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PubMed2003

["Research, medicine and tomorrow"].

In recent years health networks have developed as an essential new element in the organisation of the French health system. Under the auspices of the Regional Agency for Hospitalisation, the Franche-Comté was established in 1996 as per the Agency's order to implement a policy which facilitated the development and expansion of such networks. A Regional Federation of Health Networks was recently created in order to accompany the implementation of this policy so as to ensure coherence and efficiency. This article briefly presents one such health network in order to provide an example of the operational axis common to all networks. Furthermore, it presents the Regional Federation of Health Networks from Franche-Comté in order to highlight the necessity for research on the coordination and collaboration between the different health networks. Finally, the reader is invited to question the potential role of the Faculty of Medicine in this schema for the future expansion of the health system to one which focuses on health rather than medicine, taking into account the new professional practices and the new occupational fields which have arisen as a result of the development of health networks.

Community Networks↗

PubMed1992

Preliminary studies of sexual networks in a male homosexual community in Iceland.

In this article, we present the preliminary results of a study on sexual networks in a homosexual community in Iceland. The network data are transformed into a mixing matrix, which suggests that the pattern of sexual contact within the community is disassortative (i.e., sexual contacts occur largely between individuals of disparate sexual activity levels). The implications for the spread of human immunodeficiency virus (HIV) in the community are assessed by comparison with epidemics generated by proportionate and assortative (like with like) mixing, using a mathematical model of HIV transmission. The potential magnitude of the epidemic associated with the data is shown to be larger than both proportionate and assortative alternatives, although the early rate of growth is lower for the mixing matrix implied by the data. The assumptions made concerning behavioural changes triggered by alterations in population structure as a consequence of AIDS-induced mortality do not significantly alter the shape of the predicted epidemic. The problems in data acquisition and interpretation are discussed.

Adult↗

PubMed1998

A national HIV community cohort: design, baseline, and follow-up of the AmFAR Observational Database. American Foundation for AIDS Research Community-Based Clinical Trials Network.

This article describes the design, methodology, baseline distributions, and general follow-up characteristics of the American Foundation for AIDS Research (AmFAR) National Observational Database (ODB) Project including the benefits and limitations of collecting information on a large simple cohort in the HIV community setting. The study prospectively followed 15,611 HIV-positive men and women and collected longitudinal and cross-sectional data on demographics, medical conditions, drug therapies, laboratory parameters, and survival. Participants were followed between October 1990 and December 1993 by 252 community-based sites coordinated by 22 centers in the Community-Based Clinical Trials Network (CBCT Network) throughout the United States (including Puerto Rico) and Toronto, Canada. The ODB provided quantitative information on a national level needed to track the HIV epidemic and plan clinical trials conducted through the Network, and to provide sites with local databases to monitor patients and facilitate access to therapies in clinical trials. Overall, the ODB contains information on 1,925 women (12%) and 13,686 men (88%), 60% white, 20% African American, 17% Latino/Hispanic, with 56,254 baseline and follow-up forms, a median follow-up of about 12 months, a 16% loss-to-follow-up, and an 11% mortality rate. AmFAR plans to place the ODB in the public domain.

Adolescent↗

PubMedDate not supplied

The reemergence of the hospital-based laboratory.

The Reference Laboratory Alliance (RLA) in Pittsburgh is an example of multiple hospital laboratories integrated for the purpose of delivering competitive outpatient laboratory services in a managed-care environment. Developed in 1994, the RLA model includes a "virtual" core laboratory (comprising four tertiary care centers of excellence) and a distributed network of more than 30 community hospitals. Linked through information systems, logistics, and an extensive committee structure, the RLA is capable of delivering a "seamless" service to the region's managed-care organizations. In its first full year of operation, the RLA is expected to shift between $12 and $15 million worth of laboratory activity back into the community's hospitals. Through its pathology component, the RLA is now actively engaged in redefining the role of the clinical laboratory in the managed-care environment.

Community Networks↗

PubMedDate not supplied

New information network brings health care community closer.

Explore the source record for details and available documents.

California↗

PubMed1995

Lessons from the Essential Access Community Hospital Program for rural health network development.

The Essential Access Community Hospital (EACH) Program is testing a concept for limited-service hospitals established under Medicare called the Rural Primary Care Hospital (RPCH). The program uses cost-based reimbursement and relaxed regulatory requirements to help low-volume rural hospitals shift emphasis from acute care to primary care and emergency services. RPCHs must form "horizontal" networks with larger hospitals and may form "vertical" arrangements with ambulatory service providers and practitioners. A small number of rural hospitals have converted to the RPCH status since the program entered the implementation stage in late 1993. It is unclear how many other hospitals will convert given uncertainty regarding the financial impact of RPCH conversion and concerns with certain requirements. The program illustrates how payment policies can provide incentives for network development and reflects the importance of physician involvement and technical assistance in developing limited-service hospitals. In addition, it appears that EACH/RPCH networks that form under the program may serve as building blocks for broader networks, as the seven states involved in the program look to develop rural health networks that go beyond the EACH/RPCH model.

Comprehensive Health Care↗

PubMed2000

[Role of national insurance pharmacies in community complete home care networks--home TPN and home care supported by local national insurance pharmacies].

The reforms in the medical system and introduction of home care insurance have brought great changes to national health insurance pharmacies. In April 1998, Dr. Hirai became new director of the Chiba Togane Hospital. The development of a community complete medical system was included in a restructuring of the hospital, and various reforms were begun. A system covering all aspects of the medical/pharmaceutical field was started in August 1998. For its part, the Sanbu-gun Pharmacists Association began accepting prescriptions outside the hospital, and regular meetings for the exchange of knowledge were held with members of the physicians and pharmacists associations. After building a relationship of trust in this way, a community complete home treatment system was begun in July 1999 with Togane Hospital functioning as its backup support hospital. To date, home TPN terminal care has been provided in cases of terminal cancer, incurable neurological diseases, and for the very aged and patients with cerebrovascular impairments. Any general pharmacy in the region can participate in the program to fill prescriptions for TPN, provided that the pharmacist him or herself so wishes, establishes a clean bench at the pharmacy, and undergoes training at Togane Hospital on the preparation of i.v. medicines in order to function responsibly in this capacity. These pharmacies are called satellite pharmacies, and at present there are four of them located with a good balance within the region. These satellite pharmacies prepare liquid medications for TPN, including narcotics, and oral medicines following the prescriptions written by the physician from the hospital who is serving as the primary home treatment physician. The pharmacy also delivers the medicines to the home of the patient. The pharmacist checks the status of remaining TPN liquids and oral medicines and informs the primary home physician and support hospital by e-mail or fax, so that everyone shares the same information. The success or failure of home TPN from a general pharmacy depends on the formation of a digital network in order to share information using the Internet and a back-up system for unconditional support by the support hospital in times of patient emergency. In our region, these conditions have been fulfilled.

Community Networks↗

PubMed2004

Tracking evolving communities in large linked networks.

We are interested in tracking changes in large-scale data by periodically creating an agglomerative clustering and examining the evolution of clusters (communities) over time. We examine a large real-world data set: the NEC CiteSeer database, a linked network of >250,000 papers. Tracking changes over time requires a clustering algorithm that produces clusters stable under small perturbations of the input data. However, small perturbations of the CiteSeer data lead to significant changes to most of the clusters. One reason for this is that the order in which papers within communities are combined is somewhat arbitrary. However, certain subsets of papers, called natural communities, correspond to real structure in the CiteSeer database and thus appear in any clustering. By identifying the subset of clusters that remain stable under multiple clustering runs, we get the set of natural communities that we can track over time. We demonstrate that such natural communities allow us to identify emerging communities and track temporal changes in the underlying structure of our network data.

Cluster Analysis↗

PubMed1996