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PubMed1990

The CIO and IRM (information resources management) alliance: maneuvering for the competitive edge in hospital information management.

In 1986, Johns noted that "The hospital industry was caught unprepared for the external demands and information needs required in a case-mix reimbursement environment." Lack of a data-processing philosophy and inattention to external forces were cited as having hampered technology upgrade and integration of financial and clinical databases. The intervening years have witnessed a growth of information dissemination in the health care industry concerning information value and resource management. The frequency of appearance of articles on information management in the professional literature and the number of workshops and professional meetings addressing the topic attest to the current visibility of the information resource. Despite this flurry of interest, the industry has not developed its own models of information resources management nor validated its information evolution with accepted management information systems models. While interest in health care information resource management exists, understanding of the complex issues in this area has not developed as one would expect. While there are a myriad of reasons for this, a contributing factor is the lack of a research foundation for development and application of theory and models. Even though various graduate programs exist in medical informatics and biomedical computing, few concentrate on the study of health information resource management from an organizational perspective. Because of this, academic research in the area has been minimal. The scarcity of graduate-level programs has also meant that few individuals have been educated to deal with the challenges of managing the many disparate functional activities associated with health care information resource management. Due to a variety of internal and external forces, extreme demands were placed on the hospital information resource during the past decade.(ABSTRACT TRUNCATED AT 250 WORDS)

Hospital Administrators↗
PubMed1995

An Internet health care information resources server as a component of a statewide medical information network.

A health care information server utilizing Internet resource discovery technology is presented as a component of a statewide medical information network. The development of an information server, including the development process and its design and operation, is presented. Menu design and implementation, which involved providing access to information resources in support of the tasks that make up the health care delivery process, are described. The potential impact of this technology on the health care delivery process is explored, and ways in which access to information can be facilitated and matched with the information needs of the various health care delivery tasks are identified. Issues associated with the use of public domain information resources are discussed, including control over Internet resources, access to information resources, network operational delays, client connection and software availability, information quality, and menu navigation. This project has demonstrated that Internet information resources exist that match the information needs of the tasks that make up the health care delivery process. Positive response has been received from physicians after initial utilization of the server in a stand-alone context. In the future, more applications will integrate the vast information resources on the Internet with traditional computing systems.

Alabama↗
PubMed2000

War zone stress, personal and environmental resources, and PTSD symptoms in Gulf War veterans: a longitudinal perspective.

Cross-sectional research has demonstrated a link between personal and environmental resources and development of emotional distress after war zone service. Less is known about the longitudinal relationship between resources and distress. The authors addressed this issue in a study of 348 Gulf War returnees tested at 2 time points. Resources decreased and posttraumatic stress disorder (PTSD) symptoms increased over time. Time 1 avoidance and family cohesion predicted PTSD symptoms at Time 2. Regression analyses revealed a bidirectional relationship over time between resources and PTSD symptoms. Time 1 resources predicted Time 2 psychopathology after accounting for Time 1 emotional distress. PTSD symptoms at Time 1 also predicted changes in coping and family relationships, even after accounting for Time 1 resources. Findings are consistent with the concept of a loss spiral (Hobfoll, 1989), in which resource factors and emotional sequelae to war stress exert reciprocal effects.

Adaptation, Psychological↗
PubMed2003

Use of online resources while using a clinical information system.

BACKGROUND: Clinical information system (CIS) use is likely to evoke information needs, yet information resources use during CIS use has not been studied. METHODS: We used CIS log files and a survey to characterize clinicians' use of resources and infobuttons (context-sensitive links from a CIS to specific resources) while using a CIS. RESULTS: We examined 38,763 uses of resources and infobuttons by 2,607 users to identify specific sources and contexts (CIS functions) in which they used them. Laboratory results review was the most frequent context and Micromedex was the most popular resource. Differences in resource use were related to context and user type. The survey confirmed that resources and infobuttons were perceived as useful for patient-specific questions while using a CIS. CONCLUSIONS: Understanding context- and user-type-specific information needs can guide the development of infobuttons for use in a CIS.

Clinical Laboratory Techniques↗
PubMed2005

Knowledge and use of electronic information resources by medical sciences faculty at The University of the West Indies.

OBJECTIVE: The objective was to determine faculty's knowledge of electronic resources, access to a computer, use of electronic resources (both number and frequency) available at the Medical Sciences Library (MSL), and the areas of training needed and to identify areas for further research. METHODS: A survey was administered to faculty in medicine, pharmacy, dentistry, and veterinary sciences at The University of the West Indies. The questions covered computer literacy, computer access and location, knowledge and use of electronic resources, and training needs. RESULTS: The response rate was 70%, of whom 97% were computer users. Seventy-three percent used computers daily, and 82% felt that their computer literacy level was average or beyond. Overall, it was found that faculty had high awareness of the electronic resources made available by the MSL but low use of MSL-specific resources supporting the suggested problem of underutilization. Many respondents felt that e-resources were important, and, though many felt that they were competent users, 83% were self-taught and many still expressed a need for training. Over 60% felt that a workshop with a hands-on component was the preferred format for training. It was recommended that there be greater promotion of the library's e-resources.

Attitude to Computers↗
PubMed2005

An OGSA-based integration of life-scientific resources for drug discovery.

OBJECTIVES: The rapid progress of life-scientific research has the potential to dramatically change the paradigm of drug discovery. Efficient utilization of life-scientific resources, i.e., databases and analytic software tools, poses a challenging issue with regard to the reduction of time and cost in the drug discovery process. In this paper, a variety of heterogeneous Web-based life-scientific resources are integrated toward the improvement of drug discovery performance. METHODS: For the integration of heterogeneous life-scientific resources, a database federation technique based on three-layer architecture has been utilized. With the federation technique, life-scientific resources are integrated step by step through database layers, database integration layers and analysis layers to encapsulate complexity and heterogeneity. In this study, we have taken advantage of the latest Grid technology based on OGSA (Open Grid Services Architecture) for the implementation of our approach. RESULTS: The actual case of life-scientific resources for drug discovery demonstrates that our prototype system developed with the proposed technique works well for the identification process of candidate compounds to a target protein. In other words, the prototype system allows a researcher to retrieve candidate compounds with less effort than before. CONCLUSIONS: The usefulness of the prototypic system represents the ability of our approach to integrate heterogeneous life-scientific resources, which have the potential to dramatically improve efficiency in drug discovery, resulting in the shortening of drug development. On the other hand, the system requires further consideration from the aspect of practical use. Dynamic aggregation of the resources is one example of such a consideration.

Biological Science Disciplines↗
PubMed2006

Association between physical activity and proximity to physical activity resources among low-income, midlife women.

INTRODUCTION: The association between levels of physical activity and perceived and objectively measured proximity to physical activity resources is unclear. Clarification is important so that future programs can intervene upon the measure with the greatest association. We examined correlations between perceived and objectively measured proximity to physical activity resources and then examined associations between both measures of proximity and objectively measured physical activity. METHODS: Participants (n = 199) were underinsured women from three counties in southeastern North Carolina. Perceived proximity to physical activity resources (e.g., parks, gyms, schools) was measured using surveys. Objectively measured proximity included geographic information systems road network distance to the closest resource and existence of resources within 1- and 2-mile buffers surrounding participants' homes. To examine the association between proximity to resources and activity, the dependent variable in multiple linear regression models was the natural logarithm of accelerometer-measured moderate to vigorous physical activity in minutes per day. RESULTS: Pearson correlation coefficients for perceptions of distance and objectively measured distance to physical activity resources ranged from 0.40 (gyms, schools) to 0.54 (parks). Perceived distance to gyms and objective number of schools within 1-mile buffers were negatively associated with activity. No statistically significant relationships were found between activity and perceived or objectively measured proximity to parks. CONCLUSION: Results indicate the need for both individual and environmental intervention strategies to increase levels of physical activity among underinsured, midlife women. More work is needed to determine the most effective strategies.

Attitude to Health↗
PubMed1990

Knowledge resource preferences of family physicians.

Because of the pivotal role of medical knowledge in clinical problem solving, it is important to understand how clinicians decide to seek additional knowledge for patient care decisions and how they choose among the resources available to them. Using a self-administered questionnaire, 126 family physicians reported their use of 11 types of knowledge resources for answering patient-specific questions arising in clinical practice. They reported almost daily use of the Physicians' Desk Reference and more often than weekly use of colleagues. There was little use reported of Index Medicus or computer-based bibliographic retrieval systems. The research literature of medicine was used infrequently and rated among the lowest of resources in terms of credibility, availability, searchability, understandability, and applicability. In deciding among a subset of knowledge resources for answering a clinical practice question, resource cost variables related to clinical availability and applicability of the information to the problem at hand appeared to be more influential in the minds of physicians than factors related to quality of the resource. These findings have important implications for the development and deployment of knowledge resources intended to be useful and used in clinical practice.

Diagnosis↗
PubMed1989

Resources of supplemental security income recipients.

In order to receive payments under the Supplemental Security Income (SSI) program, an aged, blind, or disabled person's countable resources must fall below specified limits. The current limits are +2,000 for an individual and +3,000 for a couple. In 1987, when the data were collected for this study, these limits were +1,800 for an individual and +2,700 for a couple. This study found that the resource levels of most SSI recipients were well below the 1987 limits. A majority of SSI recipients had less than +100 in countable resources, and only about 12 percent of SSI recipients had more than +1,000 of resources. These low levels of resources ensure that relatively few recipients become ineligible for SSI payments because of resource accumulation. The most common forms of countable resources held by SSI recipients were cash, checking accounts, and savings accounts.

Adult↗
PubMed1986

Resource allocation under poor growth conditions. A major role for growth substances in developmental plasticity.

This article argues that the basic function for growth substance is resource allocation under poor growth conditions. The following scheme is suggested. Plants in the wild frequently suffer a paucity of resources which result from interplant competition and ecological and local environmental variation. The strategy adopted by many plants particularly ruderals (from which crops may have evolved) to help mitigate these problems is phenotypic plasticity; the growth of the plant body is adjusted to best exploit the scarce resources and help achieve desirable growth and reproductive goals. Phenotypic plasticity requires decisions to be made concerning the diversion of scarce growth resources to one facet of development rather than another; for example, to height or leaf area rather than thickness; or, between tissues, stem rather than leaves. Growth substances are coupled to these individual facets of development. They represent a simple way in which the extent of resource diversion can be controlled. Cells in specific tissues acquire sensitivity to particular growth substances at a stage in their development when environmental variability often necessitates choices to be made. This acquisition of ontogenetic sensitivity may be all or none. It may reflect acquisition of receptor proteins coupled to specific metabolic events. However in well-nourished plants these phases of development are relatively insensitive to changes in the level of the growth substance/receptor complex. Cells become more sensitive under certain well-defined but specific circumstances, characterized by the general term, poor growth conditions. These are produced by imbalances in one or more of the major environmental (nutritional) requirements for growth, light, nitrogen, water and oxygen. Imbalance in one or more of these produces characteristic and far-reaching metabolic and protein synthesis changes which normally constrain the synthetic processes for growth but amplify metabolic events coupled to growth substances. It is the function of growth substances to circumvent some of these metabolically constraining steps and by applying a constant stimulus to one specific aspect of growth or metabolism permit continued development. The additional input of growth substances into particular facets of development ensures the better maintenance (protection) of that character when competition for resources inside the plant is severe. However competition for scarce resources ensures that continuation of one growth aspect generally leads to relative depletion of others.(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Physiological↗
PubMed1998

Managing physician resources: East and West.

AIM: To examine the current physician supply in western countries, Central and Eastern Europe (CEE), and the Newly Independent States (NIS) of the former Soviet Union. To assess the current management of physician resources in these regions and the potential for their future management. METHODS: Description and analysis of current physician to population ratios, graduating physician to population ratios, and specialty distribution of physicians. RESULTS: Maldistribution of physician resources, both by specialty and geographically, exists in the East and the West. The management of physician resources varies widely in the West, from virtually no attempts to manage the resources in the United States to increasingly regulatory methods in Canada. The CEE and the NIS face problems in managing physician resources as the movement to primary care continues. At the same time, changes in payment mechanisms create new and often perverse incentives for physicians, in addition to the problems inherited from the centrally managed systems. CONCLUSIONS: Countries in the East and West face challenges in managing physician resources to overcome the current maldistribution of those resources. Efforts must be made to make the medical education system responsive to the future physician supply needs. This is especially true in the East where health systems continue the transition from centrally managed to more market based systems.

Europe↗
PubMed1996

Resource consumption and the extent of futile care among patients in a pediatric intensive care unit setting.

OBJECTIVES: To estimate resource consumption and the extent of futile care among patients admitted to the pediatric intensive care unit (PICU). STUDY DESIGN: A prospective cohort study of 353 consecutive admissions followed for 1334 patient-days during the PICU stay at the Texas Children's Hospital in Houston, Texas. Participants were 353 children and adolescents who were hospitalized in the PICU during September and October 1993. Three broad operational definitions of futility were developed to capture the maximum extent of resource consumption related to medical futility. Definition 1 (imminent demise futility) was developed by an objective, validated, severity of illness measure (Pediatric Risk of Mortality Score) to identify patients with high mortality risks. Definition 2 (lethal condition futility) was used to identify patients in the PICU whose long-term survival was unlikely. Definition 3 (qualitative futility) was used to identify patients with high morbidity. Resource consumption was measured according to the number of patient-days in the PICU and the Therapeutic Intervention Scoring System. RESULTS: Twenty-three (6.5%) patients representing 36 (2.7%) patient-days met at least one of the definitions of medical futility for some of the days when they were in the PICU. None of the patient-days that met any of the definitions of medical futility were associated with high resource consumption compared with non-futile care patient-days. CONCLUSIONS: Despite our use of broad definitions of medical futility, relatively small amounts of resources were used in futile PICU care. This suggests that attempts to reduce resource consumption in the PICU by focusing on medical futility are unlikely to be successful.

Adolescent↗
PubMed2001

"Living off the land": resource efficiency of wetland wastewater treatment.

Bioregenerative life support technologies for space application are advantageous if they can be constructed using locally available materials, and rely on renewable energy resources, lessening the need for launch and resupply of materials. These same characteristics are desirable in the global Earth environment because such technologies are more affordable by developing countries, and are more sustainable long-term since they utilize less non-renewable, imported resources. Subsurface flow wetlands (wastewater gardens(TM)) were developed and evaluated for wastewater recycling along the coast of Yucatan. Emergy evaluations, a measure of the environmental and human economic resource utilization, showed that compared to conventional sewage treatment, wetland wastewater treatment systems use far less imported and purchased materials. Wetland systems are also less energy-dependent, lessening dependence on electrical infrastructure, and require simpler maintenance since the system largely relies on the ecological action of microbes and plants for their efficacy. Detailed emergy evaluations showed that wetland systems use only about 15% the purchased emergy of conventional sewage systems, and that renewable resources contribute 60% of total emergy used (excluding the sewage itself) compared to less than 1% use of renewable resources in the high-tech systems. Applied on a larger scale for development in third world countries, wetland systems would require the electrical energy of conventional sewage treatment (package plants), and save of total capital and operating expenses over a 20-year timeframe. In addition, there are numerous secondary benefits from wetland systems including fiber/fodder/food from the wetland plants, creation of ecosystems of high biodiversity with animal habitat value, and aesthestic/landscape enhancement of the community. Wetland wastewater treatment is an exemplar of ecological engineering in that it creates an interface ecosystem to handle byproducts of the human economy, maximizing performance of the both the natural economy and natural ecosystems. Wetland systems accomplish this with far greater resource economy than other sewage treatment approaches, and thus offer benefits for both space and Earth applications.

Conservation of Natural Resources↗
PubMed1987

Resource allocation in health care: the allocation of lifestyles to providers.

The objective of this article has been to draw the spotlight onto a much neglected facet of the discussion on resource allocation in health care: the process by which society decides what lifestyle the providers of health care may extract, directly or indirectly, from the patient's pocket book. Given the slice of the GNP society surrenders to the providers of health care collectively, the quantity of real health care resources made available to patients obviously varies inversely with the elevation of the lifestyle attained by the providers. These reflections have been triggered by a vexing paradox plaguing contemporary American health care: incessant talk about rationing in the midst of plenty. Conference after conference in this country has been dedicated in recent years to the "agonizing choices visited upon American health care by the age of restricting resources." Remarkably, few of the avid conference organizers, and few of their fiery orators, ever stop to think just what resource flow has actually been constricting. Has it been the supply of physicians? Has it been the supply of hospital beds? Has it been the flow of real purchasing power into the health care system? In general, the preference has been to bypass these questions altogether and to lament in a data-free context. What has been contracting in American health care has not been the flow of money into the sector, nor the flow of professionals, facilities, and entrepreneurs seeking to to do well there by doing good, but, if anything at all, the flow of real health services from providers to patients, certainly to patients who are uninsured and of modest means. And what seems required to solve the sector's problem is not so much an infusion of yet larger sums of money, but a decision-making algorithm capable of using the money already in the system to redirect real health care resources from persons who now receive perilously too many health services to persons who now receive perilously too few. Part of such an algorithm, of course, would be a sensible determination of the lifestyles the health care process needs to support among the providers of care. Under the ideal circumstances envisaged by libertarian thinkers, the determination of these matters could safely be entrusted to the free market. For reasons not difficult to fathom, however, no modern society is willing to adopt that form of arbitration over resource allocation in health care.(ABSTRACT TRUNCATED AT 400 WORDS)

Canada↗
PubMedDate not supplied

World resources of phosphorus.

The geochemistry of phosphorus and the global distribution of its resources are reviewed. The concept of reserves and resources is discussed in view of recent price developments in the phosphate mining industry. A description is given on the application of a model called MIMIC (Mining Industry Model for Inventorization and Cost evaluation of mineral resources) for estimating the inferred global reserves and resources in different cost categories. Based on the size and growth rate of annual production, the inferred reserves can be estimated at +/- 20 000 Mt of phosphorus. This figure is in reasonable agreement with conventionally estimated demonstrated resources. Estimates of exploitable resources with the MIMIC model vary between 40 000 and 500 000 Mt with about 20 000 Mt in deposits containing about 14% P (70% BPL). The inferred reserves alone would satisfy current consumption for many hundreds of years. In this context, the historical growth rate of slightly less than 7% per annum appears neither exceptional nor particularly alarming with respect to the next doubling of the world population.

Conservation of Natural Resources↗
PubMedDate not supplied

Using databases for studying and comparing health care costs and resource use.

Data sources such as medical insurance claims are increasingly used in health outcomes research. We present opportunities and limitations associated with the use of such data for conducting studies of health care costs and resource use. We also provide examples on using databases for conducting research when the primary objective is to study costs or resource use. This information is intended to be helpful to experienced health services researchers and to those new to the field of either outcomes research or cost effectiveness research. We examine the reasons for using databases to study costs and resource use, desirable attributes of databases used for this purpose, potential pitfalls, other issues associated with conducting cost and resource use studies with databases, and appropriate methods for this research. Through examples and references, we examine issues to be considered in each of these areas, and make recommendations. Strengths and limitations of databases are indicated. Research using claims data to determine health care cost and resource use should be carried out responsibly. Limitations must be acknowledged for research using databases, and appropriate methods must be used. Still, databases represent a rich opportunity to conduct research in health care costs and resource use, and much can be learned using databases.

Databases as Topic↗
PubMed1988

Resource allocation in multifacility emergency medical service systems.

As instruments of public policy, Emergency Medical Service Systems must not only make effective use of the available resources but also ensure that those resources are shared equitably by the systems' facilities. This paper develops a multifacility EMS system resource allocation model that enables its user to evaluate the equitability of resource allocation schemes. Recognizing and objectively defining the relationships between the consumption of system resources and the provision of EMS System services, this model is appropriate for use in both prospective and retrospective EMS System resource allocation analyses.

Cost Allocation↗
PubMed2002

Calculating resource restoration for an oil discharge in Lake Barre, Louisiana, USA.

Under the United States Oil Pollution Act of 1990, natural resource trustees are charged with assessing natural resource impacts due to an oil spill and determining the type and amount of natural resource restoration that will compensate the public for the impacts. Habitat equivalency analysis is a technique through which the impacts due to the spill and the benefits of restoration are quantified; both are quantified as habitat resources and associated ecological services. The goal of the analysis is to determine the amount of restoration such that the services lost are offset by services provided by restoration. In this paper, we first describe the habitat equivalency analysis framework. We then present an oil spill case from coastal Louisiana, USA, where the framework was applied to quantify resource impacts and determine the scale of restoration. In the Louisiana case, the trustees assessed impacts for oiled salt marsh and direct mortality to finfish, shellfish, and birds. The restoration project required planting salt-marsh vegetation in dredge material that was deposited on a barrier island. Using the habitat equivalency analysis framework, it was determined that 7.5 ha of the dredge platform should be planted as salt marsh. The planted hectares will benefit another 15.9 ha through vegetative spreading resulting in a total of 23.4 ha that will be enhanced or restored as compensation for the natural resource impacts.

Animals↗