Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Allocation and cooperation”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 433 records · Page 24Linked to original sources
PubMedDate not supplied

Evaluating hypertension control in a managed care setting.

BACKGROUND: We conducted a retrospective cohort study on a random sample of adult patients with hypertension in a large health maintenance organization to assess the feasibility of documenting blood pressure (BP) control and to compare different measures for defining BP control. METHODS: Three criteria for BP control were assessed: systolic BP less than 140 mm Hg; diastolic BP less than 90 mm Hg; and combined BP control, with systolic BP less than 140 mm Hg and diastolic BP less than 90 mm Hg. Four methods of assessing hypertension control by the above criteria were examined: proportion of patients with BP under control at 75% and 50% or more of their office visits; the mean of all pressures during the study period; and the BP from the last visit during the study period. RESULTS: The proportion of patients meeting each criterion for control was similar whether we used the mean BP for all visits, the last recorded BP, or control at 50% or more of visits. Control rates were substantially lower when the more stringent assessment, 75% of visits, was used. The proportion of patients with combined BP control at 75% or more of their visits was half that of the other methods. CONCLUSIONS: In this health maintenance organization population, results with the use of the simplest approach, the last BP measurement recorded, were similar to results with the mean BP. Our findings indicate that evaluation of BP control in a large health maintenance organization will find substantial room for improvement, and clinicians should be encouraged to be more aggressive in their management of hypertension, especially with regard to the systolic BP, which until recent years has been underemphasized.

Aged↗
PubMed1997

Successful control of onchocerciasis with community-based ivermectin distribution in the Rio Santiago focus in Ecuador.

Onchocerciasis is a major blinding disease in equatorial Africa and Central and South America. Ivermectin is a safe and effective drug in the treatment of this disease and now forms the basis of disease control in most endemic areas. We report the findings of long-term control of this infection in the Río Santiago focus in Ecuador, between January 1990 and December 1996, using a strategy of giving ivermectin treatments biannually in hyperendemic communities and annually in meso- and hypoendemic communities. Ivermectin was administered by local health workers from each community. A high level of compliance to ivermectin was achieved, with 81.9% to 98.0% of those eligible receiving the drug at each treatment instance. The impact of ivermectin therapy was monitored using a cohort of 120 randomly selected infected individuals from 8 hyperendemic communities. The geometric mean microfilarial density of this group declined from 19.3 to 0 mf/mg over the 84-month observation period. Ivermectin had a significant impact on anterior segment ocular disease, acute onchodermatitis and sowda. The rate of infection of blackflies declined from 1.1% in 1989-0.08% in 1996, which is below the vectorial capacity of the Simulium vector and, as no new nodules were detected after 1994 and no children under 5 became infected over the observation period, it is likely that the transmission of this infection was interrupted in the study area.

Animals↗
PubMed2005

An interactive and contextual model of community-university collaborations for research and action.

Community-university partnerships for research and action are at the heart of many fields in the social sciences including public health, urban planning, education, and community psychology. These partnerships involve individuals from different backgrounds and disciplines working together to address social issues of importance to the community. This article proposes an interactive and contextual model for developing and sustaining community-university partnerships. The phases in the model include gaining entry into the community, developing and sustaining a mutual collaboration (developing trust and mutual respect, establishing adequate communication, respecting human diversity, establishing a culture of learning, respecting the culture of the setting and the community, and developing an action agenda), and recognizing the benefits and outcomes of partnership work. The model also includes the potential challenges that might threaten the partnership, such as resource inequality and time commitment.

Communication↗
PubMed2003

Length of docked tail and the incidence of rectal prolapse in lambs.

A multistate cooperative study was conducted to study the current issue of tail length in docked lambs and its relationship to incidence of rectal prolapse. A total of 1,227 lambs at six locations were randomly allocated to two or three tail dock treatments: 1) short--tail was removed as close to the body as possible, 2) medium--tail was removed at a location midway between the attachment of the tail to the body and the attachment of the caudal folds to the tail, and 3) long--tail was removed at the attachment of the caudal folds to the tail. Short-docked lambs had a greater (P < 0.05) incidence of rectal prolapse (7.8%) than lambs with a medium (4.0%) or a long (1.8%) dock. Female lambs had a higher (P < 0.05) incidence of rectal prolapse than male lambs. At two stations, lambs were finished either in a feedlot on a high-concentrate diet or on pasture with no grain supplementation. At one station, with a very low incidence of rectal prolapse, there was no difference in incidence between lambs finished in the feedlot or on pasture; however, at the station with a relatively high incidence of rectal prolapse, lambs in the feedlot had a higher (P < 0.05) incidence than lambs on pasture. The half-sib estimate of heritability for the incidence of rectal prolapse was low (0.14). The results of this study strongly implicate short dock length as a cause of rectal prolapse in lambs finished on high-concentrate diets. Furthermore, the results of this study and the only other study known conducted on this issue strongly suggest that docking lambs at the site of the attachment of the caudal folds to the tail will result in a negligible incidence of rectal prolapse.

Animal Husbandry↗
PubMed1976

The VA cooperative randomized study of surgery for coronary arterial occlusive disease II. Subgroup with significant left main lesions.

From a large cooperative prospective randomized study, data relating to a subgroup of 113 patients with angina pectoris and a significant lesion of the left main coronary artery were analyzed. Of these patients, 53 had been randomly allocated to a medical treatment group and 60 to a surgical treatment group. The former group received conventional medical treatment, while the surgical treatment group received one or more aortocoronary saphenous vein bypass grafts. Important risk factors were approximately uniformly distributed between the two groups. Both are being followed up to 60 months (average follow-up, 30 months). To date, 12 of 60 surgical patients (20%) and 19 of 53 medical patients (36%) died (P less than 0.06). The operative (30-day) mortality declined from a rate of 25% for the first 2 years of the study to 7% for the last 3 years. Of patients randomized in the latter 3 years of the study, 12 of 41 medical patients (29%) and three of 42 surgical patients (7%) died (P less than 0.01). The average follow-up period in this group was 24 months. The proportion surviving 24 months was clearly larger in the surgically treated group (P less than 0.02). The difference in the proportion of patients surviving after surgery as compared with medical treatment was greatest in patients with additional significant disease involving the right coronary artery, with or without left ventricular dysfunction. Relief of angina as assessed by an "anginal score" was also better in surgical patients to a significant degree. Graft-patency rates correlated well with relief of angina, but objective studies including treadmill testing are not yet available.

Angina Pectoris↗
PubMed2004

[Networking as an opportunity to profile a clinic? Strategy options after the evaluation of resource allocation].

BACKGROUND AND OBJECTIVES: Diagnosis-related groups of medical services has recently been introduced for reimbursing hospital services. The aim has been to optimize bed capacity, decrease the duration of inpatient stay and provide good follow-up medical care. This confronts hospitals with the need for closely cooperating with the referring general practitioners or specialists. METHOD: A specially structured questionnaire was sent to all those general practitioners and specialists (n=890) who had referred patients to a university department of dermatology. The response rate was 23%. The completed questionnaires were analysed with respect to criteria judged to be important in determining referral for inpatient care and the quality of medical and related service provisions. RESULTS: Especially important to the referring doctors were optimal competence of patient care, the degree of cooperation and prompt, detailed information after the patients have been discharged. CONCLUSION: This type of analysis can serve to optimize the course of diagnosis/treatment and to utilize fully the available hospital resources. Also considered are various ways in which a hospital department can, by networking with general practitioners and specialists, become a centre for providing optimal services.

Clinical Competence↗
PubMed2005

The polyp detection rate of colonoscopy: a national study of Medicare beneficiaries.

National-level data on the proportion of colonoscopies in routine practice that result in polyp detection are limited. Our goal was to determine the diagnostic yield of colonoscopy among population subgroups. We reviewed Medicare claims data for all fee-for-service beneficiaries 65 years or older who underwent colonoscopy in 1999. With the use of diagnosis and procedure codes, the proportion of procedures with polyps was estimated. Three different criteria for polyp detection were used. Approximately 1.8 million colonoscopy procedures were identified. Depending on the specific criteria used, 23.9% to 35.7% of examinations noted polyps. The detection rate was highest in younger patients, men, and whites. The apparent yield of colonoscopy in terms of polyp detection is at least 24%. These data may be informative in predicting resource allocation for therapeutic procedures associated with colonoscopy. Future studies should determine the use and yield of serial colonoscopies for polyp surveillance.

Age Factors↗
PubMed1992

System approach to effective direct contracting.

Many of the nation's employers now see direct contracting as a way to regain control over their costs for employees' healthcare benefits. As a result, provider competition for direct contracting arrangements with employers is likely to increase. For a healthcare system, the key to winning employers' contracts may lie in establishing system-wide pricing based on cost determinations. Once prices are set, a healthcare system should select the optimal revenue distribution method for maximizing returns and winning the cooperation of clinical staff.

Competitive Bidding↗
PubMed1979

Designing and analyzing clinical trials which allow institutions to randomize patients to a subset of the treatments under study.

When patients have been randomized between different sets of treatments the treatment groups are not strictly comparable. However, if one can assume that biases which are introduced affect the outcome additively, then one can compare treatments across these institutional options. This is illustrated for dichotomous response data and censored survival data. We show how the sample size must be increased to allow for this analysis and how the randomization should be weighted to obtain the best power. These results have application to simultaneous trials by different cooperative groups which have one or more common treatment arms.

Clinical Trials as Topic↗
PubMed2005

Randomized comparison of ABVD chemotherapy with a strategy that includes radiation therapy in patients with limited-stage Hodgkin's lymphoma: National Cancer Institute of Canada Clinical Trials Group and the Eastern Cooperative Oncology Group.

PURPOSE: We report results of a randomized trial comparing ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy alone with treatment that includes radiation therapy in patients with limited-stage Hodgkin's lymphoma. PATIENTS AND METHODS: Patients with nonbulky clinical stage I to IIA Hodgkin's lymphoma were stratified into favorable and unfavorable risk cohorts. Patients allocated to radiation-containing therapy received subtotal nodal radiation if favorable risk or combined-modality therapy if unfavorable risk. Patients allocated to ABVD received four to six treatment cycles. RESULTS: We evaluated 399 patients. Median follow-up is 4.2 years. In comparison with ABVD alone, 5-year freedom from disease progression is superior in patients allocated to radiation therapy (P = .006; 93% v 87%); no differences in event-free survival (P = .06; 88% v 86%) or overall survival (P = .4; 94% v 96%) were detected. In a subset analyses comparing patients stratified into the unfavorable cohort, freedom from disease progression was superior in patients allocated to combined-modality treatment (P = .004; 95% v 88%); no difference in overall survival was detected (P = .3; 92% v 95%). Of 15 deaths observed, nine were attributed to causes other than Hodgkin's lymphoma or acute treatment-related toxicity. CONCLUSION: In patients with limited-stage Hodgkin's lymphoma, no difference in overall survival was detected between patients randomly assigned to receive treatment that includes radiation therapy or ABVD alone. Although 5-year freedom from disease progression was superior in patients receiving radiation therapy, this advantage is offset by deaths due to causes other than progressive Hodgkin's lymphoma or acute treatment-related toxicity.

Adult↗