SEARCH · Search PubMed
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.
Regional health systems address many audiences. The winners in this category are: Baptist Health Systems of South Florida, Coral Gables, Fla., first place; Memorial Hospital & Health System of South Bend, South Bend, Ind., second place; and Orlando Regional Healthcare, Orlando, Fla., third place.
Even a disease as difficult to define as COPD can be addressed through comprehensive management. It's even possible to develop guidelines for patients who have COPD as a co-morbid condition.
Racial disparities in medical care should be understood within the context of racial inequities in societal institutions. Systematic discrimination is not the aberrant behavior of a few but is often supported by institutional policies and unconscious bias based on negative stereotypes. Effectively addressing disparities in the quality of care requires improved data systems, increased regulatory vigilance, and new initiatives to appropriately train medical professionals and recruit more providers from disadvantaged minority backgrounds. Identifying and implementing effective strategies to eliminate racial inequities in health status and medical care should be made a national priority.
PURPOSE. This paper is based on the author's keynote address given at the Seventh International Conference on the Health Problems of Chinese in North America. METHODS. The author/speaker reviewed the literature related to Chinese American health problems within the context of the broader demographic and aggregated health data reported on Asian Americans and Pacific Islanders. FINDINGS. In addition to background demographic statistics provided on Chinese Americans, the author/speaker focused on two categories of diseases: (1) communicable diseases; and (2) chronic diseases because of the greater availability of data on these categories. Communicable diseases from which Chinese Americans appear to suffer disproportionally are tuberculosis and hepatitis B. Infection with the hepatitis B virus also makes Chinese Americans much more susceptible to chronic liver diseases including cancer. Chinese also suffer disproportionally more from nasopharyngeal cancer; because of higher than average adult male smoking rates, these men can be expected to suffer disproportionally from a future epidemic of lung cancer cases. Unhealthy acculturation patterns in food consumption point towards changing profiles of cardiovascular morbidity and mortality as well as higher rates of dietary related cancers. OBSERVATIONS. Rather than conclusions, observations of the current health status of Chinese Americans were offered. Four measures that organizations such as the Chinese medical societies and Chinese American health professionals can pursue to advance the health status of Chinese Americans, particularly in the area of heaslth policy, are: (1) voting; (2) collecting data on health status; (3) writing for professional journals; and (4) being active in policy development. KEY WORDS. Chinese Americans; health status; tuberculosis; hepatits B; cancer; diet; acculturation; smoking
New guidelines from the federal government point out how to address the fourth leading cause of death in the United States.
The main reason behind these three letters and these two postcards addressed in 1936 by Sigmund Freud to Georg Hermann (a German realist writer, author of a great number of psychological novels) and that are presented here by Gert Mattenklott, takes root in this Freudian leitmotiv: psychoanalysis can and must speak of the work of art, not so much in relationship to its formal or technical qualities as to the impression it gives the spectator, to its "effects". This brief exchange provided an occasion for Freud to speak of the notion of unconscious guilt when replying to an objection made by Hermann, and then essentially of dreams about travelling and trains that are missed as a defence against the perspective of death. The article and the correspondence with Hermann end in the same manner, with the two last postcards sent by Freud to the German writer who died in 1943 at Auschwitz-Birkenau.
The use of an address master system in a general practice can save the doctors and secretarial staff a significant amount of time. A spirit master system (e.g. ;Scriptomaster' sets) best suits the requirements of general practice. Uses include labelling documents, request forms, prescriptions, envelopes and compiling lists of patients.
Within the domestic preparedness community, there is a growing recognition of the importance of psychosocial issues in weapons of mass destruction (WMD) incidents. Whereas social and behavioral issues were only infrequently considered just a few years ago, they are now coming to be seen as central to consequence management efforts. As a result, discussions in the domestic preparedness community are beginning to consider the extent to which psychosocial effects are addressed in the Federal Response Plan and the degree to which additional preparedness and response steps may be needed. To grapple with this crucial issue, an expert panel was brought together at the International Conference on the Operational Impact of Psychological Casualties from Weapons of Mass Destruction. The panel brought together a wide range of specialists from federal agencies, the armed services, and the academic community. This article summarizes the views and assessments of the panelists as well as their policy recommendations for enhancing preparedness.
As the American population becomes more diverse, the hospitals, health plans, and other providers across the country that provide health care to these population groups are meeting new challenges. But, addressing diversity within the health care setting means looking at a variety of issues from determining if competent and appropriate care is being provided, how health care providers are being educated to respond to diversity, and whether the health care environment is conducive to meeting the needs of the diverse population.
Pain associated with advanced cancer is multifaceted and complex, and is influenced by physiological, psychological, social, and spiritual phenomena. Suffering may be identified in patients when pain is associated with impending loss, increased dependency, and an altered understanding of one's existential purpose. Comprehensive pain management aims to address problematic symptoms in order to improve comfort, peace of mind, and quality of life. Music therapy is a treatment modality of great diversity that can offer a range of benefits to patients with advanced cancer pain and symptoms of suffering. Music therapists perform comprehensive assessments that include reviews of social, cultural, and medical history; current medical status; and the ways in which emotions are affecting the pain. A variety of music therapy techniques may be used, including vocal techniques, listening, and instrumental techniques. These techniques provide opportunities for exploration of the feelings and issues compounding the pain experience. Case examples are presented to demonstrate the "lifting", "transporting", and "bringing of peace" qualities of music that offer patients moments of release, reflection, and renewal.
Hospice and palliative care principles mandate clinicIans to provide "total" care to patients and their families. Such care incorporates not only physical, emotional, and psychosocial care, but spiritual care as well. Even though considerable attention has been directed to spiritual issues for adult patients in hospice and palliative care, spirituality in pediatric palliative care has been virtually neglected. The need for guidelines to assess spirituality in this population was identified as a priority issue by members of a subcommittee of the Children's International Project on Children's Palliative/Hospice Services, created under the auspices of the National Hospice Organization. Committee members, based on their clinical, research, and personal experiences, identified several aspects relevant to spirituality in general, and to spirituality in pediatric palliative care in particular, and developed guidelines for clinicians in pediatric palliative care. The purpose of this paper is to share the results of this committee's work and, in particular, to present their guidelines for addressing spiritual issues in children and families in pediatric hospice and palliative care.
AIMS: To describe and evaluate a simulation based course that emphasizes the role of teamwork in the management of both crises and errors. METHODS: The course allowed participants to experience and manage simulated crises. Emphasis was placed on important error management strategies such as communication, leadership and delegation of workload. A computerized mannequin that is physiologically and pharmacologically responsive was used to run life-like crisis scenarios. The scenarios were videotaped and reviewed during a debriefing discussion after each crisis. Scenarios were alternated with tutorials that addressed error management, communication and medico-legal issues. Participants evaluated the courses using 5-point Likert scales and free comments. RESULTS: In 1999 and 2000, 172 participants (34% of New Zealand anaesthetists) attended one of these courses. Evaluation forms were received from 151 participants (88%). The global evaluations had median scores of 4 or 5 and all respondents would recommend the course to others. The responses from 50 participants indicated that the course should be repeated at least every two years. CONCLUSION: New Zealand anaesthetists found this an acceptable and useful form of training. Teamwork is an effective strategy in crisis management and error reduction and is worthy of consideration within the broader context of medical education.
Proper feeding during a baby's first year of life is crucial for a sound nutritional foundation. Because of this, there are several issues that must be addressed to ensure the child is fed properly. First, bottle-feeding moms should not be made to feel guilty about their feeding decision. It is also important to review feeding practices to avoid overfeeding and encourage positive nurturing techniques. Mothers should learn the key signals to watch for from their baby, such as sleep patterns and bowel movements. Also, it is crucial to teach parents the essential issues related to preparing bottles, such as cleaning the bottles and nipples and properly mixing the formula.
Pediatric primary care clinicians usually offer a range of in-office services designed to detect and address developmental and behavioral problems. Research suggests that selecting among these services is difficult because fewer than 30% of children with disabilities are detected by their health care providers. Undetected children fail to receive early intervention, which has substantive benefits in improving high school graduation and employment rates, and reducing teen pregnancy and criminal activities. Fortunately, many recently published tools help detect the majority of children with problems. Measures relying on information from parents are flexible, brief, and accurate. One of the briefest tools. Parents' Evaluation of Developmental Status (PEDS), also offers an evidenced-based approach that helps clinicians decide when to refer, screen, advise, or reassure families or observe children more carefully over time.
Growing bacterial resistance to antibiotics is causing grave concern in both community and hospital settings. Mismanagement has been identified as the main cause. The problem can be addressed at ground level by careful use of antibiotics, through meticulous personal and environmental hygiene and preventive infection-control measures.
Medical practice today, more than ever before, places greater demands on physicians to see more patients, provide more complex medical services and adhere to stricter regulatory rules, leaving little time for coding and billing. Yet, the need to adequately document medical records, appropriately apply billing codes and accurately charge insurers for medical services is essential to the medical practice's financial condition. Many physicians rely on office staff and billing companies to process their medical bills without ever reviewing the bills before they are submitted for payment. Some physicians may not be receiving the payment they deserve when they do not sufficiently oversee the medical practice's coding and billing patterns. This article emphasizes the importance of monitoring and auditing medical record documentation and coding application as a strategy for achieving compliance and reducing billing errors. When medical bills are submitted with missing and incorrect information, they may result in unpaid claims and loss of revenue to physicians. Addressing Medical Audits, Part I--A Strategy for Achieving Compliance--CMS, JCAHO, NCQA, published January 2002 in the Journal of the National Medical Association, stressed the importance of preparing the medical practice for audits. The article highlighted steps the medical practice can take to prepare for audits and presented examples of guidelines used by regulatory agencies to conduct both medical and financial audits. The Medicare Integrity Program was cited as an example of guidelines used by regulators to identify coding errors during an audit and deny payment to providers when improper billing occurs. For each denied claim, payments owed to the medical practice are are also denied. Health care is, no doubt, a costly endeavor for health care providers, consumers and insurers. The potential risk to physicians for improper billing may include loss of revenue, fraud investigations, financial sanction, disciplinary action and exclusion from participation in government programs. Part II of this article recommends an approach for assessing potential risk, preventing improper billing, and improving financial management of the medical practice.
Two studies addressed alternative explanations for 3 pieces of evidence supporting the existence of moral hypocrisy. In Study 1, no support was found for the idea that low salience of social standards accounts for falsifying the result of a coin flip to assign oneself a more desirable task. In Study 2, no support was found for the idea that responses of those who honestly win the flip account for the higher ratings of morality of their action by participants who assign themselves the more desirable task after flipping the coin. Also, no support was found for the idea that responses of those who honestly win the flip account for the inability of personal moral responsibility measures to predict moral action. Instead, results of both studies provided additional evidence of moral hypocrisy.
When occupational therapy (OT) and physical therapy (PT) are provided as related services in educational settings, federal law, professional guidelines, and validated practices have pointed to appropriate models of service provision. Issues such as personnel shortages, professional isolation, and questionable educational relevance of services all create barriers to use of recommended practices. The overlap between OT and PT in special education suggests one strategy to help address these barriers: a primary therapist model. In this model, an OT or PT is assigned as primary therapist, with consultation from the other discipline as required to meet student needs. Potential benefits of the model, challenges in implementation, the best practice framework needed to support the model, and the need for research on costs and benefits are discussed.