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At least 811 records · Page 45Linked to original sources
PubMed1988

Nutritional evaluation of soldiers subsisting on meal, ready-to-eat operational rations for an extended period: body measurements, hydration, and blood nutrients.

To evaluate the nutritional value of a new military operational ration, meal, ready-to-eat (MRE), 27 soldiers were fed the ration as their only food during a 34-d field exercise at an elevation of 1800 m. Thirty soldiers given hot breakfasts and dinners and MREs for lunch served as control subjects. Measurements were made of body height, weight, skinfold thickness at four sites, urine volume and concentration, urinary zinc loss, hemoglobin, hematocrit, serum alkaline phosphatase activity, serum concentrations of albumin, total protein, ascorbic acid, folate, retinol, and Zn, and plasma pyridoxal phosphate concentration. The men fed only MREs experienced significant weight loss compared with those fed hot meals. Neither group appeared to be dehydrated. Hemoglobin and hematocrit values rose in response to increased elevation. Both groups of soldiers displayed normal values, indicative of acceptable nutritional status, of serum proteins, measured vitamins, and Zn.

Adipose Tissue↗
PubMed2002

Effect of the Bamako-Initiative drug revolving fund on availability and rational use of essential drugs in primary health care facilities in south-east Nigeria.

OBJECTIVES: To compare the level of availability and rational use of drugs in primary health care (PHC) facilities where the Bamako Initiative (BI) drug revolving fund programme has been operational, with PHC centres where the BI-type of drug revolving fund programme is not yet operational. METHODS: The study was undertaken in 21 PHC centres with BI drug revolving funds and 12 PHC centres without BI drug revolving funds, all in Enugu State of Nigeria. Data were collected on the essential and non-essential drugs stocked by the facilities. Drug use was determined through analyses of prescriptions in each health centre. Finally, the proportion of consumers that were able to remember their dosing schedules was determined. FINDINGS: An average of 35.4 essential drugs was available in the BI health centres compared with 15.3 in the non-BI health centres (p < 0.05). The average drug-stock was adequate for 6.3 weeks in the BI health centres, but for 1.1 weeks in non-BI health centres (p < 0.05). More injections (64.7 vs. 25.6%) and more antibiotics (72.8 vs. 38%) were prescribed in BI health centres than in the non-BI health centres (p < 0.05). The BI health centres had an average of 5.3 drugs per prescription against 2.1 in the non-BI health centres. However, the drugs prescribed by generic name and from the essential drug list were higher in the BI health centres (80 and 93%) than the non-BI health centres (15.5 and 21%, respectively) (p < 0.05). CONCLUSION: It was observed that the BI facilities had a better availability of essential drugs both in number and in average stock. However, the BI has given rise to more drug prescribing, which could be irrational. The findings call for strategies to ensure more availability of essential drugs especially in the non-BI PHC centres as a strategy to decrease medical costs and improve the quality of PHC services, while promoting rational drug use in all PHC centres. More detailed studies (for example, by focus group discussion or structured interviews) should be undertaken to find out reasons for the over-prescription and to develop future interventions to correct this.

Developing Countries↗
PubMed2005

Quality medicines for the poor: experience of the Delhi programme on rational use of drugs.

Prior to 1994, most Delhi hospitals and dispensaries experienced constant shortages of essential medicines. There was erratic prescribing of expensive branded products, frequent complaints about poor drug quality and low patient satisfaction. Delhi took the lead in developing a comprehensive Drug Policy in 1994 and was the only Indian state to have such a comprehensive policy. The policy's main objective is to improve the availability and accessibility of quality essential drugs for all those in need. The Delhi Society for the Promotion of Rational Use of Drugs (DSPRUD), a non-governmental organization, worked in close collaboration with the Delhi Government and with universities to implement various components of the policy. The first Essential Drugs List (EDL) was developed, a centralized pooled procurement system was set up and activities promoting rational use of drugs were initiated. In 1997, the Delhi Programme was designated the INDIA-WHO Essential Drugs Programme by the World Health Organization. The EDL was developed by a committee consisting of a multidisciplinary group of experts using balanced criteria of efficacy, safety, suitability and cost. The first list contained 250 drugs for hospitals and 100 drugs for dispensaries; the list is revised every 2 years. The pooled procurement system, including the rigorous selection of suppliers with a minimum annual threshold turnover and the introduction of Good Manufacturing Practice inspections, resulted in the supply of good quality drugs and in holding down the procurement costs of many drugs. Bulk purchasing of carefully selected essential drugs was estimated to save nearly 30% of the annual drugs bill for the Government of Delhi, savings which were mobilized for procuring more drugs, which in turn improved availability of drugs (more than 80%) at health facilities. Further, training programmes for prescribers led to a positive change in prescribing behaviour, with more than 80% of prescriptions being from the EDL and patients receiving 70-95% of the drugs prescribed. These changes were achieved by changing managerial systems with minimal additional expenditure. The 'Delhi Model' has clearly demonstrated that such a programme can be introduced and implemented and can lead to a better use and availability of medicines.

Drugs, Essential↗
PubMed2006

Task uncertainty and rationality in medical problem solving.

QUALITY ISSUE: Medical problem-solving situations are characterized by various degrees of 'task uncertainty'--i.e. uncertainty related to the definition of a problem, the effect of a technology, the value of a solution, and so on. The need for professional discretion varies and depends on the degree of perceived task uncertainty. SUGGESTED SOLUTION: In this report it is argued that, in order to obtain rationality in problem-solving processes, differences in the degree of task uncertainty need to be met by variation in the structure of the health care organization. IMPLICATIONS: The main implications of this view are that (under norms of rationality) problem-solving processes with low task uncertainty must be organized in one way and processes with high task uncertainty in another. Furthermore, processes with high and low task uncertainty also need to be evaluated according to different standards. Some hypotheses regarding the different organizational requirements are presented.

Humans↗
PubMed1986

"Rational" hospital psychiatry.

When, in 1974, the authors chose to describe their approach to hospital psychiatry as "rational", they were departing from the prevailing psychiatric belief that treatment should be based on theories of behavior. Instead, the authors advocated that rational treatments should be based on empirical findings and on pragmatic considerations, a view which a decade later has found its way into mainstream American psychiatry.

Anorexia Nervosa↗
PubMed1986

Philosophical reflections on a rational treatment plan.

Diagnosis is widely regarded to be governed by logical rules, but constructing a rational treatment plan has received less philosophical attention. I examine such treatment plans under three senses of the term "rational": consensual, scientific, and ethical. My thesis is that treatment plans, even those based on medical indications alone, are inherently consensual and are governed by a logic of proportionality.

Beneficence↗
PubMed1987

DRGs: justice and the invisible rationing of health care resources.

Are DRGs just? This is the primary question which this essay will answer. But there is a prior methodological question that also needs to be addressed: How do we go about rationally (non-arbitrarily) assessing whether DRGs are just or not? I would suggest that grand, ideal theories of justice (Rawls, Nozick) have only very limited utility for answering this question. What we really need is a theory of "interstitial justice," that is, an approach to making justice judgments that is suitable to assessing the social practices and institutions that comprise the interstices of our social life as opposed to its basic structure. Rawls's appeal to "our considered moral judgments" provides us with a useful starting point for this task, which we shall discuss in the first part of this essay. In the second part, we shall actually assess DRGs from the perspective of interstitial justice. What we shall show is that DRGs violate a large number of our considered judgments regarding a just approach to financing health care for the elderly in a cost-effective manner. This is true to such an extent that efforts to reform DRGs and make them fairer, such as the recent effort by Robert Veatch, should be abandoned. In the concluding section of the essay we discuss one especially pernicious feature of DRGs, namely, that they represent an invisible approach to rationing access to health care. In the minds of many this is one of the virtues of DRGs. That claim needs critical examination.

Aged↗
PubMed1990

Towards a rationalization of biological psychiatry: a study in psychobiological epistemology.

Contemporary biological psychiatry is in a seemingly inchoate state. I assert that this state of biological psychiatry is due to its violation of an epistemological criterion of rationality, i.e., the relevance criterion; that is, contemporary biological psychiatry is irrational as it adopts a conception irrelevant to the psychobiological domain. This conception is mechanistic. The irrationality of biological psychiatry is manifest as the dominance of neurochemical explanations of psychopharmacological correlations, resulting in predictive sterility and, correspondingly, in the dominance of serendipity. I suggest a rationalization of biological psychiatry through a conception relevant to the psychobiological domain. This conception is hierarchical.

Biological Psychiatry↗
PubMed1994

Going early, going late: the rationality of decisions about suicide in AIDS.

Where assistance in suicide is readily available to those dying of AIDS, as in the west coast gay communities of the United States and in the Netherlands, we must examine the different roles of physicians and friends (including lovers, spouses, family members, religious advisors, members of support groups, and intimate others) in helping a person with AIDS decide about and carry out suicide. This paper makes a central assumption: that where assistance in suicide is available, it is the moral obligation of others to protect and enhance as much as possible the rationality of that choice. Four components are identified in a rational choice about suicide in AIDS-whether it is a choice for or against suicide. Phrased as questions a person with AIDS might ask him- or herself, they are: (1) "Is suicide an option I want to consider?" (2) "Shall I hold out for the chance of a cure?" (3) "How shall I time my suicide?" (4) "What weight shall I give to the welfare and interests of others?" Although physicians often make assertions relevant to (1), they are appropriately involved only in (3); and although friends or intimate partners often provide the patient with anecdotal information relevant to (3), they should be involved primarily in (1). In short, both physicians and friends often intervene in the wrong parts of choices made by a person with AIDS about suicide.

Acquired Immunodeficiency Syndrome↗
PubMed1981

Mental health as rational autonomy.

Rather than eliminate the terms "mental health and illness" because of the grave moral consequences of psychiatric labeling, conservative definitions are proposed and defended. Mental health is rational autonomy, and mental illness is the sustained loss of such. Key terms are explained, advantages are explored, and alternative concepts are criticized. The value and descriptive components of all such definitions are consciously acknowledged. Where rational autonomy is intact, mental hospitals and psychotherapists should not think of themselves as treating an illness. Instead, they are functioning as applied axiologists, moral educators, spiritual mentors, etc. They deal with what Szasz has called "personal, social, and ethical problems in living." But mental illness is real.

Brain Diseases↗
PubMed2001

Changing the target base specificity of the EcoRV DNA methyltransferase by rational de novo protein-design.

The EcoRV DNA-(adenine-N(6))-methyltransferase (M.EcoRV) specifically modifies the first adenine residue within GATATC sequences. During catalysis, the enzyme flips its target base out of the DNA helix and binds it into a target base binding pocket which is formed in part by Lys16 and Tyr196. A cytosine residue is accepted by wild-type M.EcoRV as a substrate at a 31-fold reduced efficiency with respect to the k(cat)/K(M) values if it is located in a CT mismatch substrate (GCTATC/GATATC). Cytosine residues positioned in a CG base pair (GCTATC/GATAGC) are modified at much more reduced rates, because flipping out the target base is much more difficult in this case. We intended to change the target base specificity of M.EcoRV from adenine-N(6) to cytosine-N(4). To this end we generated, purified and characterized 15 variants of the enzyme, containing single, double and triple amino acid exchanges following different design approaches. One concept was to reduce the size of the target base binding pocket by site-directed mutagenesis. The K16R variant showed an altered specificity, with a 22-fold preference for cytosine as the target base in a mismatch substrate. This corresponds to a 680-fold change in specificity, which was accompanied by only a small loss in catalytic activity with the cytosine substrate. The K16R/Y196W variant no longer methylated adenine residues at all and its activity towards cytosine was reduced only 17-fold. Therefore, we have changed the target base specificity of M.EcoRV from adenine to cytosine by rational protein design. Because there are no natural paragons for the variants described here, a change of the target base specificity of a DNA interacting enzyme was possible by rational de novo design of its active site.

Adenine↗
PubMed2003

Rational combination of strategies to achieve synergistic stabilization of triplex.

The combination of two stabilizing strategies to increase stability of nucleic acid assembly is not always resulted in synergistic effect. In the present study, to explore the rational way to select the combination for synergistically stabilizing strategies, we examined the kinetic effects of different triplex-stabilizing strategies, poly(L-lysine)-graft-dextran (PLL-g-Dex) copolymer and N3'-->P5' phosphoramidate (PN) backbone modification of triplex-forming oligonucleotide (TFO). The former increased the association rate constant, whereas the latter decreased the dissociation rate constant in triplex equilibrium. Each strategy increased the binding constant of the triplex formation by nearly two orders of magnitude. The combination of both stabilizing strategies, which was the triplex formation with PN TFO in the presence of the copolymer, increased the binding constant by nearly four orders of magnitude, implying successful synergy of their activities. The kinetically orchestrated effects in which the copolymer and the PN modification contribute to distinct ingredients in triplex equilibrium achieved the observed synergistic stabilization. We conclude that kinetic analyses of stabilizing effects enable us to select a rational combination of stabilizing strategies.

Base Sequence↗
PubMed2004

Rational design and selection of bivalent peptide ligands of thrombin incorporating P4-P1 tetrapeptide sequences: from good substrates to potent inhibitors.

The tetrapeptide Phe-Asn-Pro-Arg is a structurally optimized sequence for binding to the active site of thrombin. By conjugating this tetrapeptide or some variants to a C-terminal fragment of hirudin, we were able to generate a series of new bivalent inhibitors of thrombin containing only genetically encodable natural amino acids. We found that synergistic binding to both the active site and an exosite of thrombin can be enhanced through substitutions of amino acid residues at the P3 and P3' sites of the active-site directed sequence, Phe(P4)-Xaa(P3)-Pro(P2)-Arg(P1)-Pro(P1')-Gln(P2')-Yaa(P3'). Complementary to rational design, a phage library was constructed to explore further the residue requirements at the P4, P3 and P3' sites for bivalent and optimized two-site binding. Very significantly, panning of the phage library has led to thrombin-inhibitory peptides possessing strong anti-clotting activities in the low nanomolar range and yet interfering only partially the catalytic active site of thrombin. Modes of action of the newly discovered bivalent inhibitors are rationalized in light of the allosteric properties of thrombin, especially the interplay between the proteolytic action and regulatory binding occurring at thrombin surfaces remote from the catalytic active site.

Amino Acid Sequence↗
PubMed2001

Rationalizing 'folk medicine' in interwar Germany: faith, business, and science at "Dr. Madaus & Co.'.

The relationship between orthodox or mainstream medicine and heterodox or alternative practices has often been expressed in terms of dichotomies, such as science versus anti-science or rationality versus irrationality. By studying the history of a company producing herbal medicines and homoepathic remedies in Germany in the 1920s and 1930s, this paper attempts to create a more differentiated picture. 'Dr. Madaus & Co.' was founded in 1919 by the three sons of a free church minister and his wife, who practised as a non-licensed healer herself. The company not only sold medicines, it also produced journals and books promoting heterodox healing methods and contributing to ongoing health political debates, for example over compulsory vaccination programmes, human experimentation, quackery, and a general 'crisis of medicine'. Gerhard Madaus, a medical doctor and one of the three founders, published in 1938 a three-volume Textbook of Biological Healing Methods, turning folk medicine into science. The essay follows the rise of the Madaus family firm and interprets the story of 'Dr. Madaus & Co.' as an example of social rationalization, emphasizing the role of commercial operations in twentieth-century alternative medicine in Germany.

Commerce↗
PubMed1997

Efficiency and rationality in the planning of health care for people with AIDS: an application of the balance of care approach. North-East Italian Group for Planning of AIDS Health Care.

OBJECTIVE: To demonstrate the application of an approach for assessing efficiency and rationality in the use of resources for the care of patients with AIDS (PWA), using data for north-east Italy. DESIGN: An economic methodology, the balance of care (BoC) approach, enabled identification of scenarios for the current, planned and recommended provision of care in the study region. METHODS: Data on the supply and utilization of care by PWA across four locations (inpatient care, day care, home care and sheltered accommodation) was collected for a 6-month period during 1994. The current BoC measured in care contacts across the locations was compared with a planned BoC scenario, derived from the Italian AIDS Health Plan, and a recommended BoC scenario based on a delphi expert panel judgement of the appropriate care location according to sets of hypothetical clinical and social characteristics of PWA. The cost consequences of reallocating patient contacts between the current BoC to the recommended BoC was assessed for inpatient and day care contacts. RESULTS: There is an overprovision of home care in the planned BoC scenario if applied to the study region. The cost consequences of a shift of care contacts according to the recommended scenario results in a potential cost reduction of 9.2% compared with the current scenario, and hence an expected efficiency improvement. CONCLUSION: The BoC approach can be applied to improve the efficiency and rationality of resource use in planning care provision for PWA.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Pharmacoeconomic impact of rational use guidelines on the provision of analgesia, sedation, and neuromuscular blockade in critical care.

OBJECTIVE: To determine the cost-effectiveness and safety of a set of rational use guidelines for analgesia, sedation, and neuromuscular blockade in critically ill ventilated patients when compared with similar factors in standard prescribing. DESIGN: Prospective cost-benefit analysis. SETTING: Medical and surgical intensive care units (ICU) of a 350-bed tertiary care university hospital. PATIENTS: Patients admitted to our ICUs who required mechanical ventilation and continuous analgesics, sedatives, and/or neuromuscular junction blockers (NMJBs). There were 72 patients in the baseline and 84 patients in the follow-up groups. INTERVENTIONS: Prospective tracking of eligible baseline patients was followed by the development and introduction of guidelines and an academic detailing process to promote the use of guidelines. Several months after the introduction of guidelines, a second group of eligible follow-up patients was tracked. The use and effectiveness of analgesics, sedatives, and NMJBs, as well as cost and outcomes, were followed in both groups. Data were subsequently reviewed and analyzed. MEASUREMENTS AND MAIN RESULTS: We recorded data by means of Paradox and Excel databases and included demographics, costs, outcomes (including adverse drug reactions, functional status, ventilator time in hours, lengths of stay), and mortality rates. Data were subsequently analyzed via the Winks statistical data analysis program. Both groups were similar with regard to demographics. There was a statistically significant increase in severity of illness in the follow-up group without a statistically significant increase in mortality. Direct drug costs, ventilator time, and lengths of stay were reduced in the follow-up group. In addition, the use of NMJBs was reduced from 30% in the baseline group to 5% in the follow-up group. CONCLUSIONS: Rational use guidelines resulted in safe, cost-effective improvements in the provision of continuous analgesia, sedation, and neuromuscular blockade to critically ill patients requiring ventilator management when compared with similar factors in baseline prescribing strategies.

APACHE↗
PubMed2001

Sexual harassment in healthcare: classification of harassers and rationalizations of sex-based harassment behavior.

This study identified how 16 Australian registered nurses classified sex-based harassers and explained their own behavior and the behavior of the harasser. A qualitative research design, relying on in-depth interviews, was used to collect the data. The study found that harassment is linked to gender roles and that the harassed are reluctant to blame the harasser--the harassed had "sound" rationalizations for harassment. Awareness of the interactional dynamics of self-blame and these rationalizations will help nurse executives ensure a harassment-free workplace.

Adult↗
PubMed2000

Modeling maps by using rational functions

Rational functions are not very useful for obtaining global differential models because they involve poles that may eject the trajectory to infinity. In contrast, it is here shown that they allow one to significantly improve the quality of models for maps. In such a case, the presence of poles does not involve any numerical difficulty when the models are iterated. The models then take advantage of the ability of rational functions to capture complicated structures that may be generated by maps. The method is applied to experimental data from copper electrodissolution.

Journal Article↗