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PubMedDate not supplied

Patient population management: taking the leap from variance analysis to outcomes measurement.

Case managers today at BCHS have a somewhat different role than at the onset of the Collaborative Practice Model. They are seen throughout the organization as: Leaders/participants on cross-functional teams. Systems change agents. Integrating/merging with quality services and utilization management. Outcomes managers. One of the major cross-functional teams is in the process of designing a Care Coordinator role. These individuals will, as one of their functions, assume responsibility for daily patient care management activities. A variance tracking program has come into the Utilization Management (UM) department as part of a software package purchased to automate UM work activities. This variance program could potentially be used by the new care coordinators as the role develops. The case managers are beginning to use a Decision Support software, (Transition Systems Inc.) in the collection of data that is based on a cost accounting system and linked to clinical events. Other clinical outcomes data bases are now being used by the case manager to help with the collection and measurement of outcomes information. Hoshin planning will continue to be a framework for defining and setting the targets for clinical and financial improvements throughout the organization. Case managers will continue to be involved in many of these system-wide initiatives. In the words of Galileo, 1579, "You need to count what's countable, measure what's measurable, and what's not measurable, make measurable."

Analysis of Variance↗
PubMed1996

Pharmacists' provision of continuity of care to patients with human immunodeficiency virus infection.

A pharmacy program for providing continuity of care to patients infected with human immunodeficiency virus (HIV) is described. The program was implemented at three practice sites in Toronto: a tertiary care teaching hospital; an outpatient community pharmacy that is part of the hospital; and an ambulatory care clinic affiliated with the hospital. An HIV pharmacy practice was established at the hospital in 1993. The community pharmacy serves at least 30% of the HIV-infected patients in Ontario who are receiving antiretrovirals; patient counseling is emphasized. The ambulatory care clinic's HIV program was established in 1994; the pharmacist sees patients at the clinic or in their homes. To address the need for greater continuity of care, the following issues were addressed: workload involved in providing pharmaceutical care to HIV-infected patients, establishing patient pharmacy profiles common to the three sites, streamlining communication among the sites, creating a process for identifying patient problems in the community setting, collaborating on research and projects, and forging links with other pharmacists caring for HIV-infected patients. The program has enhanced the ability of pharmacists to make informed recommendations and care plans, increased patient follow-up, improved cross-coverage of patients in the absence of an HIV pharmacist, increased sharing of drug information, and led to joint collaboration on projects. A pharmacy program to serve HIV-infected patients was implemented at three sites and successfully integrated under a continuity-of-care model.

Community Pharmacy Services↗
PubMed2006

Chiropractors' perceptions about intimate partner violence: a cross-sectional survey.

OBJECTIVE: The aim of this study is to assess chiropractors' attitudes, beliefs, knowledge, and experience about intimate partner violence (IPV). METHODS: This cross-sectional survey was developed by members of the Violence Against Women Health Research Collaborative. The survey was disseminated to a voluntary, nonrandom convenience sample of chiropractors attending a 3-day continuing education seminar. Surveys were distributed at the entrances of the seminar session rooms and placed on luncheon tables. Respondents returned surveys to collection boxes. RESULTS: Ninety-three doctors of chiropractic completed the survey. Respondents estimated that only 5.2% (95% confidence interval, 3.3%-7.0%) of their female patients were victims of IPV. General knowledge of IPV was good among respondents. Knowledge of clinical indicators and victim's management was fair to poor. Only 22% of respondents identified the most commonly injured body regions among battered women. Lack of knowledge, personal discomfort, and time constraints were all cited as barriers to IPV screening. CONCLUSIONS: Our survey indicates that doctors of chiropractic underestimate the prevalence of IPV among their female patients. Like other health care specialists, chiropractors cite multiple IPV screening barriers, especially lack of knowledge. Doctors of chiropractic would benefit from education and training in IPV to enable them to better identify and assist patients who are victims of IPV.

Adult↗
PubMed2006

Prevalence of vascular disease in metabolic syndrome using three proposed definitions.

BACKGROUND: There are a number of definitions available for the diagnosis of the metabolic syndrome (MetS). The MetS-associated increase in cardiovascular disease (CVD) risk may depend on the definition used. AIM: To investigate which of the 3 recently proposed definitions of MetS [the National Cholesterol Education Program-Adult Treatment Panel-III (NCEP-ATP-III), the International Diabetes Federation (IDF) and the American Heart Association/National Heart Lung and Blood Institute (AHA/NHLBI)] is related to excessive CVD risk and thus may be more appropriate to implement in clinical practice. METHODS: A cross-sectional analysis of a representative sample of Greek adults (n=9669). RESULTS: The age-adjusted CVD prevalence was 11.4% in the whole study population, 23.3% in the NCEP-ATP-III (+) subjects, 22.6% in AHA/NHLBI (+) subjects and 18.3% in IDF (+) subjects [p<0.001 for the comparison between the whole study population and all MetS groups and p<0.0001 for the comparison between IDF (+) and either NCEP-ATP-III (+) or AHA/NHLBI (+) MetS]. However, the CVD prevalence was only 11.2% in the IDF (+) but NCEP-ATP-III (-)/AHA/NHLBI (-) MetS subjects [p<0.0001 vs. either NCEP-ATP-III (+) or AHA/NHLBI (+)], which was not different compared with the whole study population. Furthermore, subjects with NCEP ATP III (+) or AHA/NHLBI (+) MetS but not diabetes (DM) had a persistently higher prevalence of CVD compared with the whole study population. However, there was no significant difference regarding CVD prevalence between the whole study population and IDF (+)/DM (-) MetS subjects. CONCLUSIONS: CVD prevalence was increased in the presence of MetS irrespective of the definition used. However, this increase was more pronounced when the NCEP-ATP-III and AHA/NHLBI criteria were implemented compared with the IDF definition. Furthermore, the IDF definition included a large proportion of subjects who did not have increased CVD prevalence compared with the whole study population. These findings may have implications regarding which definition should we use to diagnose the MetS.

Adult↗
PubMed1988

Experience from the mental health programme of the World Health Organization.

The managerial structure of collaborative studies is usually not described in reports presenting results from such investigations. The same is true about the experience obtained in the day to day conduct of such studies. Ethical rules which should govern collaboration between individuals and centres are rarely spelled out. The paper presents an outline of WHO's mental health programme and proposes, on the basis of experience obtained in the course of several WHO multicentric international studies, a set of guidelines concerning ethical aspects of scientific collaboration involving several centres or teams.

Cross-Cultural Comparison↗
PubMed2000

[Evaluation by public health physicians of collaboration and workload within municipal health services].

BACKGROUND: We wanted to explore the quality and importance of the collaboration between public health physicians and selected groups of professionals and politicians. MATERIAL AND METHODS: The study was a cross-sectional survey based on self-administered questionnaires with closed questions. Response came from 218 public health doctors who worked in the municipalities throughout the study period (1988-91), and from 98 doctors who left public health during the same period (81% and 86% of the study populations respectively). RESULTS: The doctors reported good and important collaboration with other health professionals, but less good and less important collaboration with other professionals and with politicians. With increased administrative distance between the doctor and other municipality staff, the perceived quality of the collaboration decreased. INTERPRETATION: Closer collaboration between public health doctors and important decision makers in the municipality promotes job satisfaction among doctors and may reduce turn-over.

Cooperative Behavior↗
PubMed2006

Urinary neutrophil gelatinase-associated lipocalin as a biomarker of nephritis in childhood-onset systemic lupus erythematosus.

OBJECTIVE: Renal involvement in systemic lupus erythematosus (SLE) is associated with poor prognosis. Currently available renal biomarkers are relatively insensitive and nonspecific for diagnosing SLE nephritis. Previous research suggests that neutrophil gelatinase-associated lipocalin (NGAL) is a high-quality renal biomarker of acute kidney injury, while its usefulness in SLE is unclear. We undertook this study to determine the relationship between urinary NGAL excretion and SLE disease activity or damage, with a focus on nephritis. METHODS: A cohort of 35 patients diagnosed as having SLE prior to age 16 years (childhood-onset SLE) was assessed for disease activity (using the Systemic Lupus Erythematosus Disease Activity Index 2000 update) and damage (using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology SLE Damage Index) in a double-blind, cross-sectional study. Information on current markers of renal function and disease was obtained and compared with NGAL levels (ng/mg of urinary creatinine) measured by enzyme-linked immunosorbent assay. Eight children with juvenile idiopathic arthritis (JIA) served as controls. RESULTS: NGAL levels did not differ with the age, weight, height, sex, or race of the patients. Patients with childhood-onset SLE had significantly higher NGAL levels than did those with JIA (P < 0.0001). NGAL levels were strongly to moderately correlated with renal disease activity and renal damage (Spearman's r >/= 0.47, P < 0.0001 for both comparisons), but not with extrarenal disease activity or extrarenal damage. NGAL levels of >0.6 ng/mg urinary creatinine were 90% sensitive and 100% specific for identifying childhood-onset SLE patients with biopsy-proven nephritis. CONCLUSION: Urinary NGAL is a promising potential biomarker of childhood-onset SLE nephritis. The results of the current study require validation in a larger cohort to more accurately delineate urinary NGAL excretion in relation to the diverse SLE phenotypes.

Acute-Phase Proteins↗
PubMed1998

Simultaneous transfer of mitochondrial DNA and single chromosomes in somatic cells: a novel approach for the study of defects in nuclear-mitochondrial communication.

The assembly and function of respiratory-competent mitochondria in eukaryotic cells depends on collaboration between the nuclear and mitochondrial genomes, but the molecular mechanisms underlying such cross-talk are poorly understood. Microcell-mediated chromosome transfer has been used to transfer intact chromosomes from one mammalian cell to another, helping to map loci implicated in different diseases and in the senescence process. In the present work, we show that microcells have a significant number of mitochondria which can be transferred to another cell simultaneously with a limited number of chromosomes. By fusing microcells from a colon carcinoma cell line with a mitochondrial DNA (mtDNA)-less osteosarcoma cell line, we were able to isolate transmitochondrial hybrids containing only one of three selectable chromosomes and mtDNA from the donor cell. The proportion of transmitochondrial hybrids containing one chromosomal marker with respect to the total transmitochondrial hybrids and cybrids was approximately 1% and no hybrids were isolated containing more than one nuclear marker. The genetic data correlated well with the composition and structure of the microcell preparations, which showed the presence of cytoplast-like structures and microcells containing mitochondria surrounding the micronuclei. Microcell-mediated mtDNA and chromosome transfer can be used to identify nuclear factors implicated in mtDNA maintenance and gene expression, as well as to investigate nuclear factors which modulate clinical phenotypes in mitochondrial disorders.

Bleomycin↗
PubMed2006

NCBI reference sequences (RefSeq): a curated non-redundant sequence database of genomes, transcripts and proteins.

NCBI's reference sequence (RefSeq) database (http://www.ncbi.nlm.nih.gov/RefSeq/) is a curated non-redundant collection of sequences representing genomes, transcripts and proteins. The database includes 3774 organisms spanning prokaryotes, eukaryotes and viruses, and has records for 2,879,860 proteins (RefSeq release 19). RefSeq records integrate information from multiple sources, when additional data are available from those sources and therefore represent a current description of the sequence and its features. Annotations include coding regions, conserved domains, tRNAs, sequence tagged sites (STS), variation, references, gene and protein product names, and database cross-references. Sequence is reviewed and features are added using a combined approach of collaboration and other input from the scientific community, prediction, propagation from GenBank and curation by NCBI staff. The format of all RefSeq records is validated, and an increasing number of tests are being applied to evaluate the quality of sequence and annotation, especially in the context of complete genomic sequence.

Amino Acid Sequence↗
PubMed1983

Pathogenetic mechanisms in B27 associated diseases.

Various aspects of pathogenesis, or more broadly, aetiopathogenesis, in the field of B27 related disorders are considered. The main conclusions can be expressed as follows: Genetic factors are involved in the causation of the spondarthritides, although there is still controversy within individual disorders concerning the precise mode of inheritance. For instance, in some conditions evidence appears stronger for a Mendelian mechanism, in others for a multifactorial process. The mode of the HLA-B27-receptor interaction is not yet fully established, but there is strong support for the one gene cross-tolerance theory, in ankylosing spondylitis at least. It is likely that environmental factors 'collaborate' with genetic factors in causing spondarthritic disease. The factors in the environment have yet to be proved, but there is some evidence that micro-organisms such as Klebsiella and Yersinia are involved (e.g. ankylosing spondylitis, Reiter's disease, reactive arthritis). Of noninfective environmental factors, trauma could play a part, as suggested by the mode of onset and pattern of development of some examples of ankylosing spondylitis and psoriatic arthritis.

Animals↗
PubMedDate not supplied

Crossing cultural boundaries: flexible approaches and nurse education: a case study.

Computer-mediated conferencing commonly is used to promote collaborative learning, including student learning across distance. This article presents the outcomes and experiences of Master of Nursing students in three countries using flexible learning approaches facilitated by the use of computer-mediated conferencing. It examines issues relating to support for global nursing education, presents an evaluation of one particular unit, and presents themes in the feedback from students about their experience. The authors report the findings in three categories: broadened perspectives, tackling the technology, and adaptive learning. Furthermore, the article offers suggestions for enhancing student-learning experiences when computer-mediated conferencing facilities are used.

Attitude of Health Personnel↗
PubMed2002

What are the determinants of quality of life in people with cervical dystonia?

BACKGROUND: Little is known about the quality of life in patients with cervical dystonia, although pain and depression are relatively common. OBJECTIVE: To test the hypothesis that an individual's ability to cope with the disease will modify the association of intrinsic, extrinsic, and disease related factors with quality of life. METHODS: Patients with cervical dystonia diagnosed by a movement disorder specialist were recruited from seven European countries. Data on quality of life (SF-36), measures of coping, and intrinsic, extrinsic, and disease related factors were collected by a self completed postal questionnaire. RESULTS: 289 patients (101 men and 188 women), mean age 55 years, completed the questionnaire. Both physical and mental quality of life scores were predicted by self esteem and self deprecation, educational level, employment status, social support, response to botulinum toxin, disease severity, social participation, stigma, acceptance of illness, anxiety, and depression. In multivariable analyses, the strongest predictors were anxiety and depression. Severe depression was associated with a 19.1 point decrement in the physical summary score (95% confidence interval, -31.7 to -6.6; p = 0.003); however, disease duration and severity remained predictors. CONCLUSIONS: Care for patients with cervical dystonia must not only focus on reducing the severity of the dystonia but also on the psychological wellbeing of the patient. Interventions aimed at treating depression or anxiety, especially of a cognitive nature, may have a large impact on improving quality of life.

Adaptation, Psychological↗
PubMed2005

Inter-population variations in concentrations, determinants of and correlations between 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153) and 1,1-dichloro-2,2-bis (p-chlorophenyl)-ethylene (p,p'-DDE): a cross-sectional study of 3161 men and women from Inuit and European populations.

BACKGROUND: The study is part of a collaborative project (Inuendo), aiming to assess the impact of dietary persistent organochlorine pollutants (POPs) on human fertility. The aims with the present study are to analyze inter-population variations in serum concentrations of 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153) and 1,1-dichloro-2,2-bis (p-chlorophenyl)-ethylene (p,p'-DDE), to assess inter-population variations in biomarker correlations, and to evaluate the relative impact of different determinants for the inter-individual variations in POP-biomarkers. METHOD: In study populations of 3161 adults, comprising Greenlandic Inuits, Swedish fishermen and their wives, and inhabitants from Warsaw, Poland and Kharkiv, Ukraine, serum concentrations of CB-153 and p,p'-DDE, were analysed by gas chromatography-mass spectrometry. RESULTS: The median serum concentrations of CB-153 were for male and female Inuits 200 and 110, for Swedish fishermen 190 and their wives 84, for Kharkiv men and women 44 and 27, and for Warsaw men and women 17 and 11 ng/g lipids, respectively. The median serum concentrations of p,p'-DDE were for Kharkiv men and women 930 and 650, for male and female Inuits 560 and 300, for Warsaw men and women 530 and 380, and for Swedish fishermen 240 and their wives 140 ng/g lipids, respectively. The correlation coefficients between CB-153 and p,p'-DDE varied between 0.19 and 0.92, with the highest correlation among Inuits and the lowest among men from Warsaw. Men had averagely higher serum concentrations of CB-153 and p,p'-DDE, and there were positive associations between age and the POP-biomarkers, whereas the associations with BMI and smoking were inconsistent. Dietary seafood was of importance only in the Inuit and Swedish populations. CONCLUSION: CB-153 concentrations were much higher in Inuits and Swedish fishermen's populations than in the populations from Eastern Europe, whereas the pattern was different for p,p'-DDE showing highest concentrations in the Kharkiv population. The correlations between the POP-biomarkers varied considerably between the populations, underlining that exposure sources differ and that the choice of representative biomarkers of overall POP exposure has to be based on an analysis of the specific exposure situation for each population. Age and gender were consistent determinants of serum POPs; seafood was of importance only in the Inuit and Swedish populations.

Adult↗
PubMed2001

New strategies to prevent restenosis.

The Holy Grail of cardiovascular pharmacology has been the search for an effective therapy targeting restenosis after angioplasty and/or intra-arterial stenting. The failure of promising therapeutics in clinical trials underscores the complexity and redundancy of the signaling cascades regulating mitogenesis and fibrogenesis. Novel therapeutic modalities have potential to target dysfunctional signaling elements directly in vascular smooth muscle cells. Significant progress in the treatment against restenosis will require the exploitation and cross-fertilization of developments in the fields of pharmacology, bioengineering, genetics, and molecular biology. Collaboration among researchers in these fields will be essential.

Angioplasty↗
PubMed1992

[Dental hygiene in 10-to-18-year-old youths in Flanders. Results of a school survey].

This study is part of the cross-national Survey on Health and Lifestyles in School-aged children--a WHO collaborative study (HELENA). The aim of this report was to describe the oral health habits (oral hygiene, use of dental floss and fluoride, consumption of sugar snacks) in schoolchildren aged 10 to 18 in the Flemish-speaking community of Belgium. Toothbrushing was consistently less frequent among boys than among girls. There is a negative correlation between the frequency of toothbrushing and the consumption of soft drinks in both sexes, and between toothbrushing and sweets consumption in girls. The use of dental floss is still very rare. Efforts must be continued to reduce the consumption of sweets and soft drinks. No differences in oral health habits were noted among children from different school types. Parental profession did not influence oral health habits in this study.

Adolescent↗
PubMed1992

[Prevalence of HIV-1 and other sexually transmitted diseases among Spanish prostitutes].

BACKGROUND: Many studies in Western countries point to the high prevalence of HIV infection in groups of prostitutes especially among those using intravenous drugs (IVDA). Furthermore, there appears to be a low but increasing number of heterosexually infected prostitutes. METHODS: A cross-sectional study was carried out in a sample of 374 prostitutes selected by collaborating groups in 11 provinces with the aim of studying the prevalence of HIV and its associated risk factors in Spanish prostitutes. Furthermore, the prevalence of other sexually transmitted diseases (HIV-2, HTLV-I/II, hepatitis B and syphilis), the frequency of different sexual activities and the use of condoms were investigated in this group. The data were collected by interview using a previously tested questionnaire. RESULTS: Serological analysis demonstrated that 54 persons were positive for HIV-1 (16%), none for HIV-2, 1 for HTLV-I/II, 113 for hepatitis B (46%) and 84 for syphilis (25%). The main risk factor for HIV infection was IVDA; 60% of this group was positive vs 3% of the non IVDA (OR = 47.6; confidence interval 18.4-128.0). Consistent condom use in this population is low, although it varies according to the type of relation and sexual partner. Forty-nine percent of the women having vaginal relations with their customers reported using condoms at all times or almost all times vs 36% for anal relations and 22% for oral relations. These percentages were reduced to 10%, 6% and 3%, respectively with private sexual partners. CONCLUSIONS: Studies concerning HIV prevalence and its associated risk factors in Spanish prostitutes should be continued in order to monitor trends in HIV infection and the use of protective measures.

Adolescent↗
PubMed2004

Use of HOS data in Florida.

The Medicare Health Outcomes Survey (HOS) is a longitudinal cohort study that assesses physical and mental functioning of Medicare enrollees in MCPs. Realizing the potential of HOS data to improve health care, the Florida Medicare Quality Improvement Organization (QIO) analyzed HOS scores and shared them with M+COs to assist in evaluating the efficacy of their disease management programs. The QIO also discusses additional uses for HOS data such as cross-linking with a patient satisfaction survey and sharing with health care organizations that collaborate with the QIO.

Aged↗
PubMed2006

Can science be a business? Lessons from biotech.

In 1976, Genentech, the first biotechnology company, was founded by a young venture capitalist and a university professor to exploit recombinant DNA technology. Thirty years and more than 300 billion dollars in investments later, only a handful of biotech firms have matched Genentech's success or even shown a profit. No avalanche of new drugs has hit the market, and the long-awaited breakthrough in R&D productivity has yet to materialize. This disappointing performance raises a question: Can organizations motivated by the need to make profits and please shareholders successfully conduct basic scientific research as a core activity? The question has largely been ignored, despite intense debate over whether business's invasion of basic science-long the domain of universities and nonprofit research institutions- is limiting access to discoveries, thereby slowing advances in science. Biotech has not lived up to its promise, says the author, because its anatomy, which has worked well in other high-tech sectors, can't handle the fundamental challenges facing drug R&D: profound, persistent uncertainty and high risks rooted in the limited knowledge of human biology; the need for the diverse disciplines involved in drug discovery to work together in an integrated fashion; and barriers to learning, including tacit knowledge and murky intellectual property rights, which can slow the pace of scientific advance. A more suitable anatomy would include increased vertical integration; a smaller number of closer, longer collaborations; an emphasis by universities on sharing rather than patenting scientific discoveries; more cross-disciplinary academic research; and more federal and private funding for translational research, which bridges basic and applied science. With such modifications, science can be a business.

Biotechnology↗