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At least 757 records · Page 42Linked to original sources
PubMed1992

Transurethral incision of the prostate: a viable alternative to transurethral resection.

TUIP has been shown to be an effective method of relieving urinary outflow obstruction caused by BPH when prostatic size is 30 g or less. This is the situation for approximately 80% of patients undergoing TURP today. The long-term results of TUIP are quite favorable when compared with those of TURP. It is an easier technique to master than TURP. In addition, TUIP has a reduced operative time, little intraoperative and postoperative hemorrhage, reduced incidence of dilutional hyponatremia (TUR syndrome), and decreased length of hospitalization. TUIP also offers a lower risk of complications, especially with regard to impotence and retrograde ejaculation. This makes TUIP particularly well suited for patients in whom maintenance of sexual function is an important consideration. TUIP is also indicated in chronically ill, debilitated patients in whom the risk of anesthesia-related complications is high. Orandi and Graversen et al have shown that TUIP can be satisfactorily performed using only local anesthesia in high risk patients. However, TUIP is not without disadvantages. It is not effective for patients with a prominent median lobe or those with a markedly enlarged prostate gland (greater than 30 g). Another disadvantage is that no tissue is obtained for pathological analysis. Thus, all patients undergoing TUIP should be evaluated preoperatively with both a serum prostate-specific antigen determination and a meticulous digital rectal examination. As cost containment becomes a key factor for our health care system, it is quite likely that TUIP, as well as other less invasive procedures, will have expanded indications. Although the role of TURP in the management of very large prostates causing bladder outlet obstruction is not in question, smaller glands might be better managed with such a treatment as TUIP. As indicated earlier in this report, 80% of patients undergoing TURP could be effectively treated with TUIP--a less invasive, more cost effective treatment that has fewer associated side effects than TURP. Without question, TUIP is a grossly underutilized procedure in 1992. However, its future appears bright as more urologic surgeons are becoming aware of its many advantages and excellent long-term results.

Clinical Trials as Topic↗
PubMed1993

[Economic and structural aspects of modern medical technology].

Medical techniques are one of the few innovative factors that can improve the efficiency and economics of the health services. However, as illustrated for the example of Germany, the outlay and subsequent costs for expensive technical appliances in medicine account for only 1% of the total expenditure for health. But they provide the potential for improved quality and lower costs for the health service and the economy in general. The availability of modern medical technology is indispensable for research, health care, education, and training in medicine. Further innovative aspects arise. The digital images obtained by various methods (Fig. 13) can be collected by image archiving and communication systems (20), mutually related, and indexed for morphological and functional information, thus opening improved strategies for therapy. Major challenges are awaiting all of us.

Germany↗
PubMed1998

[Prostatic cancer in the Grand Duchy of Luxembourg. Role of PSA].

We reviewed the trends in prostate cancer incidence and mortality in Luxembourg between 1983 and 1995 to discuss the importance of total and free PSA in early detection. The study was performed on all the new cases recorded by the National Cancer Registry (Registre Morphologique des Tumeurs). Total and free PSA were measured with the automated Immulite System (DPC, Los Angeles) using a chemoluminescent immunometric assay. The performance of free-to-total serum PSA was analysed by a hospital based study of 113 patients (55 PC, 58 BPH). The age standardized incidence rate increased from 29.3/100,000 in 1983 to 71.5/100,000 in 1995. Mortality rates only changed slightly. The widespread use of PSA testing from 1988 on is probably the main cause of this incidental increase; however no major changes in the age-specific-incidence have been found suggesting the absence of a systematic screening policy by the PSA. The superiority of free-to-total serum PSA ratio in discriminating between cancer and benign condition was confirmed. Early health-conscious man over 50 should be proposed prostate cancer screening by digital rectal examination and PSA. However a systematic screening policy cannot been recommended since a benefit in survival after early treatment has not yet been proven.

Adult↗
PubMed1995

Smart practice: smart card design considerations in health care.

Recent innovations in microelectronics and advances in cryptography are driving the appearance of a new generation of smart cards with wider applications; this has important repercussions for our society in the coming years. Essentially, these breakthroughs include built-in microprocessors capable of generating cryptographic transactions (e.g.,Jelectronic blinded signatures, digital pseudonyms, and digital credentials), developments toward a single electronic card offering multi-access to services such as transport, telecommunications, health, financial, and entertainment (Universal Access Services), and incorporation of personal identification technologies such as voice, eye, or skin pattern recognition. For example, by using electronic representatives or cryptographic blinded signatures, a smart card can be used for multi transactions across different organizations and under different generated pseudonyms. These pseudonyms are capable of recognizing an individual unambiguously, while none of her records can be linked [1]. Moreover, tamper-proof electronic observers would make smart cards a very attractive technology for high-security based applications, such as those in the health care field. New trends in smart card technology offer excellent privacy and confidentiality safeguards. Therefore, smart cards constitute a promising technology for the health sector in Australia and other countries around the world in their pursuit of technology to support the delivery of quality care services. This paper addresses the main issues and the key design criteria which may be of strategic importance to the success of future smart card technology in the health care sector.

Computer Security↗
PubMed1996

RETAIN--an ATM pilot project for applications in health care.

The availability of ATM-based broadband wide-area networks facilitates a range of new applications in health care, especially the performance of videoconferences combined with software for computer-supported cooperative discussion and diagnosis of digital medical images. This report about a research project for applications of the 'European ATM pilot network' in radiology describes the technical, economic and structural framework for the application of broadband technology in health care.

Computer Communication Networks↗
PubMed1998

Managing behavioral health care: an employer's perspective.

Employee life cycle events and behavioral health disorders impact productivity and well-being. Employers use wellness initiatives and employee assistance or work-family programs to help manage those factors that can distract employees from performing optimally. Employer-sponsored health benefits are designed to protect employees from the catastrophic costs of illness. However, today's plan designers struggle with employee and employer affordability that does not compromise quality or effectiveness. In 1990, Digital Equipment Corporation, Maynard, Mass., shifted its strategy from an indemnity model to a managed care model that uses health maintenance organizations. Comprehensive standards are used to ensure the delivery of quality behavioral health care that is cost effective, is delivered at the clinically appropriate levels, and uses a broad continuum of treatment approaches with measurable outcomes.

Cost of Illness↗
PubMedDate not supplied

The North American Menopause Society 1998 menopause survey: Part II. Counseling about hormone replacement therapy: association with socioeconomic status and access to medical care.

OBJECTIVE: The purpose of this study was to examine two predictors of women's obtaining hormone replacement therapy (HRT) counseling: socioeconomic status and access to health care. DESIGN: During May-July 1998, by means of random-digit telephone dialing, 749 postmenopausal women who were living in the United States and aged 50-65 years were interviewed. On average, they were 56.8 years and 11.8 years postmenopausal. Most (86.0%) were Caucasian, and their median annual income was approximately $40,000. Nearly all (90.8%) had medical insurance coverage; 47.6% of those insured received care from a managed care organization. Access to medical care was evidenced by 92.3% being under the care of a primary care physician, 92.3% ever having had a mammogram, 96.9% ever having had a pelvic examination, and 91.1% ever having had a serum cholesterol determination. RESULTS: Of these 749 women, 75.4% reported that they had received counseling about post-menopausal HRT from healthcare providers. Both level of education and level of income were associated with an increased likelihood that HRT counseling would be obtained. Having a personal physician, and particularly receiving care from a gynecologist, increased the likelihood that counseling would be available. There were no substantial differences in counseling frequency between women in managed care plans and those having other types of health insurance. In a multivariate model, adjusted odds ratios for receiving HRT counseling were 2.9 (95% confidence interval [CI] = 1.7-4.8) for having an annual income of $50,000 or more versus less than $30,000, 2.8 (95% CI = 1.7-4.5) for receiving care from a gynecologist versus other primary care physician, 1.9 (95% CI = 1.1-3.2) for being Caucasian versus not, and 1.5 (95% CI 1.0-2.2) for having a hysterectomy versus not. CONCLUSIONS: Three quarters of a sample of US postmenopausal women aged 50-65 years reported that they had been counseled about HRT. However, women of lowest socioeconomic status and those who did not have a primary care physician were least likely to have received counseling. No differences were observed in prevalence of counseling between women in managed care settings and those with other types of health insurance. The findings suggest that special efforts are necessary to provide menopause education and counseling to underserved women.

Counseling↗
PubMed1998

Physical abuse among depressed women.

OBJECTIVE: To provide estimates of physical abuse and use of health services among depressed women in order to inform efforts to increase detection and treatment of physical abuse. DESIGN: Retrospective assessment of abuse and health services use over 1 year in a cohort of depressed women. SETTING: Statewide community sample from Arkansas. PARTICIPANTS: We recruited 303 depressed women through random-digit-dial screening. MEASUREMENTS AND MAIN RESULTS: Exposure to physical abuse based on the Conflict Tactics Scale, multi-informant estimate of health and mental health services. Over half of the depressed women (55.2%) reported experiencing physical abuse as adults, with 14.5% reporting abuse during the study year. Women abused as adults had significantly more severe depressive symptoms, more psychiatric comorbidity, and more physical illnesses than nonabused women. After controlling for sociodemographic and severity-of-illness factors, recently abused, depressed women were much less likely to receive outpatient care for mental health problems as compared to other depressed women (odds ratio [OR] 0.3; p = .013), though they were more likely to receive health care for physical problems (OR 5.7, p = .021). CONCLUSIONS: Because nearly all depressed women experiencing abuse sought general medical rather than mental health care during the year of the study, primary care screening for physical abuse appears to be a critical link to professional help for abused, depressed women. Research is needed to inform primary care guidelines about methods for detecting abuse in depressed women.

Adolescent↗
PubMedDate not supplied

The use of digital images in evaluating homecare nurses' knowledge of wound assessment.

PURPOSE: The purpose of this study was to evaluate homecare nurses' knowledge of wound assessment using digital images and case studies. DESIGN: A descriptive design was used. SUBJECTS AND SETTING: Subjects were a convenience sample of 33 registered nurses from a Washington, DC, metropolitan-based home health agency. METHODS: Participants were asked to complete a demographic data sheet and a wound assessment checklist, while viewing projected digital images of 10 different wounds. A case study accompanied each image and provided wound assessment data that could not be visualized. Frequencies were calculated to determine the percentage of homecare nurses who were accurate in their assessment. RESULTS: The most common error in staging was a lack of recognition of wounds that were not stageable. The majority of the homecare nurses were able to accurately identify wound bed and periwound characteristics; the greatest variability was found in the ratings for wound bed color. CONCLUSIONS: Despite the difficulty of interpreting digital images of wounds, the study findings support the value of using them to evaluate nurses' knowledge of the visual aspects of wound assessment as a basis for educational programs.

Adult↗
PubMed2004

Underutilization of digital rectal examination when screening for prostate cancer.

BACKGROUND: Screening for prostate cancer is controversial. American Cancer Society and American Urology Association recommend screening with both digital rectal examination (DRE) and prostate-specific antigen (PSA) testing. Often, PSA testing is not combined with DRE when screening for prostate cancer. METHODS: We collected a list of veteran outpatients who had PSA testing performed between June 1, 1998, and September 30, 1998, from our computerized database. We reviewed their records for documentation of age, race, urinary symptoms, family history of prostate cancer, DRE, and professional training and sex of the health care provider. RESULTS: Of the 588 records reviewed, DRE was not performed in 311 patients (52.9%). Digital rectal examination was not performed in 276 (53.2%) of 519 patients who had a PSA level less than 4.0 ng/mL; in 202 (58.7%) of 344 patients by male providers and in 109 (44.9%) of 243 patients by female providers (P<.001); and in 231 (61.1%) of 378 patients by doctors of medicine (MDs), 24 (40%) of 60 patients by physician assistants (PAs), and in 56 (37.3%) of 150 patients by nurse practitioners (NPs) (MDs vs PAs, P<.001; MDs vs NPs, P<.001; and NPs vs PAs, P =.42). CONCLUSIONS: Digital rectal examination is underutilized when screening for prostate cancer. This leads to nondetection of some prostate cancers. Although the DRE rate was poor among all health care providers, female providers and physician extenders outperformed male providers and physicians, respectively.

Adult↗
PubMedDate not supplied

Questionnaire survey of California consumers' use and rating of sources of health care information including the Internet.

OBJECTIVE: To understand how Californians use and rate various health information sources, including the Internet. RESEARCH DESIGN: Computer-assisted telephone interviews through which surveys were conducted in English or Spanish. SUBJECTS: A household sample generated by random digit dialing. The sample included 1007 adults (18+), 407 (40%) of whom had access to the Internet. MAIN OUTCOME MEASURES: Past health information sources used, their usefulness and ease of use; future health information sources, which are trusted and distrusted; and concerns about integrating the Internet into future health information seeking and health care behaviors. RESULTS: Physicians and health care providers are more trusted for information than any other source, including the Internet. Among those with Internet access, a minority use it to obtain health information, and a minority is "very likely" to use e-mail to communicate with medical professionals or their own doctors and nurses, to refill prescriptions, or to make doctor appointments. Also, most of those with Internet access are "unlikely" to make their medical records available via the Internet, even if securely protected. CONCLUSIONS: The public, including frequent Internet users, has major concerns about the confidentiality of electronic medical records. Legislation may not assuage these fears and a long-term, open and collaborative process involving consumers and organizations from all the health care sectors may be needed for full public assurance.

Adolescent↗
PubMed1998

Income distribution, socioeconomic status, and self rated health in the United States: multilevel analysis.

OBJECTIVE: To determine the effect of inequalities in income within a state on self rated health status while controlling for individual characteristics such as socioeconomic status. DESIGN: Cross sectional multilevel study. Data were collected on income distribution in each of the 50 states in the United States. The Gini coefficient was used to measure statewide inequalities in income. Random probability samples of individuals in each state were collected by the 1993 and 1994 behavioural risk factor surveillance system, a random digit telephone survey. The survey collects information on an individual's income, education, self rated health and other health risk factors. SETTING: All 50 states. SUBJECTS: Civilian, non-institutionalised (that is, non-incarcerated and non-hospitalised) US residents aged 18 years or older. MAIN OUTCOME MEASURE: Self rated health status. RESULTS: When personal characteristics and household income were controlled for, individuals living in states with the greatest inequalities in income were 30% more likely to report their health as fair or poor than individuals living in states with the smallest inequalities in income. CONCLUSIONS: Inequality in the distribution of income was associated with an adverse impact on health independent of the effect of household income.

Adolescent↗
PubMedDate not supplied

Family practice residents' compliance with preventive medicine recommendations.

We conducted a medical records survey of 270 randomly selected patients 20 years of age or older seen by family practice residents in a university-based training program. This study concerned residents' compliance with certain preventive recommendations made by four expert groups: the American Cancer Society, the Canadian Task Force on the Periodic Health Examination, the Immunization Practices Advisory Committee, and the National Institutes of Health Consensus Development Conference on treating elevated cholesterol. The interventions studied were breast examination, mammography, pelvic examination, Pap testing, digital rectal examination, stool guaiac slide testing, serum cholesterol screening, and pneumococcal and influenza vaccinations. We calculated the percentage of eligible patients receiving each of these interventions. The highest rates of resident compliance with health screening recommendations were for Pap testing in women 20-34 and 35-59 years of age (31.7% and 22.6%, respectively), breast examination in women 20-39 years of age (27.3%), and influenza vaccination (23.0%). There were no other rates of compliance that exceeded 20%. Our data thus indicate that residents in this program did not comply well with health maintenance recommendations.

Adult↗
PubMed2001

Subnational sources of toxicology information: state, territorial, tribal, county, municipal, and community resources online.

The rapid assimilation data and information on the Internet and the World Wide Web (WWW) is reflected in the development of these electronic services by state, county, local, and other subnational agencies, departments, offices, bureaus, and intergovernmental bodies. The content of state and territorial, tribal, county, and local government Web pages varies considerably. However, information about health and the environment are among the most frequently posted resources by subnational government bodies. This article describes the environmental health and toxicology-related data and information resources provided by government agencies and representative associations for subnational government bodies. Standard reference sources for identifying subnational government bodies are described with particular reference to those in electronic and digital formats. Means for identifying and locating electronic resources are described for appropriate subnational environmental quality, environmental (public) health agencies, occupational health and safety, toxicology-related agencies and departments, emergency response, fish consumption advisories, and cancer registries are provided. Professional organizations of state, county, municipal (local) governments and intergovernmental bodies are also described.

Environmental Health↗
PubMed2003

Hearing aid users benefit from induction loop when using digital cellular phones.

OBJECTIVE: Hearing aid users have recently been reported to experience problems with electromagnetic interference when using digital cellular phones. This study was undertaken to investigate the possible benefit of an induction loop system developed for use with some cellular phone models, and also to compare the possible benefit in two languages (Finnish and American English) as well as the benefit with two hearing aid technologies (analog versus digital). DESIGN: The study was performed in controlled laboratory conditions at two tertiary care hearing health care centers, one in Oulu, Finland and the other in Dallas, in the United States. The subjects were experienced users of behind-the-ear hearing aids and served as their own controls in three different listening conditions. Thirty-two eligible subjects (20 in Oulu and 12 in Dallas) participated in three test conditions: 1. call with a landline phone, 2. call with a digital cellular phone alone and 3. call with a digital cellular phone coupled to an induction loop. RESULTS: Sentence recognition scores and subjective judgments using a visual analog scale revealed the poorest results with the digital cellular phone alone. When the induction loop was used with the digital cellular phones, sentence recognition scores and the visual analog scale scores were comparable to the scores obtained with a landline phone. The mean sentence recognition score for analog hearing aids was 62.4% (95% confidence interval 50.2 to 74.6) with the landline phone, 12.6% (-1.6 to 26.9) with the digital cellular phone alone, and 63.3% (44.2 to 82.3) when using the digital cellular phone with the induction loop. For digital hearing aids, the sentence recognition scores were 62.4% (51.9 to 72.9), 37.4% (18.0 to 56.8) and 57.6% (39.0 to 76.2), respectively. There was no significant difference in performance between the two centers. However, when using the digital cellular phone alone, there was no drop in the sentence recognition scores with the few (N = 5) digital hearing aids in Dallas. The subjects ranked the digital cellular phone alone as the poorest test condition and the digital cellular phone with an induction loop as the best. CONCLUSIONS: Induction loops appear to offer one possible solution for the incompatibility problem between hearing aids and digital cellular phones. However, the generalizability of the results must be viewed cautiously, because testing included only one induction loop and two digital cellular phone models.

Adult↗
PubMed2000

Depressive symptoms in rural West Virginia: labor market and health services correlates.

The prevalence and socioeconomic correlates of depressive symptoms in rural West Virginia were assessed. A random-digit-dialed telephone interview was administered to a community-dwelling sample of adults, ages 18 to 64, residing in the 40 rural counties of the Appalachian State of West Virginia. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Overall rates of depressive symptoms were substantially higher than in the nation as a whole. Gender differences were lower than expected due to a high rate of depressive symptoms among men. Depressive symptoms were inversely associated with higher socioeconomic position. One-third of those who described themselves in "good mental health" reported depressive symptoms. About half who reported depressive symptoms had never seen a mental health professional or a physician for mental health problems. Efforts to increase awareness and access to mental health services are needed to promote the mental health of rural West Virginian populations.

Adult↗
PubMed1998

The Information Commons: a model for (physical) digital resource centers.

Since its planning, construction, and opening in 1996, the Information Commons, located in The University of Iowa's Hardin Library for the Health Sciences, has served as a common ground for self-directed learning, information research, hands-on class sessions, and multimedia development. Initiatives launched from the Information Commons not only have helped increase the visibility of Hardin Library as an environment well equipped to support traditional research and education needs, but have promoted the library as a campus leader and viable partner in planning and delivering digital technologies effectively. Ongoing initiatives have focused on better integrating the library's services and resources with the curricula and research needs of the university's health sciences units. This paper describes the facility, its programmatic elements, and its impact on education, communication, and technology trends in an academic health sciences setting. Particular attention is paid to initiatives launched during the first two years of operation. This paper also discusses plans for expansion of the facility.

Budgets↗
PubMed2005

A laboratory comparison of three imaging systems for image quality and radiation exposure characteristics.

AIM: To measure and compare the relationships between image quality and X-ray exposure for three types of intraoral imaging system (conventional film, phosphor plate system and CCD-based system). METHODOLOGY: Kodak 'Insight' F-speed film, Digora FMX (phosphor plate system) and Visualix USB (CCD system) were used to produce series of radiographic images of two tooth-bearing jaw specimens (maxillary molar and mandibular molar regions) at a range of X-ray exposures from 10 ms to 2000 ms (all at 6 mA and 60 kV). Digital images were viewed from a computer monitor and films viewed on a conventional light box. Five observers scored each image using a five-point subjective image quality scale (0-4). RESULTS: Optimum image quality (4) was seen for conventional film. Neither digital system achieved this score at any exposure, achieving in both cases a maximum mean score of 3.1 (adequate visualization). The two digital systems, however, provided adequate visualization at substantially lower exposure times. Dose reduction over conventional film for maximum quality images with Visualix USB was 20%, but for Digora FMX it was 70%. All three systems gave acceptable (quality score of two or higher) images over a broad range of exposures. CONCLUSIONS: In terms of subjective image quality, F-speed film performed better than the two digital systems, but this must be weighed against the ability of the two digital systems to give adequate image quality at lower radiation doses.

Humans↗