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PubMed1965

THE NATURE OF AIR POLLUTION AND THE METHODS AVAILABLE FOR MEASURING IT.

At present the principal sources of energy in Europe are coal and oil and fuels derived from them, and in European towns air pollution consists mainly of their combustion products. These combustion products naturally divide into two categories, gaseous and particulate, which are very different chemically and which behave very differently when they are near collecting surfaces; they therefore require very different techniques both for collecting and for estimating samples. Some methods of measurement, suitable for everyday routine use in Europe, are described; these offer a compromise between completeness and economy, and can help to give a general outline of the air pollution situation without undue complexity or prohibitive cost.

Air Pollutants↗
PubMed2005

Building the occupational health team: keys to successful interdisciplinary collaboration.

Teamwork among occupational health and safety professionals, management, and employees is vital to solving today's complex problems cost-effectively. No single discipline can meet all the needs of workers and the workplace. However, teamwork can be time-consuming and difficult if attention is not given to the role of the team leader, the necessary skills of team members, and the importance of a supportive environment. Bringing team members together regularly to foster positive relationships and infuse them with the philosophy of strength in diversity is essential for teams to be sustained and work to be accomplished. By working in tandem, occupational health and safety professionals can become the model team in business and industry delivering on their promise of a safe and healthy workplace for America's work force.

Cooperative Behavior↗
PubMed2005

Are employees informed about their health care coverage? Evidence from the buyers health care action group.

More than half of all Americans receive health insurance coverage through an employer. The rising costs and escalating complexity of health insurance has led many employers to embark on extensive employee education campaigns. In 2002, 1,365 randomly selected employees from 16 Buyers Health Care Action Group firms in the Minneapolis region were surveyed to evaluate their awareness of employer-provided health plan quality information and the extent to which this information influences their enrollment decisions. The study found mixed evidence with respect to the value of employer communication. On one hand, employer communication does not significantly increase the probability that an employee responded correctly to the pharmacy benefit question posed in the survey. However, employer communication has a large effect on the awareness of quality information. How well those campaigns work, and by extension how well employees are informed about the health benefits decisions they make, is a key issue in health care today.

Adolescent↗
PubMed1992

[Pharmaceutical companies as sponsors of clinical trials--advantages and limitations].

The therapeutic progress achieved in the second half of this century was made possible only due to the interest taken by the pharmaceutical industry in the research field. It can be considered as the primum movens of the therapeutic revolution which has strongly benefited the humanity in these last decades. The clinical trials of new drugs constitute an integral part of the pharmaceutical and medical research. However its complexity and the costs involved make its execution impossible without the help or sponsorship of the pharmaceutical firms. Even in the more advanced countries it would be unthinkable that clinical trials could be carried out without the assistance of the pharmaceutical industry. The sponsorship by the pharmaceutical firms turns the relationship doctor-firm into a symbiotic association as both the parties reap benefits thereof: the physician because he is able to satisfy his inquisitiveness and his interest for the clinical research and the pharmaceutical firm because through these trials it will collect the information it requires. Besides having to bear the expenses inherent to the research, the sponsoring firms equally contribute for other pursuits usually of academical character and of interest to the investigator. Therefore it is not rare that these firms assume the costs of presence of these investigators in scientific meetings or to contribute for the arrangements of such meetings or even subsidise the acquisition of the equipment for the hospital services, etc.--measures which in countries with poor investments in research sector, such as Portugal, may constitute the only possibility to be carried out.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗
PubMed2006

[Use of robotics in laparoscopic urological surgery: state of the art].

OBJECTIVE: To evaluate the current place of robotics in laparoscopic urological surgery. MATERIAL AND METHODS: A review of the international literature was conducted to evaluate the various available endoscope robot systems and telemanipulator robots and to establish their practical limitations and their contribution to surgery. RESULTS: Robotic systems are based on various structures, which each present specific disadvantages. Two types of systems can be distinguished: endoscope robots and telemanipulator robots (complete robotic systems) with different degrees of complexity, dimensions and costs. Each system is different in terms of service rendered. Endoscope robot systems (EndoAssist, AESOP, LapMan) are reliable and eliminate the need for an assistant to hold the camera. Man-machine interfaces can be manual, by pedal or by voice recognition. They are relatively large and expensive, limiting their diffusion at the present time. Complete instrument-handling robots (master-slave manipulators) are currently represented by 2 robots (Zeus and Da Vinci) which have demonstrated their efficacy in many difficult operations. Their very high cost and their large dimensions also constitute limitations to their diffusion, making them inaccessible to the majority of centres. The urological community has largely contributed to the evaluation of robots in laparoscopic operations, as reflected by the large number of publications. CONCLUSION: Considerable technological progress has been made over recent years to make laparoscopic surgery more accessible. Current robotized tools are still imperfect systems, but, in the future, may possibly facilitate difficult laparoscopic operations, particularly in urology.

Equipment Design↗
PubMed2006

[Insulin resistance in type 1 diabetic children and adolescents -- a simplified method of estimation].

BACKGROUND AND AIM OF THE STUDY: Our own studies confirm the hypothesis, that insulin resistance of various degree is often observed in children and adolescents with type 1 diabetes mellitus (T1DM). The knowledge of this parameter characterizing individual patients may be of great value not only for better understanding of the disease course but also as a potential source of specific treatment. Reliable estimation of insulin resistance with hyperinsulinemic euglycemic clamp is a complex, laborious and costly procedure. These facts were enough to motivate us to make an attempt to elaborate an indirect, simplified method of insulin resistance assessment in T1DM children, that would be based on patients characteristics and on clinical parameters of the disease course. MATERIALS AND METHODS: 142 children and adolescents with T1DM (79 boys, 63 girls) aged 7.7-20.3 years (mean age - 13.7+/-3.3 years) were included into the study. Duration of diabetes was 0.5-12.5 years (mean 2.7+/-2.3 years). The stage of puberty was assessed by the Tanner scale. Euglycemic-hyperinsulinemic clamp by de Fronzo was performed to estimate insulin resistance. Glucose disposal rate (M index) determined during the last 30 min of the test estimated insulin resistance. Looking for clinical and metabolic factors characterizing insulin resistance: a) the plasma cholesterol, HDL-Ch, triglycerides and HbA1c were examined, b) the height, weight, waist circumference and blood pressure were measured, c) body mass index and daily dose of insulin were calculated. For statistical analysis the multiple regression was used (forward stepwise method). RESULTS: In the study group M index ranged from 2.1 to 17.4 mg/kg/min (mean 7.27+/-2.62 mg/kg/min). The boys presented better insulin sensitivity than girls (7.79 vs. 6.62, p=0.008). The insulin resistance depended on the patients' age (r=-0.46, p<0.001) and stage of puberty (p<0.001). A correlation between M index and insulin dose (r=-0.34, p<0.05) and HbA1c (r=-0.17; p=0.04) were found. There was a significant relationship between M index and parameters of adiposity, lipids and blood pressure. All significant clinical parameters of insulin resistance were subjected to the analysis. Multiple linear regression analysis was performed. The model with the strongest correlation with index M was used to work out the formula: M index = 17.065 + 1.547 x (gender: boys=1, girls=0) - 0,183 x (age) - 0,117 x (Waist circumference) - 2,019 x (Daily insulin dose) - 0,016 x (LDL-CH) + 0,041 x (DBP). CONCLUSION: In T1DM children and adolescents it is possible to estimate for daily use extent of insulin resistance on the basis of clinical features.

Adolescent↗
PubMed2006

Formulary implications of management of pulmonary arterial hypertension: Part I--An overview of existing and new pharmacological treatment options.

Pulmonary arterial hypertension (PAH) represents a significant challenge to physicians, particularly because of its etiology and nonspecific presentation. Unfortunately, the majority of patients are not diagnosed until the condition is at an advanced stage. In this two-part White Paper from The Pharmacy and Therapeutics Society, prostanoids, administered as continuous intravenous or subcutaneous infusions, are the most effective treatments but are inconvenient and costly, owing to complex parenteral administration. The endothelin-receptor antagonist bosentan and the phosphodiesterase-5 inhibitor sildenafil are currently the only oral therapies licensed for PAH; however, bosentan has an identified risk of liver toxicity. Newer PAH treatments may offer benefits over existing therapies in terms of less potential for liver damage and more favorable interaction profiles.

Formularies as Topic↗
PubMedDate not supplied

[Assessment of supply and demand for hip arthroplasty in Puglia (Italy) in the years 1996-2003].

Hip arthroplasty is one of the major achievements of orthopaedic surgery. In the Puglia region the demand for this procedure is moderately met. This study evaluates the regional distribution of hip arthroplasty procedures in Puglia in the years 1996-2003. Demand and supply was estimated through analysis of discharge abstract forms. Between 1996 and 203, 21,392 hip arthroplasty procedures were performed. of these, 12,491 (58,4%) were total hip arthroplasties, 7,742 (36,2%) were hip endoprostheses and 1,159 (5,4%) wee revisions. The median age of patients undergoing any of these procedures was 70 years and the proportion of females was almost double that of males (64%). The main indication was primary osteoarthrosis and 52,1% of all procedures were performed in the province of Bari. The average annual crude hospitalisation rate for hip arthroplasty procedures was 75,9 cases/100.000 inhabitants; this rate places the Puglia region in an intermediate position with respect to other Italian regions and is lower than that found in the literature. Discharge abstract forms are currently the sole source of data regarding hip arthroplasty procedures and this presents several limits. This factor, in addition to the complexity and high costs of these procedures and to the increasing average life expectancy of the general population all point to the need for a regional Hip arthroplasty Register, which would allow better planning for patients.

Adolescent↗
PubMed1991

Reference values in the nineties: from theory to practice?

Following a brief summary of the published documents on the theory of reference values, the reasons for the still limited practical implementation of the theory itself in clinical laboratories are discussed. It is suggested that cooperative efforts could overcome the difficulties in obtaining an adequate reference sample group, provided that some basic requirements are strictly fulfilled, such as the stability and the homogeneity of the analytical quality and of the reference population. Banks of biological materials will further reduce the complexity and the cost of production of reference values.

Chemistry, Clinical↗
PubMedDate not supplied

[Comparison of duplex systems and simple Doppler equipment in obstetric diagnosis].

Duplex systems are normally used in obstretric Doppler sonography. The fact that these systems are technically complex and very costly to some extent contradicts the use of Doppler sonography as a screening method. This study examines whether simplex Doppler systems without tomographic imaging and not involving costly technology, such as frequency analysis, are as suitable for Doppler examination in pregnancy as the costly duplex systems. Examinations of 83 patients between GW 32 and 42 showed that both the umbilical and uterine arteries can be reliably identified using the simplex Doppler unit. A comparison of Doppler curves obtained with duplex and simplex Doppler systems showed that the two devices produced the same results. The Doppler curves were compared both as regards their geometry, according to the score described by Fendel et al. (1988), as well as on the basis of calculated parameters. The scores were correlated to delivery mode and birth weight. However, the fetal aorta cannot be reliably located with the simplex Doppler unit unless it has been tomographically imaged beforehand. Doppler examination of the umbilical and uterine arteries provides the best information for selection of high-risk pregnancies. It therefore appears sufficient to screen patients with the simplex Doppler described here and to perform more detailed diagnostic investigations with a duplex systems in the event of pathologic findings.

Blood Flow Velocity↗
PubMedDate not supplied

Cell-mediated immunity in healthy and uremic adults assessed by in vivo and in vitro techniques. Validation of delayed hypersensitivity skin testing.

Cell-mediated immunocompetence was assessed in 16 healthy and 10 uremic subjects by "in vivo" and "in vitro" techniques, simultaneously. PHA-induced lymphocyte transformation, Multitest and classical skin testing with a panel of 7 antigens have been used. Similar cutaneous delayed-type hypersensitivity (DTH) results were obtained when using either Multitest or the classical panel, both in healthy subjects (R = 0.66) and in uremic patients (R = 0.61). The results were the same for both the total scores and the number of positive responses per subject. The two DTH methods were of similar accuracy in the evaluation of normal DTH responses and hypoergy in both populations but the sensitivity in detecting anergy among the uremics was higher for the classical panel (80%) than for Multitest (60%). However, no method proved to be more prone to classify a healthy subject as anergic. Anergy was more frequent among uremic patients both with Multitest (60%) and the conventional panel (80%) but was unusual among healthy controls (6.3% and 7.1%, respectively) (p less than 0.0001 for both). Depressed DTH reactivity in uremia was correlated with longer blood transfusion-free intervals (p less than 0.05) and influenced by the duration of haemodyalisis and the number of blood transfusions. Similar CMI impairment rates were found in uremic patients with Multitest (76.9%), the classical panel (63.8%) and "in vitro" techniques (63.7%). Therefore, cutaneous DTH testing proved to be a useful mean of evaluating CMI. Moreover, the high cost and technical complexity of "in vitro" techniques are major drawbacks against their use and strenghthen the role of DTH skin testing as a useful clinical tool to measure CMI.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Episode-of-care physician payment: a study of coronary artery bypass graft surgery.

Paying physicians for an episode of care is a possible alternative to current fee-for-service payment. We studied physician billing patterns for 512 Medicare beneficiaries who received coronary artery bypass graft (CABG) surgery in 1983. Relatively elaborate decision rules had to be created to exclude services that were not part of a routine CABG. We found that 72% of charges for an episode were associated with services provided on the day of surgery. Forty-seven percent of charges were by the primary surgeon, 15% by the assistant surgeon(s), and 9% by the anesthesiologist. Our results suggest that episode-of-care payment is a complex, and somewhat costly, alternative to other methods of prospective payment to physicians, although selective contracting by a health insurer for an episode of care for certain procedures might both reduce costs and improve quality.

California↗
PubMedDate not supplied

[[Evaluation of various methods of studying fecal occult blood].

Occult blood testing for detection of asymptomatic colorectal cancer is an old concept. The authors review the literature about the screening value of current tests. Among the chemical tests, Hemoccult is the most popular and the best studied. Sensitivity and specificity are moderate. False negative reactions are due either to the test itself (high level of sensitivity, loss of reactivity) or to the tumour (intermittent or insufficient bleeding, localization etc...). False positive reactions are due to the interference of a high peroxidase diet. The Hemoccult test is nevertheless interesting because it is simple, cheap and well accepted. Detected cancers tend to be at a relatively early stage: 60 to 80% of Dukes A or B. New methods--Hemoquant and immunochemical methods--are being developed. Their high degree of sensitivity and specificity for human hemoglobin makes them too complex and too costly. Whatever the efficacity of a test to detect occult blood may be, we must know whether the screening of an asymptomatic population could decrease the mortality rate of colorectal cancer, before using it on a large scale. Only long-term controlled trials can give us an answer in the future.

Colorectal Neoplasms↗
PubMed1988

[Psychiatric diagnostic classification in transcultural epidemiologic studies].

The utility of transcultural psychiatric epidemiology research is discussed as well as the methodological difficulties inherent in this type of investigation. The comparison across different cultures of the prevalence and incidence of mental illness in population studies can be used to obtain a better understanding of the risk and etiological factors involved in the development of specific psychiatric disorders. Nevertheless, most population studies have been carried out in developing countries mostly due to the complexity and high cost of these studies. As a consequence, a gap in psychiatric knowledge is created between the developed and developing countries resulting in the false notion that many of the psychiatric disorders observed in developed countries are universal to all human beings. The cross-cultural validity of certain psychiatric disorders based on the American Psychiatric Nosology (DSM III) are discussed. The article discusses the methodological difficulties which arise from the need of maintaining methods and criteria uniform in cross-cultural studies in order to allow comparisons, as well as the need of incorporating into the methodology the cultural differences existent in the manifestation or definition of the specific psychiatric disorders studied. Various possible methodologies are discussed which address this dilemma, such as the combination of empirical and ethnographic approaches and the cross-cultural comparison of empirically defined syndromes.

Anthropology, Cultural↗
PubMed1983

Government revamp of the health care system: effect on patient care and research.

Since the end of World War II, the United States has been in a golden age of medicine. Unprecedented advances in biomedical research have resulted in a fundamental understanding of many disease processes; pharmaceutical research and development has produced a host of new therapeutic agents; and new technology has opened new vistas in the areas of diagnosis and therapeutics. This new knowledge has been translated into the health care delivery system. The federal government made the crucial decision that new hospital construction and increased bed capacity were needed to upgrade medical care in the modern, high-technology era. Another crucial decision made by the government was that health care was a fundamental right of all its citizens, and access to the health care system for the elderly, poor, and middle class had to be assured. This decision was culminated by the enactment of the entitlement programs of Medicare and Medicaid in 1965. These policies helped to decrease the mortality rate of our population by 1.5 percent per year. Our elderly citizens are healthier as a group and living longer. During the past decade strains on the economy secondary to the inflationary spiral produced by the Arab Oil Embargo and the huge budget deficits of the Reagan Administration have led to broad-based efforts to decrease spending on health care. A complex system of cost limits has been initiated, including a prospective reimbursement system for Medicare and Medicaid based on diagnostic-related groups. This system will force hospitals to shift from direct medical care to ambulatory, lower-cost services, making it costlier and more difficult for individuals, particularly the poor, elderly, and middle class, to have access to the health care system.

Cost Control↗
PubMed1981

Four methods for determining albumin in azotemic sera evaluated.

The methods most commonly used for determination of albumin in serum depend on its binding of dyes. The binding of many drugs as well as of several dyes is impaired in azotemic sera from patients with renal failure. We therefore evaluated four methods used to measure albumin concentration in sera of patients with various degrees of renal failure, comparing results with those by the most specific method, radial immunodiffusion. The automated bromcresol green, manual immediate bromcresol green, cellulose acetate electrophoresis, 2-(4'-hydroxyazobenzene)benzoic acid binding, and Na2SO3 precipitation/biuret methods were evaluated. The correlations with results of radial immunodiffusion for azotemic sera differed from method to method but were approximately the same for each method, as in previous published reports for samples from a heterogeneous population of patients. The ratios of serum albumin concentration by these methods to albumin concentration as measured by radial immunodiffusion ranged from 0.96 to 1.13 for 29 to 41 normal and azotemic sera, but none of the ratios showed any variation beyond random scatter over a range of serum creatinine from 6.0 to 180 mg/L. Thus the choice of method to apply to azotemic sera will depend on the relative importance of accuracy, speed, cost, and technical complexity.

Autoanalysis↗
PubMedDate not supplied

[Simplified methods for the isolation and preservation of axenic Lamblia cultures].

The complexity and high cost of the existing methods of obtaining and preserving axenic cultures of Giardia (Meyer, 1970) have motivated the authors to look for new ways and means of simplifying the procedure. Solid media gave fair results which substantially simplified and accelerated the process and proved to be favourable for preserving the cultures longer without repassaging. Accordingly, the method recommended by the above authors facilitates the elimination of yeast from the cultures of Giardia in 15 to 24 days and the preservation of the axenic cultures over a period of 4 to 6 months without passaging, and within first two months at least the cultivation of new populations is guaranteed.

Animals↗
PubMed1981

Laboratory costs and utilization: a framework for analysis and policy design.

A conceptual framework is outlined as the basis for analysis and evaluation of laboratory test-ordering patterns. This framework highlights the input, process, and output phases of the laboratory inquiry system. Data are presented from a contemporary Canadian study to show that the cost of laboratory testing is escalating and represents a sizable proportion of hospital costs. Practical policy interventions intent on reducing the costs in this complex system will require thorough analysis within a conceptual framework such as is outlined here and will require ultimately sophisticated control programs at various levels in the laboratory inquiry system.

Clinical Laboratory Techniques↗