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PubMed1977

Vascular access in a University transplant and dialysis program. Results, costs, and manpower implications.

Vascular access has become the most common operation performed at North Carolina Memorial Hospital, Chapel Hill. Three hundred vascular access procedures performed between 1971 and 1975 were reviewed as to results, costs, and manpower commitment. Subcutaneous radial arterial venous fistula was the procedure of choice, with a 67% two-year patency and the lowest incidence of complications. An average of 1.7 operations per patient was necessary to maintain access. Patients used an average of 19 hospital days per year of dialysis for vascular access and an average of 35 hospital days per year of dialysis for all medical problems. Cost of hospitalization averaged $6,818 per patient per year of dialysis, and for vascular access alone averaged $3,452 per patient per year of dialysis. To create and maintain vascular access, 1,000 hours of operating room time were required, at an expense of $200,000. Vascular access in support of patients undergoing chronic hemodialysis requires a massive commitment of dollars, time, and personnel.

Animals↗
PubMed1999

S.T.E.P.S.: a comprehensive program for controlling and monitoring access to thalidomide.

In July 1998, the US Food and Drug Administration approved the marketing of thalidomide for the treatment of cutaneous manifestations of erythema nodosum leprosum. To ensure that fetal exposure to this teratogenic agent does not occur, the manufacturer has instituted a comprehensive program to control prescribing, dispensing, and use of the drug. This program, known as the System for Thalidomide Education and Prescribing Safety (S.T.E.P.S. [Celgene Corporation, Warren, New Jersey]), is based in part on experience gained with other drugs--specifically isotretinoin and clozapine--that offer important clinical benefits but carry the potential for serious harm. To achieve its goal of the lowest possible incidence of drug-associated teratogenicity, the S.T.E.P.S. program uses a three-pronged approach: (1) controlling access to the drug; (2) educating prescribers, pharmacists, and patients; and (3) monitoring compliance. Clinicians who wish to prescribe thalidomide must be registered in the S.T.E.P.S. Prescriber Registry and agree to prescribe the drug in accordance with S.T.E.P.S. patient eligibility criteria and monitoring procedures. Pharmacies must also register and agree to comply with patient identification and monitoring criteria. Finally, patients receive visual aids, including a videotape, written material, and verbal counseling about the benefits and risks of thalidomide therapy, the importance of not becoming pregnant during therapy, and the types of contraception required (including emergency contraception) and their availability. Women of childbearing potential must agree to undergo pregnancy testing before starting therapy and on a regular schedule during therapy. All patients must agree to complete a confidential survey about their compliance with contraception, testing, and drug therapy. The manufacturer is monitoring survey results and outcome data and is prepared to make whatever modifications to the S.T.E.P.S. program are necessary to ensure its effectiveness. In addition to minimizing the potential risk for fetal harm associated with thalidomide therapy, the S.T.E.P.S. program may provide a model for future cases in which a drug offers compelling benefits but poses profound risks unless its distribution is carefully controlled.

Dermatologic Agents↗
PubMed1998

The Australian health system: continuity and change.

The health of Australians, with the exception of Aboriginals and Torres Strait Islanders, compares favourably with other industrialised nations. Since 1984, universal access for citizens to medical and public hospital services has been achieved under a national Health Insurance Scheme called Medicare, partially funded by a 1.4 percent levy on all taxpayers. Medicare found early widespread support from the electorate but continues to be buffeted by a minority coalition of some medical associations, private health insurers, and conservative "libertarian" politicians. Over the decade since its inception, Medicare has provided stability in maintaining total health costs around 8 percent of GDP. This has been largely due to capping hospital costs via Commonwealth-State agreements. Medicare has failed in the past five years to contain medical costs which have increased proportionally with increases in the medical workforce. This article examines the structure and performance of Medicare and its role within Australia's overall health system. Benefits of a universal access insurance program are outlined together with challenges associated with inequities in health status, geography, aging of the population, burgeoning technology, ideological diversity, and an economic climate requiring cost containment and favouring privatisation and the role of the market. It can be concluded that, despite these challenges, universal access to health care is here to stay. Australia's Medicare program has become popular with the electorate.

Australia↗
PubMed1997

The cervical cancer screening program in Mexico: problems with access and coverage.

A cross-sectional study was carried out in two geographic regions of Mexico - Oaxaca (rural area) and Mexico City (urban area) - to determine the main factors for predicting participation in Cervical Cytology Screening Programs (CCSP), in populations with high mortality due to cervical cancer. We included 4,208 women aged between 15 and 49 years, randomly selected through a national household-sample frame. Knowledge of what the Pap test is used for strongly predisposes use of CCSP in Mexico City (odds ratio [OR] = 46.1, 95 percent confidence interval [CI] = 33.1-64.1) and Oaxaca state (OR = 61.5, CI = 42.0-89.9), as well as high socioeconomic level (Mexico: OR = 2.0, CI = 1.1-7.6; Oaxaca: OR = 4.1, CI = 3.1-5.3), high education level (Mexico: OR = 3.6, CI = 1.5-8.8; Oaxaca: OR = 5.3, CI = 2.8-10.0), and access to social security (Mexico: OR = 1.7, CI = 1.4-2.2; Oaxaca: OR = 2.2, CI = 1.8-2.7). Low coverage of the CCSP is confirmed as an important problem in Mexico.

Adolescent↗
PubMed2001

Migration of legacy mumps applications to relational database servers.

An extended implementation of the Mumps language is described that facilitates vendor neutral migration of legacy Mumps applications to SQL-based relational database servers. Implemented as a compiler, this system translates Mumps programs to operating system independent, standard C code for subsequent compilation to fully stand-alone, binary executables. Added built-in functions and support modules extend the native hierarchical Mumps database with access to industry standard, networked, relational database management servers (RDBMS) thus freeing Mumps applications from dependence upon vendor specific, proprietary, unstandardized database models. Unlike Mumps systems that have added captive, proprietary RDMBS access, the programs generated by this development environment can be used with any RDBMS system that supports common network access protocols. Additional features include a built-in web server interface and the ability to interoperate directly with programs and functions written in other languages.

Computer Communication Networks↗
PubMed2000

The facilitating role of mobile dental van programs in promoting professional dental education.

The main goal of the University of Texas Health Science Center (UTHSCSA) dental van programs is to provide training in delivering care to diverse segments of the population. The UTHSCSA is the Academic Health Center for all of South Texas, a region with 25% of the State's population and 60% Hispanic. About 60% of the region's counties are federally designated dental health personnel shortage areas. Interdepartmental efforts with the participation of dental hygiene, community dentistry, oral diagnosis, periodontics and general practice carried out two programs during the 1994-95 academic year. At the Saint Philip of Jesus Clinic, a charity clinic, and at the Willows Development Center for Severely and Profoundly Mentally Retarded, the dental van was used to provide preventive and restorative care. A questionnaire to measure the value of the programs indicated that students perceived them as important educational activities which increased their confidence in treating persons in the community, especially persons with disabilities. Program output was quantitatively assessed. An average of 8 preventive procedures, 7 fillings, 2 sealants and 1 extraction or referral were provided each working day. Eighty patients were seen at the Saint Philip Clinic (2.5 visits per patient) and 130 patients were seen at the Willows Development Center. Overall, 80 students and 6 faculty participated in providing screening, treatment and referral services. Dental van programs promote access to dental care and increase the visibility of dental schools within the university and community. Current tendencies to halt new program initiatives and phase out existing programs due to shifting financial priorities should be carefully considered in view of the 1995 Institute of Medicine (IOM) report on the future of dental education.

Attitude↗
PubMed2004

Preserving the pipeline: a model dental curriculum for research non-intensive institutions.

Current advanced degree and research training programs no longer attract adequate numbers of students. The present system of dental education severely limits the appeal of these programs due to overcrowded curricula and clinical components that operate in an environment segregated from the academic/research enterprise. To make research-oriented education/training programs more accessible and increase the number of interested students, the culture of dental schools and dental education must change. Programs for future dental researchers and academicians must be supported by curricula that foster an appreciation of research/discovery, an interest in academic/research careers, and the application of biomedical/clinical advances to practice. The Marquette University School of Dentistry has designed a comprehensive new curriculum that supports student research and scholarly activity throughout all four years of dental education. The curriculum minimizes discipline-based courses and is structured into interdisciplinary content tracks that integrate biomedical, behavioral, and clinical sciences while emphasizing the application of science to patient care. A specific research/scholarly track represents dedicated didactic time that exposes all dental students to material not traditionally included in dental curricula. This track includes mentored research/scholarly experiences at local and national sites that are individually structured for each student. Customized student schedules facilitate participation in these experiences without hardship or penalty. This curriculum structure may serve as a model for research non-intensive institutions seeking to increase student interest in academic and research careers.

Curriculum↗
PubMed2004

Access to health care among Hispanic/Latino children: United States, 1998-2001.

OBJECTIVE: This report presents national estimates on access to health care for five subgroups of Hispanic/Latino children in the United States: Mexican, Puerto Rican, Cuban, Central or South American, and other Hispanic. For comparison, estimates are also presented for non-Hispanic white children. METHODS: Data for persons of all ages in the U.S. civilian noninstitutionalized population are collected each year in the National Health Interview Survey (NHIS), which is conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. Each year, data are collected for approximately 100,000 persons in 40,000 households. In the 1998-2001 surveys combined, 53,510 interviews (14,284 Hispanic/Latino children) were completed by knowledgeable adults for a subsample of children under age 18 years, with an overall response rate of 80.2%. RESULTS: Each year, an estimated 3.0 million (25.7%) Hispanic/Latino children lacked health insurance coverage at the time of interview, 1.6 million (14.1%) had no usual place to go for health care during the past year, and 1.4 million (17.6%) experienced unmet health care needs during the past year due to cost. Of the five Hispanic/Latino subgroups, Mexican children were most likely (30.4%) to lack health insurance coverage, followed by Central or South American children (23.8%) and other Hispanic children (18.6%). The percentage of children having a usual place to go for health care was highest for Cuban children (93.5%) and lowest for Mexican children (83.3%). The percentage of children who experienced unmet medical needs due to cost in the past year was 18.3% for Mexican children, 16.3% for Puerto Rican children, 12.8% for Central or South American children, and 8.3% for Cuban children. Lack of access to health care was most prevalent among Hispanic/Latino children who had poor or near poor poverty status, whose parents had less than a high school diploma, and who were foreign born. CONCLUSION: Access to health care varied among subgroups of Hispanic/Latino children. Understanding subgroup differences may help community-based programs improve access to care among Hispanic/Latino children.

Adolescent↗
PubMedDate not supplied

Development of interactive patient-based multimedia computer programs in veterinary orthopedic radiology.

Three computerized multimedia programs on large and small animal veterinary orthopedic radiology were developed and implemented for the radiology curriculum as an alternative to traditional film-based laboratory learning. Programs utilized "hot words" (colored text words that displayed an overlaid image label that highlighted lesions) and interactive quizzes which responded appropriately to selected answers. "Hot words" helped students develop confidence in accurate lesion detection and the interactive quizzes transformed learning from a passive to an active process. Multiple examples were provided for reinforcement and concepts were incorporated from other clinical disciplines for curriculum integration. Programs were written using a presentation software program, Toolbook for DOS based platform, and contained radiographic images made by laser-scanning digitization. Multiple students could simultaneously access the programs through a network server. These pilot programs were implemented successfully and computerized multimedia presentation proved to be well suited to teaching radiology. Development of the programs required attention to a number of hardware, software, time and cost factors.

Computer Communication Networks↗
PubMed1998

Evaluation of outcomes and cost-effectiveness of a community behavioral support and crisis response demonstration project.

A behavioral support and crisis response demonstration project authorized by the Minnesota Legislature in 1992 was evaluated. We described the demonstration program, its service users, and satisfaction and concerns with the program of service recipients, their families and careproviders, and county case managers. We also provided follow-up data on the outcomes of the first year service users and gave the service outcomes projected by case managers had the program not been established. These projected outcomes were validated by follow-up of a comparison group of persons unable to access the program's services. Cost-effectiveness was computed from costs of establishing and operating the demonstration program and the actual average costs of the services that were projected to otherwise have been used.

Adolescent↗
PubMed2006

Access to health care among Hispanic or Latino women: United States, 2000-2002.

OBJECTIVE: This report presents national estimates on access to health care for the following five subgroups of Hispanic or Latino women aged 18 years and over in the United States: Mexican, Puerto Rican, Cuban, Central or South American, and other Hispanic. For comparison, estimates are also presented for non-Hispanic white women and non-Hispanic black women. METHODS: Data for persons of all ages in the U.S. civilian noninstitutionalized population are collected each year in the National Health Interview Survey (NHIS), which is conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. Each year, data are collected for approximately 100,000 persons in 40,000 households. In the 2000-2002 surveys combined, data were collected for 54,763 women aged 18 years and over (9,082 Hispanic or Latino women), with an overall response rate of 73.4%. Estimates in this report are presented as annual estimates, averaged over the 3 survey years. Estimates were age adjusted to the 2000 U.S. standard population to permit comparison among the various race and ethnic subgroups. RESULTS: Among the 33.4 million Hispanic or Latino women in the United States, 31% lacked health insurance coverage at the time of interview, 20% had no usual place to go for medical care during the past year, and 22% experienced unmet health care needs during the past year due to cost. Of the five subgroups of Hispanic or Latino women, Mexican women (35%) and Central or South American women (36%) were more likely than Puerto Rican women (14%) and Cuban women (23%) to lack health insurance coverage. Mexican women (78%) and Central or South American women (78%) were less likely to have a usual place to go for health care compared with Puerto Rican women (90%), Cuban women (82%), and other Hispanic women (90%). The percentage of Hispanic or Latino women who had an unmet medical need due to cost was highest among Mexican women (24%) and lowest among Cuban women (14%). Lack of access to health care was most prevalent among Hispanic or Latino women who had poor or near poor poverty status, had less than a high school diploma, or were foreign born. CONCLUSION: Access to health care varied among subgroups of Hispanic or Latino women. Understanding these subgroup differences may help community-based programs improve access to care among Hispanic or Latino women.

Adolescent↗
PubMedDate not supplied

Nontraditional graduate training for administrators of neighborhood health centers.

Because of the shortage of qualified health care administrators who are members of minority groups, many neighborhood health centers, organized as a result of the Great Society legislation of the 1960's, suffered from their staffs' lack of administrative skills and from rapid turnover as staff members gained experience and moved upward to other jobs. To rectify this shortage, the National Association of Neighborhood Health Centers was funded to offer master's degree programs at the University of Michigan and the University of Southern California. These on job/on campus programs, which began in 1972, allowed participants to work and study concurrently. At Michigan, students attended class 8 hours a day, 4 days a month, for 2 years. At U.S.C., they attended classes for 14 consecutive days 3 times a year for 2 years. Since the usual admission requirements of established graduate programs limit access of minority students, who frequently lack adequate educational backgrounds, admission criteria were modified for the 56 persons enrolled in the program. For example, the Graduate Record Examination scores were not considered in the program at Michgan. Findings in an independent evaluation conducted in 1974 indicated that the programs at both universities were successful in providing graduate education relevant to the special needs of the staffs of neighborhood health centers. Only four students were dropped for academic reasons. More special programs in health administration are needed in both graduate and undergraduate schools to train people in the effective administration of health care centers, particularly those serving communities of disadvantaged persons.

Adult↗
PubMed1979

Center provides emergency care without unneeded inpatient units.

When a study showed that a hospital had enough beds for its service area but that one growing segment of this area needed faster access to emergency care, the Ambulatory Care Center/Emergency Services System (ACCESS) was established. Through its program and facility, ACCESS provides immediate ambulatory and emergency care in its community and, through referrals to the hospital's ED, ensures the provision of more extensive emergency or inpatient care, as needed. Telecommunications, coordination with the county rescue services and the hospital's ED, and cooperation with local private practitioners are vital elements of the program.

Ambulances↗
PubMed1984

Providing primary health care with non-physicians.

The definition of primary health care is basically the same, but the wide variety of concepts as to the form and type of worker required is largely due to variations in economic, demographic, socio-cultural and political factors. Whatever form it takes, in many parts of the developing world, it is increasingly clear that primary health care must be provided by non-physicians. The reasons for this trend are compelling, yet it is surprisingly opposed by the medical profession in many a developing country. Nonetheless, numerous field trials are being conducted in a variety of situations in several countries around the world. Non-physician primary health care workers vary from medical assistants and nurse practitioners to aide-level workers called village mobilizers, village volunteers, village aides and a variety of other names. The functions, limitations and training of such workers will need to be defined, so that an optimal combination of skills, knowledge and attitudes best suited to produce the desired effect on local health problems may be attained. The supervision of such workers by the physician and other health professionals will need to be developed in the spirit of the health team. An example of the use of non-physicians in providing primary health care in Sarawak is outlined.

Allied Health Personnel↗
PubMed2006

Information and communication technology in supporting people with serious chronic illness living at home - an intervention study.

We studied the experiences of two people with serious chronic illness who used information and communication technology (ICT) to communicate with their district nurse. The study was a qualitative case study. The intervention was performed using an electronic messaging program. The program was accessible to any computer with an Internet connection. The programme consisted of different virtual rooms, where people could communicate using text messages. The participants used the program 2-4 times each week from the beginning of November 2003 to February 2004. Semistructured interviews were performed before, during and after the intervention and were analysed using thematic content analysis. The results showed that the participants' communication with the district nurse was improved because of easy accessibility and that they felt increased security. They also felt there were fewer limitations and that their everyday life was improved, which can also be seen as an improvement in care.

Chronic Disease↗
PubMed2006

A computer based telemedicine protocol to predict acute coronary syndrome in patients with chest pain at home.

The decision to admit a patient to a coronary care unit for acute coronary syndrome (ACS) has serious medical and financial consequences. In this study, we aimed to develop a computer program to predict the existence of ACS in patients with chest pain at home; it is intended that patients will be able to access the program via the website to test its validity. This study proceeded in two phases. In the first phase, a computer-based decision protocol was developed using recursive-partitioning analysis to predict ACS in 250 patients with chest pain on the basis of their historical data. In the second phase, this protocol was tested in 115 patients for diagnosis of ACS prospectively. Thirty-two of the patients answered the algorithm questions on the website. All of the patients who visited the website of this study were advised to go to the emergency department. Although the algorithm showed the presence of ACS in 82 of 115 patients, 60 of 115 patients were diagnosed as having ACS in the emergency department (n = 55) or at follow-up. The agreement between the diagnosis of the algorithm and the true diagnosis was moderate and statistically significant (Kappa coefficient 0.61, P < 0.001). The sensitivity of the algorithm was 100%, although its specificity was 60%. The accuracy of the algorithm in diagnosing ACS was 81%. The algorithm diagnoses patients with ACS at a high ratio and decreases the number of patients being unnecessarily admitted to the emergency with non-ACS.

Algorithms↗
PubMed1986

Health care provider and family acceptance of a rural community-based nursing service for chronically ill children.

Health care providers' and families' overall acceptance of a community-based nursing program was assessed in relationship to their perceptions of the program nurses' accessibility, professional competence, and personal qualities. Perceptions were measured by questionnaires completed by 139 health care providers and 140 families. Overall, providers indicated that the program has been of benefit to both the children it serves and the medical community. The majority of families felt that the nurses were helpful to them despite a few complaints related to poor availability.

Adult↗