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PubMedDate not supplied

The maturing of telemedicine technology. Part 1.

A part of the solution to scarce medical resources is telemedicine--a bundling of high- and low-tech equipment with distinct advantages for both rural and urban providers. Here is Part One of a two-part series on the state-of-the-art and its practical uses.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2006

Perinatal care in Portugal: effects of 15 years of a regionalized system.

AIM: To share information on the organization of perinatal care in Portugal. METHODS: Data were derived from the Programme of the National Committee for Mother and Child Health 1989, National Institute for Statistics, and Eurostat. RESULTS: In 1989, perinatal care in Portugal was reformed: the closure was proposed of maternity units with less than 1500 deliveries per year; hospitals were classified as level I (no deliveries), II (low-risk deliveries, intermediate care units) or III (high-risk deliveries, intensive care units), and functional coordinating units responsible for liaison between local health centres and hospitals were established. A nationwide system of neonatal transport began in 1987, and in 1990 postgraduate courses on neonatology were initiated. With this reform, in-hospital deliveries increased from 74% before the reform to 99% after. Maternal death rate decreased from 9.2/100,000 deliveries in 1989 to 5.3 in 2003 and, in the same period, the perinatal mortality rate decreased from 16.4 to 6.6/1000 (live births + stillborn with > or = 22 wk gestational age), the neonatal mortality rate decreased from 8.1 to 2.7/1000 live births, and the infant mortality rate from 12.2/1000 live births to 4/1000. CONCLUSION: Regionalization of perinatal care and neonatal transport are key factors for a successful perinatal health system.

Female↗
PubMed2006

Trends in perinatal regionalization and the role of managed care.

OBJECTIVE: To describe trends in regionalization of perinatal care and identify factors that predict the extent of regionalization. METHODS: Data were drawn for four states for every year between 1989 and 1998. Panel data models estimated the effect of managed care enrollment on site of delivery for low, very low, and extremely low birth weight neonates. RESULTS: Strong evidence for regionalization over time was observed for North Carolina and Illinois, with little change in site of delivery in Washington. A shift from level III to level II hospitals was observed for low and very low birth weight neonates in California. Although managed care enrollment increased substantially in all four states, managed care had no effect on site of delivery; that is, the effect of managed care was near zero and not statistically significant in any state. CONCLUSION: Evidence supports the delivery of high-risk neonates at tertiary care centers. Despite changes in site of delivery, the percentages of very low birth weight neonates delivered at level III hospitals were substantially lower than the goal of 90% set by Healthy People 2010. Financial pressures introduced by managed care cannot be blamed for the failure to meet this goal. LEVEL OF EVIDENCE: II-2.

Delivery, Obstetric↗
PubMed2004

National and regional health information infrastructures: making use of information technology to promote access to evidence.

The vision for national and regional health information infrastructures (HII) includes provision of a framework that is supportive of access and integration of health information with the goal of improving the health and safety of individuals, public health systems, and nations. Internationally, prominent examples of national and regional HIIs exist that provide a means for achievement of this goal. However, to fully realize benefits, an explicit mechanism is needed for linking national and regional HIIs with existing knowledge, automated processes and evaluation of the ability of HIIs to meet the information needs of primary recipients. Using the United States' Na-tion Health Information Infrastructure (NHII) as an example, the authors describe expansion of the conceptual framework to explicitly acknowledge the role of access to evidence at the overlap between the three dimensions of the NHII to create an "evidence-based" link between interrelated components. The role of national measures in setting e-communication goals and evaluating the evolving infrastructure in meeting informational needs of users is discussed. Additionally, automated knowledge management tools such as practice guidelines are presented as a means by which access to critical information is delivered to users, in a format that is appropriate for their health literacy level and that provides adequate support for informed decision making.

Decision Support Techniques↗
PubMedDate not supplied

Improving the public health/physician partnership for influenza vaccination.

BACKGROUND: Alberta doctors can request supplies of publicly funded influenza vaccine to administer to patients who meet provincial program criteria. PURPOSE: To describe the proportions of Alberta family doctors who vaccinate patients, the sources from which they obtain vaccine and their evaluation of public health influenza vaccination program components. METHODS: Cross-sectional postal survey, 2003. Doctors were asked to complete a nine-page questionnaire or to answer a one-page "mini-survey". The proportion of physicians who vaccinated patients against influenza was estimated separately for the main questionnaire and the mini-survey. Frequencies and cross-tabulations were used to examine sources of vaccine supply and physician ratings of five aspects of influenza vaccine program services provided by Regional Health Authorities (RHA). RESULTS: The survey response rate was 52.3% (1387/2650); an additional 14% (372) returned a mini-survey. The proportion of respondents who vaccinated one or more patients against influenza in the fall of 2002 was 81.5% for the main questionnaire and 83.1% for the mini-survey. Vaccine was most commonly obtained from the RHA. Three items were rated as poor/fair by more than 10% of respondents: provision of information for distribution to patients (37%), timeliness of vaccine delivery to offices (16%) and vaccine availability over the entire influenza season (18%). Item ratings varied by RHA but provision of information for distribution to patients was consistently a problem. CONCLUSION: A high priority should be placed on improving resources for doctors to give to patients, timeliness of vaccine deliveries to doctors' offices and vaccine availability over the entire season.

Alberta↗
PubMed1984

Evaluation of the TALON Cooperative Acquisitions Program for monographs.

The TALON Cooperative Acquisitions Program for monographs (TALON/CAP) was implemented in 1979 by eleven resource libraries in the South Central Regional Medical Library Program. Each participating library acquired books from selected publishers within a profile covering subject and format. The program was evaluated by comparing interlibrary loan requests, surveying participants, and analyzing cataloging records. The results were that ten of the eleven libraries significantly increased their coverage of assigned publishers, and that academic medical libraries are not all buying the same books, even from major medical publishers. The fifty-six publishers in the program accounted for 60% to 83% of the titles with 1977-80 imprints held by participating libraries. The computer-generated collection analysis reports provide a baseline for future collection management studies.

Books↗
PubMedDate not supplied

The Toronto Cardiac Rehabilitation and Secondary Prevention Program: 1968 into the new millennium.

Given our approach to the cardiac rehabilitation process, which is reflected in the program structure and services and our high patient volume, this program model is effective for us. The model permits us to treat relatively large number of patients with relatively small numbers of staff. On average, a patient attends 32 supervised exercise sessions at the Centre over the course of 12 months. This is actually fewer supervised sessions than the popular model of 3 times per week for 12 weeks. However, the 12-month program provides an additional 9 months to work with patients on heart-healthy lifestyle modifications. At the same time, we realize our model is not the model of choice for all people in all settings for a variety of reasons. We trust that some elements of our program may be of interest and beneficial to some readers. Undoubtedly, the program will continue to evolve and develop into the future. Currently, we are conducting a cardiac rehabilitation outcomes study in an effort to determine the appropriate duration of cardiac rehabilitation to achieve optimal physiological, psychological, and cost benefits for patients. This study involves more than 700 patients and the results are intended to help us further refine the program structure and selected program elements. As the new millennium approaches, healthcare system reforms and continuing changes in the delivery of medical care to cardiac patients present opportunities, challenges, and some uncertainties for cardiac rehabilitation. To continue our services to patients and the medical community, cardiac rehabilitation programs will need to identify and develop even more innovative and effective concepts in response to ever-changing local, regional, and national issues.

Coronary Disease↗
PubMed2001

[Organizational and medical aspects of transition of juveniles with congenital heart defects to adult cardiology care].

A growing, heterogeneous group of children with congenital heart disease is surviving into adulthood due to advances in medicine. These patients including those with simple and complex congenital heart disease and operated on during childhood are facing long-term complications. Superspecialist care and expertise are required during their life to deal with their unique problems the most common being ventricular failure, arrhythmias, valve and conduit longevity. Teenagers and adolescents disappear from both medical and parental care because of the lack of transition programs. Transition of care from pediatric to adult cardiologists must be organized in each country and must reflect regional history, regional politics and realities. Transition of care requires goodwill from parents, adolescents, pediatric and adult cardiologists. Transition clinics being held jointly by pediatric and adult cardiologists between the age of 16 and 18 years are essential to encourage the adolescents to take charge of their own life and health issues. Adequate information about their heart defect, their operations and their residual lesions may help them understand the implications for the future and improve their compliance. A transition program must include counseling on education, career, endocarditis prophylaxis, insurance and lifestyle issues such as sexuality and reproduction (including anticonception, pregnancy), cardiovascular risk factors and sports activities. Medical reports including operative reports and heart catheterization reports must be transferred to the adult cardiologists. In Switzerland, care of adults with congenital heart disease is based on three levels: 1) primary caregivers including general practiioners, internists and community cardiologists; 2) cardiologists with special commitment and expertise to patients with congenital heart disease who organize regional outpatient clinics; 3) supraregional referral centers with cardiologists trained in pediatric and adult congenital heart disease and experienced in the special needs, problems and management of this unique population. A close collaboration between pediatric and adult cardiologists participating jointly in the care of congenital heart disease patients is very important. An interdisciplinary team offers all non-invasive and invasive facilities for diagnostic and therapeutic procedures in a supraregional referral center. A close collaboration among all physicians is crucial for optimal care and management. Integration of adolescents with congenital heart disease into an adult medical system improves both compliance and quality of care and supports the patient's esteem because many medical aspects and lifestyle issues are completely different from those during childhood.

Adolescent↗