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PubMed1996

The economic costs of caring for people with HIV infection and AIDS in England and Wales.

The objectives of this study were firstly to estimate total lifetime care costs for an individual with HIV/AIDS, and secondly to estimate the total costs of caring people with HIV infection and AIDS in England and Wales between 1992 and 1997 inclusive. Questionnaires and monthly diaries were used to collate data on healthcare utilisation from patients with HIV infection over a 6-month period. These data were then used to estimate the annual total direct costs of care (stratified by disease stage), total lifetime costs of care, and present and future total national care costs for England and Wales. Costing data were obtained from providers of services throughout Greater London. In total, 235 patients with HIV infection were recruited from 2 clinics in Greater London. All costs were calculated in 1992-93 pounds sterling (pound; 1 pound = $US1.58, December 1995). Annual care costs were estimated at 4515 pounds ($US7134) for a person with asymptomatic HIV disease, 8836 pounds ($US13,961) for a person with symptomatic non-AIDS and 15 268 pounds ($US24,123) for a person with AIDS. Lifetime care costs were estimated at 84,522 pounds ($US133,545) per patient. The total costs of care for England and Wales were forecast to increase from 116,627,400 pounds ($US184,271,300) in 1992 to 162,638,100 pounds ($US256,968,200) in 1997. In conclusion, our study further emphasises the continued shift in hospital services from the inpatient sector to the outpatient sector. The importance of community care and informal care, in terms of the associated direct economic costs, is also highlighted. This emphasises the need for close collaboration between different agencies and strategic coordination of services. Finally, the study forecasts an increase in care costs in England and Wales during the 1990s.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Centralising drug review to improve coverage decisions: economic lessons from (and for) Canada.

Drug coverage decisions require information about clinically relevant benefits and risks, as well as economic information about direct and indirect costs, in comparison with relevant treatment alternatives. A recent Canadian initiative aims to improve the evidentiary basis for drug coverage decisions through centralised evaluation of the clinical and economic value of new drug products. Centralised review can make important, 'positive' contributions to decision making by raising the evidentiary basis for decisions. Even in the absence of a single-payer for medicines, such information can directly inform decisions focussed on matters of technical efficiency. Centralised review also provides necessary but not sufficient information for the many decisions in this sector that concern allocative efficiency and therefore have 'normative' implications. Thus, in addition to processes for collecting and critically assessing clinical and economic data, effective priority setting requires processes at a local level for engaging affected populations in the consideration of the trade-offs inherent in coverage decisions.

Canada↗
PubMed2004

Telemedicine and eHealth in Norway: administration and delivery of services.

OBJECTIVES: This article reviews the situation in Norway concerning the administration and delivery of telemedicine and eHealth. METHODS AND RESULTS: By introducing the Norwegian hospital reform implemented in January 2002, the review provides the background allowing to understand the shift in strategy within this field in Norway. It also provides a historical context regarding the use and development of telemedicine in Norway. Since the implementation of the hospital reform, it can be argued that, presently, there has been a significant change in strategy from what can be described as a "muddling through"-strategy to a more rational approach, based on common and clearly defined goals. CONCLUSIONS: The hospital reform can be regarded as an important crossroads for the use of information and communication technology in Norway. The hypothesis put forward is that the development since the reform was implemented has strengthened both the willingness and the ability to make rational choices and take important steps forwards regarding the use of information and communication technology in the health sector in Norway, when discussing both telemedicine and eHealth.

Health Care Costs↗
PubMed1997

1997 JEMS salary survey. Long hours, modest pay.

As in years past, the 1997 Jems salary survey tracks trends in compensation and career development in both the public and private sectors. This year, we've included some information about volunteer agencies as well. While the survey serves as a barometer for EMS wages and benefits, relying solely on the absolute numbers may create an incomplete picture because of changes in the number of respondents, organizational characteristics and other variables. However, combined with other industry data, the annual salary survey is a useful tool for comparing your pay with that of your peers. The survey should also prove useful to organizations and labor groups planning and preparing competitive compensation packages.

Administrative Personnel↗
PubMedDate not supplied

Win/win: urban and rural hospitals network for survival.

In an increasingly competitive, regulated, and politicized environment, the future of small or rural hospitals must rely on an organizational affiliation with an urban multihospital system to optimized opportunities for survival. Development and implementation of a small or rural hospital's affiliation with an urban multihospital system may provide necessary support and strength to survive as an independent entity, avoid mergers and acquisitions from investor-owned systems, and incorporate technical assistance and access to the resources of large, urban "lead" hospitals. Diversification into long-term and alternative care services will provide the foundation for hospital-wide survival through adaptation of alternative delivery plans to both the public and private sectors. Networking, whether through a formal or informal structure, may provide both urban and rural, large and small hospitals, with the only opportunity for survival in the 1980s and beyond. Networking gives hospitals an opportunity to develop symbiotic relationships with previously competing institutions for physicians, services, and patients. Networking solidifies missions, goals, and objectives for healthcare delivery systems and produces a win/win situation for everyone. It may be a legal entity (a corporate structure) or an informal affiliation among like groups of providers. A discussion of networking is provided for consideration by hospitals currently evaluating options in the multihospital systems arena.

Hospital Administration↗
PubMed2001

Using the internet in patient-centred diabetes care for communication, education, and decision support.

The New England Journal of Medicine 329 (1993) 977- The present paper describes two systems for communication, education, and decision support in patient-centred diabetes care. Both systems are developed under the assumption that while the clinical resources in the health care sector are limited, patients' resources and new information technology may be able to play a much more central role. With DiasNet patients can experiment with their own data. They can, retrospectively, adjust insulin doses or meals sizes, and thereby learn how to cope with various situations. DiabVision, brings together algorithms for detection of retinal lesions in digital images and for aligning time series of retinal images. While the former algorithms are aimed at automated procedures for screening for diabetic retinopathy, the latter can be used to enable motivated patients to see the actual retinal lesions in their own eyes, illustrating how the changes appear, and perhaps disappear, as a consequence of changes in lifestyle and glycaemic control. One of the long-term goals of our work is to assess the potential of integrating all health related information for patients with diabetes and other major chronic diseases. One solution to these problems would be to organise data and information as one virtual database, which then could be accessed by both health professionals and by patients. This structure would facilitate easy access, a clear overview, and quality control. A web site taking the first step in this process has been launched.

Algorithms↗
PubMed2001

Training the health workforce of tomorrow.

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a small group of grantmakers and national experts concerned about health workforce issues. This roundtable - held on October 31, 2001, in Washington, DC - explored various issues related to the supply, composition, and competency of the health workforce, and the role that these factors play in maintaining and improving the health status of individual patients and broader populations. The session also highlighted the current activities of and future opportunities for foundations.This Issue Brief synthesizes key points from the day's discussion with a background paper prepared for roundtable participants. It includes quantitative and qualitative information on workforce issues and profiles public sector and grantmaker strategies for addressing workforce problems.

Clinical Competence↗
PubMed2004

Venous leg ulcer patient priorities and quality of care: results of a survey.

A comprehensive patient evaluation of quality of care encompasses assessment and patient-rated prioritization of the various provisions of care. One hundred consecutive venous leg ulcer patients treated in a multidisciplinary wound healing center were invited to participate in a cross-sectional study to assess the quality of and assign priority to 28 aspects of medical technical, interpersonal, and organizational care. The response rate to the mailed questionnaire and follow-up telephone survey was 80%. Almost half (46%) of patients (median age 76 years, range 30 to 92) had an ulcer history of >5 years. Seventy-three patients (91%) were satisfied with the overall quality of care. A linear relationship was observed between average assessment score and the relative importance of the quality aspects studied. The quality of medical technical care and empathy aspects of interpersonal care received the most positive assessments and were given highest priority. Next in importance were the quality and coherence of information provided and cooperation between different healthcare sectors. Organizational aspects of care were less positively assessed and received lower priority ratings. Venous leg ulcer care, as provided in a multidisciplinary wound healing center, was assessed as satisfactory by patients, but areas for improvement - notably, cooperation between healthcare sectors and continuity of care - were observed.

Adult↗
PubMedDate not supplied

[Evaluation of myopia in a group of people working with video terminals: first results].

UNLABELLED: Since the 70's the occupational use of electronic systems equipped with visual display terminals (VDTs) became wide-spread also in Italy. Some longitudinal studies on large samples of VDT workers found no significant changes of myopia (M) with regard to years and daily hours spent working at a VDT. OBJECTIVE: To evaluate the prevalence and the time course of M in 209 VDT workers employed in the service sector. MATERIALS AND METHODS: After obtaining workers' informed consent their work, social, family and personal medical histories were collected. Myopia was defined as need of >0.25 D negative spherical correction. Average daily hours duringfollow-up and overall years spent working at a VDT were calculated as exposure indexes. RESULTS: The mean baseline age was 39.2 years (SD: 8.7, min-max: 22-62) and the mean education was 14 years (SD: 2.2). The mean follow-up period was 5.5 (3-9) years. The prevalence of M was 45.5% at the start and 49.8% at the end of the study. It was higher in workers with >13 years of education and in those < 40 year-old. A slight but significant increase of the degree of M (dioptres) occurred during the follow-up. The change in the degree of M was not different between the classes of VDT exposure (< or = 4 and >4 daily hours; < or =15 and >15 years spent), of education and of age at the end of follow-up. DISCUSSION: The high mean educational level can partly explain the higher prevalence of M detected in the workers on study with respect to the one described elsewhere on VDT workers and general population. The progression of the M seems not to be related to the professional and personal variables analyzed, but to depend on the natural evolution of M. Further studies are needed to confirm these preliminary data in larger groups of VDT workers.

Adult↗
PubMed1982

Trials of an acoustic transponding fish tag compass.

The instantaneous orientation of a fish can be determined by attaching a magnetic compass sensor to it and then by acoustically telemetering the information to a research vessel's electronic sector scanning sonar. The sensor is housed in a cylindrical capsule with an acoustic transponder to which it is electronically interconnected. Its size and weight are such that it can be fitted to fish of about 40 cm length and above. An operational life of 52 h is obtained from the tag when it is interrogated by the sonar at a consistent rate of 2 pulses s-1. If the rate is reduced by half, the life can be extended to about 68-70 h. Directional accuracy is limited to +/- 22.5 degrees by the physical size of components used in the sensor. Trials of the prototype are described.

Acoustics↗
PubMed1999

Older people's health information needs.

This paper, originally given at the Health Libraries Group conference 'First aid for the front line' in September 1998, argues that older people's health information needs are in many respects little different to anyone else's. It looks at different formats of information that may be helpful for older people, and at the needs of two specific groups, carers and elders from ethnic groups. Direct user involvement in the development of information is seen as important. It is emphasized that there is a particular need for primary care workers to know how other services, such as those within social care and the voluntary sector, operate. The paper ends by looking at the information professional's role in providing resources and training to such workers, and suggests a broader remit for the profession as a whole, to help to ensure social inclusion for older people.

Aged↗
PubMed2006

[Availability of physicians in Chile at the year 2004].

BACKGROUND: The number of physicians available in a given country, their efficiency, quality and specialization is of utmost epidemiological importance. AIM: To evaluate the availability of physicians in Chile. MATERIAL AND METHODS: The information about the number of physicians in Chile up to the year 2004, was obtained from the Ministry of Health, national universities and the register of immigrant physicians since 1950. RESULTS: The total number of physicians licensed to practice was 25,542, of whom 2,700 are immigrants. The physician/inhabitant ratio increased from 1/921 in 1998 to 1/612 in 2004. The greater impact in the increment of available physicians was given by the immigration of professionals and by the increase in the number of physicians graduated from national universities, mainly from the new private universities. Forty two percent of physicians work at public services and 61% of these are certified specialists. The regional distribution of general practitioners and basic specialists is adequate. Along the country, the mean physician/beneficiary ratio is 8.45/10,000, the specialist/beneficiary ratio is 4.9/10,000 and the general practitioner/beneficiary ratio is 2.3/10,000. CONCLUSIONS: The national information of available physicians, especially in the private sector, should be improved. Immigration of physicians should be regulated, maintaining validation examinations and a National Medical Test to assess medical proficiency should be instituted.

Certification↗
PubMed1999

Outcomes of transrectal ultrasound scan of the prostate with sector biopsies for 323 New Zealand men with suspicion of prostate cancer.

AIMS: To assess the results and clinical outcomes of the first four years of transrectal ultrasound scanning (TRUS) with sector biopsies of the prostate, as the definitive second-line investigation for men with suspicion of prostate cancer, including comparability with subsequent information from histology of surgical specimens. METHODS: Information was collated from the author's ongoing surgical audit. TRUS and sector biopsies were carried out as a rooms procedure using a Toshiba Sono-Layer SSA-270A ultrasound machine with a PVL 725 RT transrectal probe and biopsy guide. Six or eight sector biopsies were taken with a Manan biopsy gun using 18 French gauge biopsy needles. Prophylactic ciprofloxacin and tinidazole were administered. Men with suspicion of prostate-specific antigen assay or digital rectal examination were considered for the investigation, especially if they were candidates for potentially curative treatments. RESULTS: Of 330 TRUS procedures performed on 323 men, 328 were done in rooms under local anaesthetic. The only significant complication was a transient bacteraemia in one patient not taking the antibiotics. Twenty men had prostate intraepithelial neoplasia or atypia, and 94 (29%) had cancer, of whom 24 (25%) had evidence of metastases. Curative treatment by radical prostatectomy or radiotherapy was attempted in 62 men (66%) and 28 are being managed by surveillance only. Comparisons with subsequent radical prostatectomy in 44 men showed that if only one TRUS biopsy core was involved with cancer (15 men), surgical margins were clear. For those with more cores involved (29 men), one-third (9 men) had positive margins or capsular perforation. The Gleason Score was different, more often higher, for 29 men by histology at radical prostatectomy compared to TRUS. Twenty-eight men had a subsequent transurethral resection of the prostate of which the histology resulted in management changes for ten of the 28, including three who were placed on surveillance and seven who underwent radical prostatectomy. CONCLUSIONS: TRUS and sector biopsy is a tolerable rooms procedure for men with suspician of prostate cancer. Complications are rare if prophylactic antibiotics are taken. The procedure provides information of sufficient quality to advise patients further. No defects in specificity were detected. Defects in sensitivity were demonstrated by comparison with later histology following transurethral resection. Therefore, men with benign results at TRUS need ongoing follow-up. TRUS histology tends to underestimate the extent of cancer present as determined by subsequent radical prostatectomy histology. When used with prostate-specific antigen and digital rectal examination, TRUS and sector biopsy is capable of detecting prostate cancer before it has metastasized, more reliably than if symptoms are awaited before diagnosis is attempted. It may also recognize forms of cancer of apparent low clinical significance which can be managed by surveillance.

Adenocarcinoma↗
PubMed2003

Research governance: implications for health library and information professionals.

The Research Governance Framework for Health and Social Care published by the Department of Health in 2001 provides a model of best practice and a framework for research in the health and social care sector. This article reviews the Department of Health Research Governance Framework, discusses the implications of research governance for library and information professionals undertaking research in the health- and social-care sector and recommends strategies for best practice within the information profession relating to research governance. The scope of the Framework document that covers both clinical and non-clinical research is outlined. Any research involving, amongst other issues, patients, NHS staff and use or access to NHS premises may require ethics committee approval. Particular reference is made to the roles, responsibilities and professional conduct and the systems needed to support effective research practice. Issues such as these combine to encourage the development of a quality research culture which supports best practice. Questions arise regarding the training and experience of researchers, and access to the necessary information and support. The use of the Framework to guide research practice complements the quality issues within the evidence-based practice movement and supports the ongoing development of a quality research culture. Recommendations are given in relation to the document's five domains of ethics, science, information, health and safety and finance and intellectual property. Practical recommendations are offered for incorporating research governance into research practice in ways which conform to the Framework's standards and which are particularly relevant for research practitioners in information science. Concluding comments support the use of the Research Governance Framework as a model for best practice.

Benchmarking↗
PubMed2005

Using a set of strategic indicator systems as a decision-making support implement for establishing a recycling-oriented society. A Taiwanese case study.

UNLABELLED: BACKGROUND, SCOPE AND AIMS: To realize the vision of sustainable development (SD) originating from the 'only one earth' philosophy, and to integrate the conceptions of ecology and sustainability into the planning and decision-making criteria of urban growth management, the establishment of a recycling-oriented society (ROS) is essential. However, before the above intention can be achieved, it is indispensable to develop a system of strategic indicators for supporting a radical reformation of the urban development plan. Therefore, this study, based on the conception of the new urban development pattern ROS, attempted to carefully choose a sample city in Taiwan for launching a preliminary case study, and furthermore designed and proposed a concise and strategy-oriented assessment indicator system termed ROSAIS. ROSAIS, on the one hand, can act as a compass for understanding resource using efficiency and recycling status during city development and, on the other hand, can serve as an implement supporting decision-making for ROS construction. METHODS: According to the definition and spirit of ROS, the structure of ROSAIS should clearly represent the relationship between resources and environment in human activities. The eco-efficiency indicator system (EEIS) and environmental symbiosis indicator system (ESIS) can be considered two key subindicator systems, and are the necessary components of ROSAIS. EEIS chooses the dominant production sectors in urban economic activities to calculate their eco-efficiency (EE). Separately, for obtaining a consensus regarding the framework of ESIS, the questionnaire approaches and expert consultation, together with the research experience and foundation of current relevant studies and indicator systems, are applied when crucial resource and environmental issues and respective indicators are selected. RESULTS AND DISCUSSION: The calculation results of EEIS in this case study indicated that among the three dominant production activities (agricultural, fishery, and animal husbandry sector) the fishery sector has the highest EE, which indicates that the fishery activities and resources significantly influence the sustainability of the economic-environmental system of the sample city. Furthermore, according to a consensus achieved in ESIS, local green spaces, resource recovery, energy consumption pattern change, freshwater conservation and greenhouse effect abatement were considered as the five crucial issues influencing how the case study city can develop into an ES-city. The rate of local green spaces, resource recycling, freshwater conservation and the rate of reduction of nonrenewable energy use as well as carbon dioxide (CO2) emissions were used to evaluate the above five issues. CONCLUSION: This case study is unparalleled in Taiwan. Even in Japan, where ROS legislation has been implemented, this kind of study remains in the preliminary stages. Furthermore, when communicating the indicator results, it is essential to provide the context and countermeasures of the crucial issues that are faced. The two sub-indicator systems proposed in this case study could comply completely with the above-mentioned requirements. For example, the EEIS provides information for achieving a balance between environmental burden and economic benefits among dominant production sectors; the ESIS provides information for setting strategies for overcoming the crucial issues faced. RECOMMENDATION AND OUTLOOK: This study recommends that urban planers should consider the construction of the corresponding strategic indicator system to be indispensable, and makes further use of the indicator results related to the environmental education of residents for identifying and promoting participation with ROS, and turning them into implements for supporting urban SD decision-making. Furthermore, a successful indicator system depends on data availability and quality. This study recommends that urban planers should pay considerable attention to constructing relevant data collection channels, databases and the data quality.

Cities↗
PubMed2000

Mobile Medical Data (MOMEDA)--a Personalized Medical Information System.

MOMEDA is a two-years project supported by the European Commission (Telematics Applications Programme of DGXIII--Health Care Sector). The main objectives of the project are the development of a compact personal information terminal for hospital and home care environments that could be used by patients and a demonstrator that allows the consulting physician to access electronic patient record data from outside the hospital, using a hand held companion device connected to GSM network. Special attention is paid to a Personalized Medical Information System (PMIS) which will allow patients to access customized disease-specific information material that will enable them to fully understand in a simple and constructive form what their medical problem is, what the planned procedures are, what lifestyle they should follow during and after their hospitalization, thus becoming more qualified partners in the recovery process. Considering the fact that in most cases informed and educated patients are usually satisfied patients when the treatment is finished, patient satisfaction can be also accomplished. The design considerations for the PMIS system are presented and the implementation is discussed.

Computer Security↗