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Comprehensive health care clinic for hemophiliacs.

One hundred hemophiliacs were examined at a formal comprehensive health care clinic. Sixty-eight percent had abnormal results of liver function tests, and 26% had spleens that were palpable. Measurement of range of motion of knees, ankles, hips, shoulders, and elbows showed a high incidence of hemophilic arthropathy and established a precise baseline by which to judge efficacy of therapy. Results of dental examination disclosed a 14% incidence of multiple severe caries, which is an incidence lower than that of the population as a whole. Examples of inadequate dosage of replacement therapy (16%) and chronic delay in application of self-therapy (14%) were discovered. An 8% incidence of hypertension was noted; prior experience suggests that the combination of hypertension and hemophilia may be lethal. Other clinical and laboratory data also illustrate the importance of a periodic, formally structured, comprehensive examination of hemophiliacs.

Adolescent↗

A comprehensive health care directive in a home for the aged.

OBJECTIVES: To examine the use of and compliance with a new comprehensive health care directive by residents of a home for the aged and to determine the effect of the directive on the use of health care services. DESIGN: Descriptive study with a before-after design. SETTING: A home for the aged providing residential care to women. PARTICIPANTS: All 119 residents (ages 71 to 103 years, mean age 87.5 years). INTERVENTION: Introduction of a comprehensive health care directive and follow-up at 1 year. OUTCOME MEASURES: Residents' treatment choices, compliance with the directive, number of hospital admissions and length of hospital stay, number of deaths and places where deaths occurred. RESULTS: Ninety (76%) of the residents completed the directive. In the event of reversible life-threatening illness 34, 24, 11 and 21 residents requested supportive, limited, maximum and intensive care respectively. For irreversible illness the numbers were 75, 12, 3 and 0 respectively. In case of cardiac arrest 88% requested that cardiopulmonary resuscitation not be done. In the year before the introduction of the directive there were nine deaths, one in the home and eight in hospitals. In the year after there were 17 deaths, 11 in the home and 6 in hospitals. The mean length of hospital stay was significantly lower in that year than in the year before implementation (p less than 0.001). CONCLUSIONS: This innovative health care directive seems to be feasible, practical and well supported by residents, their families and health care professionals. Further studies are required to establish the generalizability and reproducibility of the data to other elderly people in institutions, to chronically ill patients and to the community at large.

Advance Directives↗

Core and comprehensive health care services: 3. Ethical issues.

The CMA's Working Group on Core and Comprehensive Health Care Services recognizes ethics to be one of the three key factors in determining which services should be publicly funded. The role of ethics is to identify and make explicit the principles and values, at individual and societal levels, that lie behind judgements and positions. Two types of ethical issues are addressed: one deals with the criteria for these services and the other with the process to be followed. The five ethical criteria discussed are fairness, age, lifestyle, the identifiable versus the statistical patient, and futility. An ethical process incorporates appropriate roles for the public physicians and payers (government) and accountability of all participants. A provided checklist for determining a fair process asks such questions as Do potential users of a service, its providers and the public have an adequate say in the decision about whether the service should be publicly funded? Are the reasons for the decision communicated to those affected by it? and is the service being denied to potential users on the basis of unfair discrimination or lifestyle?

Age Factors↗

[Day care as a component of comprehensive health care structure after introduction of nursing care insurance].

Detailed time protocols based on direct observation as well as socio-demographic and morbidity-related data were collected in Day-Care-Facilities for the Aged and the Handicapped (Tagespflege), in order to gain information regarding the users and the service activities of these institutions. Women aged 80 years and over constitute the main users; they use the facilities between 8 am and 4.30 pm in most cases. The analysis of employee activities showed that roughly one quarter of the time was spent on specific services of such facilities, e.g. group activities, individual activating therapy of patients. Should Day-Care-Facilities play an (increasingly) important role in the domestic social service provision for the aged and the handicapped, the financing of their costs (on the average DM 88 per day, not counting transportation cost) must be reconsidered.

Aged↗

[The role of dentistry in the interdisciplinary team: contributing to comprehensive health care for the elderly].

This literature review focuses on dentistry's role in comprehensive health care for the elderly. The authors discuss the need for an interdisciplinary approach. They begin by analyzing the current situation in geriatric dentistry and related problems in Brazil, relating primarily to the lack of specific studies and human resources with training in geriatrics and gerontology. The authors emphasize interactions between dentistry and other health professions for health promotion, specific prevention, and rehabilitation of elderly patients, with special attention to the importance of communication and information exchange.

Aged↗

Core and comprehensive health care services: 1. Introduction to the Canadian Medical Association's decision-making framework.

The CMA's decision-making framework on core (i.e., publicly funded) and comprehensive health care services emphasizes flexibility and recognizes three levels at which decisions can be made: between patients and physicians (micro), in the community or by society (meso) and by governments (macro). Three major content dimensions are considered quality of care (e.g., effectiveness, appropriateness and efficiency of health care services), ethics (e.g., decisions that reflect fairness and acceptability to patients and physicians) and economics (e.g., measurement of service costs against economic benefits in a time of severe economic restraint). There are challenges in applying the framework; however, by providing decision-makers with the knowledge and tools needed to assist in the process, it is hoped that the first and foremost concern will continue to be the quality of patient care so highly valued by Canadians.

Canada↗