Based Crossover--that is able to use traces of the base planner as raw genetic material to be injected into the evolving population.

Algorithms↗
PubMed2002

Black and Hispanic veterans in intensive VA treatment programs for Posttraumatic Stress Disorder.

OBJECTIVES: This study examines differences in treatment process and outcomes among minority veterans treated in specialized intensive VA programs for war-related Posttraumatic Stress Disorder (PTSD). DESIGN: A concurrent panel study assessing four different types of intensive PTSD treatment program. SUBJECTS: Black (n = 2,906; 23.4%), Hispanic (n = 661, 5.3%), and white veterans. METHODS: Hierarchical linear modeling was used to compare black and Hispanic veterans with white veterans on admission characteristics, treatment process, and outcomes, overall, and to determine whether treatment in three newer types of programs, each designed to improve efficiency, was associated with in changes in minority group experiences. RESULTS: At the time of program admission, black patients had less education, were less likely to be married or to receive VA compensation, and had more severe alcohol and drug problems, but had less severe PTSD symptoms than either white patients or Hispanic patients. There were no differences among groups on 8 of 11 measures of treatment process or outcome but black patients showed greater improvement than white patients on one measure of PTSD symptoms and Hispanic patients were more satisfied with their treatment than white patients although they showed smaller gains in employment income. There were few changes associated with newer program types: gains for minorities were observed on three measures and losses on two. CONCLUSIONS: Using data from a large national sample, this study found little evidence of systematic differences in either treatment process or outcome between white, black, and Hispanic patients overall, or in association with the implementation of more efficient program types.

Adult↗
PubMedDate not supplied

[Managing epilepsy in the primary care network in Brazil: are health professionals prepared?].

OBJECTIVE: To assess attitudes and beliefs concerning epilepsy held by physicians and allied health professionals who work in the primary care network in Brazil. METHODS: The data were collected during a national family and community medicine conference held in Rio de Janeiro in 2004, which was attended by 1,200 health professionals from throughout the country. Two questionnaires were used, one for physicians and another for nonphysician health workers. RESULTS: A total of 598 conference participants (345 physicians and 253 nonphysician health professionals) completed a questionnaire. Both the physicians and the nonphysician health professionals had acceptable personal attitudes towards persons with epilepsy. According to data from 286 physicians who provided information, the estimated mean percentage of individuals with epilepsy in the populations cared for by the physicians' health care systems in the preceding year was 0.78% (range, 0 to 8%; median = 0.37%). The estimated mean percentage of seizure-free patients was 60%. The estimated mean percentage of persons on monotherapy was 55%. The estimated mean percentage of referrals to a neurologist was 59%. The estimated mean percentage of patients who were working or studying was 56%. Of the 345 physicians, 252 of them (73%) reported not feeling confident about managing individuals with epilepsy, whereas 84 (24%) felt confident, and 9 (3%) were not sure. Of the 252 physicians who did not feel confident, 226 (90%) said that they would participate in a training program to improve the quality of the care provided to individuals with epilepsy. CONCLUSIONS: The professionals participating in the study indicated that the primary care system has the essential elements needed to provide comprehensive epilepsy care, including professional personnel who want to improve their skills. However, establishing an efficient, effective program of epilepsy management in the primary care network will require an effective referral network, regular distribution of antiepileptic drugs, the close monitoring of epilepsy management by using the federal primary health information system, and the ongoing education of health professionals, with emphasis on psychological support and the inclusion in society of individuals with epilepsy.

Adolescent↗
PubMed2004

Rapid recovery protocol for peri-operative care of total hip and total knee arthroplasty patients.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are among the most successful procedures performed in terms of quality-of-life years gained. The long-term goals of arthroplasty, to relieve pain, increase function, provide stability, and obtain durability, are accomplished in the vast majority of cases. The short-term goals, however, have become the target of aggressive peri-operative programs that aim to speed recovery, reduce morbidity and complications, and create a program of efficiency while maintaining the highest level of patient care. The concept of rapid recovery is built upon the burgeoning interest in less-invasive and small-incision surgeries for (THA and TKA). However, the incision size does not appear to be the most critical aspect of the program. This article outlines the specific elements of the rapid-recovery program for lower-extremity arthroplasty patients, including pre-operative patient education, peri-operative nutrition, vitamin and herbal medication supplementation, preemptive analgesia, and post-operative rehabilitation. A holistic peri-operative, rapid-recovery program has lead to a significantly decreased hospital length of stay and significantly lower hospital readmission rates in patients who undergo primary THAs and TKAs. Combining these results with minimally invasive techniques and instrumentation should make recovery even faster.

Aged↗
PubMed1997

Direct comparison of two commercially available computer programs for analysing DNA fingerprinting gels.

Randomly amplified polymorphic DNA (RAPD) fingerprints were generated with M13 and DAF4 primers for 25 isolates of Acinetobacter spp. obtained from 16 different hospitals situated in 12 countries. The overall robustness of the algorithms and the reproducibility of the cluster analysis results generated by two commercially available computer programs (GelCompar and DENDRON) for analysing DNA fingerprinting gels were tested by examining the same set of fingerprinting data independently in two laboratories with the different software packages. Both programs were efficient at recognising and grouping strains with closely similar RAPD fingerprints, i.e., strains which might be expected to have a close epidemiological or evolutionary relationship. However, the relationships suggested for less closely related strains showed considerable variation in terms of the overall similarity or percentage correlation values suggested by the programs. It was concluded that both programs were useful tools for indicating close genotypic relationships between individual strains, but that epidemiological conclusions based on the similarity or correlation values (or the dendrograms derived from them) obtained for less closely related strains should be treated with considerable caution.

Acinetobacter↗
PubMed1993

Congenital hypothyroidism: diagnosis and management.

Every newborn infant should be screened for congenital hypothyroidism before discharge from the nursery. Neonatal screening for hypothyroidism was introduced to North America in 1972 and has been demonstrated to be cost effective in the prevention of neurological damage in children. Interpretation of diagnostic test results from such programs is based on understanding the physiology of the thyroid gland and recognition that neonatal hypothyroidism primarily stems from an embryological disorder of thyroid development rather than central causes involving the hypothalamic-pituitary axis. Early diagnosis of hypothyroidism is dependent on proper timing and collection of blood samples and an efficient screening program reporting accurate results. A thorough maternal and family history in conjunction with clinical signs and symptoms of hypothyroidism, biochemical tests, and radiological findings should be used to rapidly establish the diagnosis. Early detection and treatment with thyroxine normalizes skeletal maturation, physical growth, cognitive functioning, and motor development of affected newborns. Nurses play an important role in identification, management, and supportive care of infants with hypothyroidism so that maximal potential is achieved.

Clinical Protocols↗
PubMed2003

Surgery in Taiwan.

Taiwan is an island located southeast of the Asian continent. Surgery in Taiwan has changed rapidly during the past 20 years. Approximately 4500 surgeons (including orthopedic surgeons, neurosurgeons, and urologists) serve a population of 23 million on this 36000-km(2) island. Much progress has been made in the development of basic science surgical research, the use of new technology, and the improvement of the quality of care of our patients. National Health Insurance was launched in 1995 and has had a great impact on the clinical practice of surgery. To attract more medical graduates to the specialty of surgery and enrich the resources of manpower, reasonable reimbursement and a new education program with efficient core content but no prolongation of the training period are needed.

Education, Medical↗
PubMed1996

Likely effects of devolution on the redistributive character of policy agendas.

This article assesses two competing views of the effects federal devolution may have on the future of health, education and welfare programs in the United States. One school of thought argues that devolution of social policy to the state and local level will have negative consequences for the less affluent. A contrasting view maintains that devolution will spur innovations at the state and local level, which in turn will lead to more effective and efficient social programs. Dileo analyzes presidential and gubernatorial speeches over a period of 5 years to assess the state of U.S. social policy. He concludes that the federal government is generally more supportive of redistributive policies than are the states.

Cost Control↗
PubMed1987

Matching relational patterns in nucleic acid sequences.

We describe a program that efficiently searches sequence data banks for complex patterns where sites are linked by common relations such as identity, complementarity or span. Its algorithm is closer to those of automatic demonstration than to the finite state machines used in fast pattern matching. The repertory of relations can be enriched at will without rewriting the core of the program. The program is written in Pascal-ISO and runs on a microcomputer.

Base Sequence↗
PubMed2003

Guidance document on delivery, treatment planning, and clinical implementation of IMRT: report of the IMRT Subcommittee of the AAPM Radiation Therapy Committee.

Intensity-modulated radiation therapy (IMRT) represents one of the most significant technical advances in radiation therapy since the advent of the medical linear accelerator. It allows the clinical implementation of highly conformal nonconvex dose distributions. This complex but promising treatment modality is rapidly proliferating in both academic and community practice settings. However, these advances do not come without a risk. IMRT is not just an add-on to the current radiation therapy process; it represents a new paradigm that requires the knowledge of multimodality imaging, setup uncertainties and internal organ motion, tumor control probabilities, normal tissue complication probabilities, three-dimensional (3-D) dose calculation and optimization, and dynamic beam delivery of nonuniform beam intensities. Therefore, the purpose of this report is to guide and assist the clinical medical physicist in developing and implementing a viable and safe IMRT program. The scope of the IMRT program is quite broad, encompassing multileaf-collimator-based IMRT delivery systems, goal-based inverse treatment planning, and clinical implementation of IMRT with patient-specific quality assurance. This report, while not prescribing specific procedures, provides the framework and guidance to allow clinical radiation oncology physicists to make judicious decisions in implementing a safe and efficient IMRT program in their clinics.

Algorithms↗
PubMed2026

Associations between smart infusion pump-electronic health record interoperability and healthcare outcomes: A systematic review.

OBJECTIVE: This study synthesized available evidence on the associations between smart infusion pump-electronic health record (EHR) interoperability and healthcare outcomes. METHODS: A systematic review of PubMed, CINAHL, Embase, and Scopus databases identified 901 records, which were imported into Rayyan® for duplicate removal, independent screening by three reviewers, and resolution of discrepancies. Eligible studies were peer-reviewed, data-driven, and reported associations between smart infusion pump-EHR interoperability and healthcare outcomes. Studies focused solely on technical validation or interoperability prototypes were excluded. A backward citation search identified additional studies. Two reviewers independently extracted and cross-validated study characteristics using standardized templates. Methodological quality was assessed with the Joanna Briggs Institute Critical Appraisal Tools. RESULTS: Twenty records of 14 full-text studies and 6 conference proceedings were included. Most records reported positive associations between smart infusion pump-EHR interoperability and outcomes related to safety (e.g., medication administration errors, safety-reported events, pump alerts, and compliance with interoperability and drug library), operational efficiency (e.g., programming and documentation time and technical issues), financial performance (e.g., charges captured, and cost avoided), and user experience domains. Most studies used observational designs, reflecting real-world interoperability implementations, where controlling confounding factors is challenging. Limited reporting of baseline characteristics, pump type, and sample sizes limited comparability across studies. CONCLUSIONS: Smart infusion pump-EHR interoperability was associated with improvements in patient safety, efficiency, charge capture, and user experience, with variable findings across studies. Future research should use rigorous methodologies and standardized measures, examine relationships across outcome domains, assess limitations of pump-EHR interoperability, and evaluate underexplored outcomes, including team communication, cognitive workload, and AI-enabled pumps. IMPLICATIONS FOR CLINICAL PRACTICE: Interoperability should be viewed as a component of a broader sociotechnical system, in which technology, user, workflow, clinical content, and organizational practices collectively determine overall effectiveness.

Humans↗
PubMed1982

Decentralized budgeting: holding the purse strings, part 1.

A decentralized nursing structure allows the head nurse to become actively involved in the planning and budgeting process. In Nursing Decentralization: The El Camino Experience (published in November 1981 by Nursing Resources) the authors describe the development of a budgeting system that supports autonomy, accountability, and authority at the practitioner level. For JONA readers, we present, in two parts, an abridged version of the chapter "Budgeting: Holding the Purse Strings." Part 1, which follows, outlines important steps for the development of a successful and efficient budgeting program that can be adapted to meet the needs of other decentralized organizations. Part 2, which details a typical budget session, will appear in the next issue of JONA.

Budgets↗
PubMed1980

Genetic aspects of embryo transfer.

Use of embryo transfer can lead to increases in rates of genetic improvement from selection programs from as little as 5% to a maximum of near 100%, depending on species, trait, and extent of use of other tools such as A.I. In general, embryo transfer will have much less impact on rates of genetic improvement than A.I., and in a dairy cattle program where A.I. is used effectively, embryo transfer is likely to add less than 10% to rate of genetic improvement. The potential for increasing rate of genetic improvement appears to be greater in beef cattle. In any species with low reproductive rate, embryo transfer offers a potential means of rapidly increasing numbers of animals of a breed, strain, mutant genotype or group exceeding a stringent threshold; such use may be of considerable value to a specific genetic research or multiplication program. Maximizing selection intensity through combined use of A.I. and embryo transfer can lead to a rapid increase in inbreeding, and steps should be taken to avoid this in any population which it is desired to maintain in the long term. Embryo transfer offers an effective tool for research on maternal-fetal and fetal-fetal interactions, and in this way can make important indirect contributions to more efficient breeding programs. With improved embryo storage capability, embryo transfer has the potential for useful contributions in the areas of transfer of germ plasm between countries, preservation of rare breeds, and provision of genetically stable control populations.

Journal Article↗
PubMedDate not supplied

A comparison of the efficiency of diagnosis of early cervical carcinoma by general practitioners and cytology screening programs in the Netherlands.

The efficiency of general practitioners and cytology screening programs in the Netherlands in diagnosing neoplasia by means of cervical cytology was investigated. For all age groups of women living in rural or urban areas, the general practitioners were almost twice as successful in detecting cases of cervical neoplasia. No reason could be found why the general practitioners were relatively more successful. The important role of the general practitioner and his or her ability to encourage the high-risk group of women to have early and regular smears is stressed.

Adult↗
PubMed1999

The application of latent curve analysis to testing developmental theories in intervention research.

The effectiveness of a prevention or intervention program has traditionally been assessed using time-specific comparisons of mean levels between the treatment and the control groups. However, many times the behavior targeted by the intervention is naturally developing over time, and the goal of the treatment is to alter this natural or normative developmental trajectory. Examining time-specific mean levels can be both limiting and potentially misleading when the behavior of interest is developing systematically over time. It is argued here that there are both theoretical and statistical advantages associated with recasting intervention treatment effects in terms of normative and altered developmental trajectories. The recently developed technique of latent curve (LC) analysis is reviewed and extended to a true experimental design setting in which subjects are randomly assigned to a treatment intervention or a control condition. LC models are applied to both artificially generated and real intervention data sets to evaluate the efficacy of an intervention program. Not only do the LC models provide a more comprehensive understanding of the treatment and control group developmental processes compared to more traditional fixed-effects models, but LC models have greater statistical power to detect a given treatment effect. Finally, the LC models are modified to allow for the computation of specific power estimates under a variety of conditions and assumptions that can provide much needed information for the planning and design of more powerful but cost-efficient intervention programs for the future.

Case-Control Studies↗