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At least 883 records · Page 49Linked to original sources
PubMed1995

Perinatal regionalization versus hospital competition: the Hartford example.

OBJECTIVES: The increasingly competitive health care environment may undermine effective traditional regional organizations. It is urgent to document the benefits of perinatal regionalization for the emerging health care system. We present a case study that illustrates many of the challenges to and benefits of perinatal regionalization in the 1990s. BACKGROUND: The controversy in Hartford was sparked by a proposed merger of two major pediatric services into a full-service children's hospital. Community hospitals reacted with plans to upgrade their obstetrics/neonatal facilities toward level II (intermediate) or II+ (intensive) neonatal intensive care units (NICUs). The fear that unrestricted competition would drive up overall health care costs prompted the hospital association and Chamber of Commerce to retain consultants to evaluate the number and location of regional NICU beds. METHODS: The consultant team interviewed stake-holders in area hospitals, health maintenance organizations, insurance companies, businesses, state agencies, and community groups, and analyzed quantitative data on newborn discharges. RESULTS: The existing system worked remarkably well for clinical care, training, referrals, and provider and patient satisfaction. There was a high level of inter-hospital collaboration and regional leadership in obstetrics and pediatrics, but strong and growing competition between their hospitals. Hospital administrators enumerated the competitive threats that obligated them to compete and the financial disincentives to support the regional structures. Business leaders and insurance executives emphasized the need to control costs. Analysis of discharge data showed marginal adequacy of NICU beds but maldistribution between NICUs, particularly between level III and level II units. The consultants recommended no new beds based on population projections, declining lengths of stay nationally, and substantial gains available from aggressive back-transport of convalescing infants. The consultants emphasized the need for all stakeholders to support the regional infrastructure (referral, transport, education, evaluation, quality assurance) and to modify competition when it impaired effective regionalization. CONCLUSIONS: Regionalization permits better care at lower cost, yet competition may disrupt this effective system. Active cooperation by stakeholders is vital. Substantial new research is required to define optimal regional organization.

Bed Occupancy↗
PubMed1995

[Microinvasive, CT-controlled periradicular therapy in treatment of chronic intervertebral disk-induced functional disorders].

The disease of the spinal column is number 2 of common diseases world-wide and leads to high business- and commerce-related losses as well as to high expenses for the health care systems. An effective treatment of this disease is given by the microinvasive. CT controlled periradicular therapy (micro PRT). Under visibility, the tip of a canula is led directly and high precisely in close neighbourhood to the prolaps, then locally NaCl and cristaline cortisone (40 mg Volon A) is instillated. The periradicular distribution and the distribution into the epidural space is documented via contrast medium. A retrospective study with 220 patients and a prospective randomized double blind study with 40 patients (10 mg vs. 40 mg Volon A) were carried out. The average age of the retrospective collective was 53.1 +/- 12.4 years, average treatment period 18.4 weeks, and the mean follow-up 17 months. The mean value of successful treatment of lumbal spine was at 60% (spine 88.5%) with protrusion, with prolaps at 75% (spine 94%), with sequester at 94%, and with stenoses at 69% (spine 60%). With 78.8% of the patients, the percentual result was constantly good at the time of questionnaire as to the end of the treatment. 7.7% still took analgesics, 5.9% were post-operated. 1.8% of the patients made a pension application. The average age of patients within the prospective randomized double-blind-study was 47.2 +/- 11.9 years. At 27.5% of the patients, the start of pain was about more than 5 years ago and goes back to about 23 years (72.5% had pain more than 1 year). The mean value of visits was 4 physicians per patient, and 5 months of follow-up. There is a high significant improvement in results within the group with 40 mg Volon A (p = 0.0351479). The entire improvement, subjectively estimated (visual analogical scale) within this group was at 90%. After end of therapy, 83.3% (n = 30) had stopped the taking of analgesics and the neurologic deficit decreased significantly. Furthermore, significant reduction of prolapses could be observed at 60% of the patients in both study groups (n = 156). The CT scopic micro PRT with 40 mg Volon A leads to a significant improvement of pain and neurologic symptoms caused by chronical disk herniation.

Adult↗
PubMed1993

[International health organizations facing the emergence of new infectious diseases].

Throughout history, international health collaboration gradually came into being to counteract the emergence of new diseases. This process went through five stages.: 1) Quarantine regulations were established for maritime commerce to safeguard public health. 2) Scientific data were studied to understand the causes of infectious diseases and their modes of transmission; a single solution to the problem was not sufficient because of the diversities of the various factors triggering these diseases. Furthermore, defensive and protective measures adopted in Europe were inadequate after the colonial expansion of European countries. 3) If 19th century international health politics were defensive, the aim in the 20th century was to fight infectious diseases and to eradicate them. This third phase saw the rise of international institutions. These agencies aimed at favouring better health organization in individual countries. 4) The World Health Organization was founded, the aim being to fight existing epidemics, little importance being given to 'emerging diseases'. 5) A series of new infectious diseases and the reemergence of old diseases (a consequence of major ecological changes) that were thought to be eradicated revealed the need for continuous surveillance.

Communicable Disease Control↗
PubMed1994

Cruising the information highway: online services and electronic mail for physicians and families.

Commercial online service providers, bulletin board services, and the Internet make up the rapidly expanding "information highway." Physicians and their families can use these services for professional and personal communication, for recreation and commerce, and to obtain reference information and computer software. Commercial providers include America Online, CompuServe, GEnie, and MCIMail. Internet access can be obtained indirectly through America Online or directly through specialized access providers. Today's online services are destined to evolve into a National Information Infrastructure that will change the way we work and play.

Computer Communication Networks↗
PubMed1994

Surveillance for selected tobacco-use behaviors--United States, 1900-1994.

PROBLEM/CONDITION: Surveillance of tobacco use is an essential component of any tobacco-control program. The information gathered can be used to guide research initiatives, intervention programs, and policy decisions. REPORTING PERIODS: This report covers the period 1900-1994 for per capita cigarette consumption; 1965-1991 for trends in cigarette smoking prevalence and cessation; 1974-1991 for trends in the number of cigarettes smoked daily by current smokers; 1987-1991 for recent patterns of tobacco use; 1970, 1987, and 1991 for trends in cigar/pipe smoking and snuff/chewing tobacco use; 1984-1992 for trends in state-specific prevalences of regular cigarette smoking; 1987-1992 for state-specific estimates of smokeless-tobacco use; and 1976-1993 for trends in cigarette smoking among U.S. high school seniors. DESCRIPTION OF SYSTEMS: Estimates of cigarette consumption are reported by the U.S. Department of Agriculture, which uses data from the U.S. Department of the Treasury, the U.S. Department of Commerce, the Tobacco Institute, and other sources. The National Health Interview Survey uses household interviews to provide nationally representative estimates (for the civilian, noninstitutionalized population) of cigarette smoking and other behaviors related to tobacco use. The Behavioral Risk Factor surveillance System uses telephone surveys of civilian, noninstitutionalized adults (> or = 18 years of age) to provide state-specific estimates of current cigarette smoking and use of smokeless tobacco. The University of Michigan's Institute for Social Research uses school-based, self-administered questionnaires to gather data on cigarette smoking from a representative sample of U.S. high school seniors. RESULTS: During the period 1900-1963, per capita cigarette consumption increased; after 1964, consumption declined. During the years 1965-1991, current cigarette smoking prevalence among persons ages > or = 18 years declined overall and in every sociodemographic category examined. Decrease in current smoking prevalence was slow in some groups (e.g., among persons with fewer years of formal education). Both the prevalence of never smoking and the prevalence of cessation increased from 1965 through 1991. The prevalence of current cigarette smoking, any tobacco smoking, and any tobacco use was highest among American Indians/Alaska Natives and non-Hispanic blacks and lowest among Asians/Pacific Islanders. The prevalence of cigar smoking and pipe smoking has declined substantially since 1970. The prevalence of smokeless-tobacco use among white males ages 18-34 years was higher in 1987 and 1991 than in 1970; among persons > or = 45 years of age, the use of smokeless tobacco was more common among blacks than whites in 1970 and 1987. Cigarette smoking prevalence has decreased in most states. The prevalence of smokeless tobacco use was especially high among men in West Virginia, Montana, and several southern states. From 1984-1993, prevalence of cigarette smoking remained constant among U.S. high school seniors. However, prevalence increased slightly for male seniors and white seniors, decreased slightly for female high school seniors, and decreased sharply for black high school seniors. INTERPRETATION: With the exceptions of increases in cigarette smoking among white and male high school seniors and in the use of smokeless tobacco among white males ages 18-34 years, reductions in tobacco use occurred in every subgroup examined. This decrease must continue if the national health objectives for the year 2000 are to be reached. ACTIONS TAKEN: Surveillance of tobacco use is ongoing. Effective interventions that discourage initiation and encourage cessation are being disseminated throughout the United States.

Adolescent↗
PubMed1994

[A case of pulmonary eosinophilic granuloma with extrapulmonary involvement treated effectively with steroid hormone].

A 21-year-old female was admitted to Tamono City Hospital with chief complaint of dyspnea due to spontaneous pneumothorax. The patient was transferred to our clinic for further examination of abnormal chest X-ray findings together with skin lesions and other symptoms of polyuria, amenorrhea and narrowed visual fields. Histochemical and electron microscopic examination of lung tissue obtained by open lung biopsy led to the diagnosis of eosinophilic granuloma. Furthermore, enhanced computed tomography and magnetic resonance images showed the existence of an intracranial tumor in the supra-hypophyseal region which was interpreted as the cause of hormonal and visual disturbances. Because of dyspnea and enlargement of intracranial tumor, treatment with steroid hormone was commerced followed by tapering of the dose. Chest X-ray findings and skin lesions improved markedly and the intracranial tumor regressed significantly with this steroid therapy, indicating that the intracranial tumor represented involvement with eosinophilic granuloma.

Adult↗
PubMed1994

Addressing emerging infectious disease threats: a prevention strategy for the United States. Executive summary.

The spectrum of infectious disease is changing rapidly in conjunction with dramatic societal and environmental changes. Worldwide, explosive population growth with expanding poverty and urban migration is occurring; international travel and commerce are increasing; and technology is rapidly changing-all of which affect the risk of exposure to infectious agents. Recent examples of important emerging infectious diseases include prolonged diarrheal illness due to waterborne cryptosporidium, hemorrhagic colitis and renal failure from foodborne Escherichia coli O157:H7, pneumonia and middle-ear infections caused by drug-resistant pneumococci, and rodentborne hantavirus pulmonary syndrome. These diseases as well as resurgent diseases (e.g., tuberculosis and cholera) illustrate human vulnerability to microorganisms in the environment. Three recent reports by the Institute of Medicine document the need to address emerging infectious disease threats. In partnership with representatives from health departments, other federal agencies, medical and public health professional associations, and international organizations, CDC has developed a strategic plan to address emerging infectious disease threats. The plain contains four goals that emphasize surveillance, applied research, prevention and control, and public health infrastructure. To ensure sustainability, plan implementation will be approached in stages, as a long-term endeavor with emphasis on extramural programs. As health-care reform proceeds, priority should be given to strengthening partnerships between health-care providers, microbiologists, and public health professionals to detect and control emerging infectious diseases.

Communicable Disease Control↗
PubMedDate not supplied

[Example of organizing a middle-size business in medical industry].

The paper deals with the organization of activities of a joint venture in diagnostic medical equipment under the conditions of arising market relations in Russia. A block diagram of the enterprise is proposed, which ensures rather effective research, production, and commerce activities. The tasks facing a marketing sector are given in detail.

Biomedical Engineering↗
PubMed1976

[Disinfection of sewage waters from rendering plants by means by peracetic acid].

In our experiments, peracetic acid -- known in commerce as "Wolfasteril" was tested as a new and efficient disinfectant to disinfect sewage waters from rendering plants. Peracetic acid was used in experiments in concentration of 0.1 to 1.0% for 30 sec. to 60 min. As a comparative agent, 5% chloramine was used. Results obtained in preliminary and main experiments proved that peracetic acid is fully appropriate to disinfect biologically cleaned sewage waters in rendering plants. Sewage waters supplying the main stream has to pass mostly a short section after having left the water clariflier. Consequently, the concentration of 1% peracetic acid acting for 30 sec. is the optimum one. The recommendation of this application norm for peracetic acid in water clarifiers from rendering plants being at least suitable in controlling disasters.

Acetates↗
PubMed1993

[A case of status asthmaticus complicated by with pneumoperitoneum during mechanical ventilation therapy].

A 46-year-old woman was admitted to our hospital for a severe asthma attack. On admission, systemic cyanosis was observed, and her consciousness state was drowsy. Arterial blood gas showed severe respiratory acidosis, hypoxia, and hypercapnea, with pH, PaO2, and PaCO2 of 7.163, 29.9 torr and 81.3 torr, respectively. Immediately, mechanical ventilation was commerced but on the third hospital day pneumomediastinum and subcutaneous emphysema appeared, and on the sixth day pneumoperitoneum also appeared. The chest CT scan on the sixth day showed free air around bilateral internal mammary vessels. This indicated that air moved from the mediastinum into the peritoneal cavity through an anterior route, via the sternocostal triangle formed by the xiphoid origins of the diaphragm medially and the costal origins laterally.

Female↗
PubMed1993

Regulation and federalism: legal impediments to state health care reform.

In recent years, many states have attempted to address the cost and access problems that face their health care systems. Such efforts, however, are significantly impeded by a variety of federalism doctrines that limit the ability of states to regulate the health care market. This Article surveys some of those federalism barriers, including the constitutional restraints imposed by the Commerce Clause, the Privileges and Immunities Clause, and the Fourteenth Amendment, and the statutory hurdles created by ERISA, the Social Security Act, and the Americans with Disabilities Act of 1990. This Article concludes that the restraints that these doctrines and statutes place on states reflect not only federalism concerns, but also deeper ambivalence about governmental regulation of the health care market. Only when that ambivalence is resolved can a proper division of labor between the states and federal government be determined.

Constitution and Bylaws↗
PubMed1993

Nutritional products as drugs or food implications for development.

It is currently recognized that food, other than supplying calories, produces profound effects on bodily function. Consumers and patients receive information regarding whole foods, individual ingredients, and diets from many sources, most of which are unverified for efficacy and safety. No satisfactory mechanism exists for the production of this data, and its regulatory oversight is made more difficult, since many of the products are in everyday commerce and readily available to the consumer. The differences between the methods by which consumer-patient behavior is modified, are discussed. A framework is suggested by which research and development investment over time could be created and maintained, so as to provide well-documented data on safety and medical benefits. Patent and regulatory issues are important elements of the proprietary position essential to sustain an intensive, extended research and development effort in this area.

Aged↗
PubMed1993

Major issues confronting the practicing dermatologist in the 1990s.

Protein issues confront the dermatologic practitioner in this last decade of the twentieth century, including 1) the role of managed care; 2) the decline of direct access to the specialist; 3) malpractice liability and the need for reform; 4) declining reimbursements in the face of escalating practice overhead; and 5) conflict between the individual's right to care and society's ability to subsidize that right. Correcting and improving the American health care system demands a return to the emphasis and values that made that system the envy of the entire world. We must re-emphasize the sanctity of the doctor-patient relationship, halt the incursion upon physician autonomy, and eliminate those third party factors such as insurance companies, bureaucrats, and administrators that accentuate commerce instead of compassion in medicine. It is hoped that by expanding and equalizing the American health care system, it is not made unpalatable and unresponsive to every citizen.

Dermatology↗
PubMed1995

[Angioma in childhood: current criteria for therapy].

After examining the most recent literature on this subject, the authors assess the state of the art of current knowledge regarding cutaneous angioma in the light of their personal experience. The histological, biological and clinical characteristics are analysed and enable a new nosographic evaluation of this frequent pathology which must be differentiated from vascular malformations. In the light of these unique features, the authors examine the current forms of treatment for angioma using local, systemic or physical therapy. Cutaneous angioma may be present at birth or may appear during the first months of life, occasionally regressing spontaneously up until the child is seven years old. They also present a population of proliferating endothelial cells. This explains the possibility that these neoformations will spontaneously regress, an event that must be taken into account before commercing therapy. With regard to their diagnosis valuable information is provided by telethermography, ultrasonography, Doppler scan and CAT. If an angioma is present from the first weeks of life, a wait-and-see policy should be adopted unless the lesion is localised in an orbital, mammary, palpebral, subglottic, nasal or labial region. Local therapy of angioma using sclerosant substances is now controversial; the best results are obtained using periodical administrations of triamcinolone acetonide or betamethasone. Systemic treatment with prednisone is indicated in forms localised on the orbita where interlesional injections are frequently followed by complications such as hematoma and infections. Systemic treatment requires an interdisciplinary approach, especially in pediatrics, due to the repercussions which the use of high dose conrticosteroids provokes on hormone function in children. The use of alpha interferon with discordant results has recently been reported in the literature. In superficial forms physical therapy may be more appropriate. Cryotherapy provoked a lesion caused by cold: an ionic alteration of tissues through freezing leads to necrosis. Plesiotherapy has been now virtually abandoned due to the risks of growing tissue. In terms of therapy and application there has been a widespread increase in the use of argon laser over the past years: the "Tunable Dye Laser" present unique characteristics which allow the wave length to be modulated in relation to the colour and depth of the lesion to be treated, causing selective photothermolysis. Encouraging results can be obtained by subjecting immature angioma to applications every 3-4 weeks using an every of 7-8 J/cm2. The use of the tunable dye laser is, however, preferable in superficial angioma. Compressive therapy using elastic bandages or specially made garments is effective only in those localisation where it is possible to obtain compression, like limbs and the parotid region. From the above comments it can be seen that the treatment of immature angioma is extremely complex due to their clinical and evolutive variability. It is therefore vital to following the rules laid down by experience: waiting for the involution of the angioma, even if it is commonly observed event, is often difficult to achieve due to the scarce collaboration of parents. Moreover, it is important to achieve a close interdisciplinary collaboration between pediatrician, dermatologist and plastic surgeon.

Child↗
PubMed1977

Metrication and AIHA.

AIHA supports a planned orderly national program for conversion to the metric system and will cooperate with other technical societies and organizations in implementing this voluntary conversion. The Association will use the International System of Units (SI) as modified by the Secretary of Commerce for use in the United States in all official publications, papers and documents. U.S. customary units can be presented in parentheses following the appropriate SI unit, when it is necessary for clarity.

Metric System↗
PubMed1995

Hepatitis C virus variants and the role of genotyping.

Hepatitis C virus demonstrates considerable divergence in nucleotide sequence. This variation may affect virus detection, disease outcome, and the effectiveness of interferon treatment. For example, infection with genotype 1 is associated with a lower response rate to interferon treatment. Hepatitis C virus can be classified into six distinct types, comprising at least 74 different subtypes. Both types and subtypes are subject to geographical differences in distribution, presumably reflecting the epidemiological history of the virus. However, because this history may be blurred by migration and by commerce in blood products between regions, screening and typing assays must recognize both the major indigenous and more exotic virus genotypes. Little information exists about the role of virus sequence variation in screening for hepatitis C virus antibodies, but there is some evidence that the reactivity of current serological screening assays for hepatitis C virus is genotype dependent. In the future, screening assays may need to include antigens specific for different virus types or may need to be designed with regard to the particular types found in a certain area. Antigenic variation may also mean that an effective vaccine needs to be multivalent to protect against all genotypes present in a given region. There are several polymerase chain reaction-based methods of distinguishing between hepatitis C virus variants. These methods must be continually updated, however, as new sequence variants are discovered. Alternative genotyping assays are based on the host's serological response to virus infection, but these cannot distinguish between virus subtypes and are unsuitable for immunocompromised patients. As more countries are sampled, it is likely that more genotypes will be identified and this may help elucidate the origins of hepatitis C virus. Detailed epidemiological studies may delineate past and current routes of transmission.

Enzyme-Linked Immunosorbent Assay↗
PubMedDate not supplied

Workplace tobacco interventions.

Health promotion programs are becoming an integral part of work site activities. Recent data from Indiana businesses suggest that smoking is a leading concern. An objective has been adopted by the Indiana Chamber of Commerce that states that the number of employers with work site smoking cessation policies should increase. Smoking control and cessation programs implemented in industry have contributed to a decrease in the number of smokers and in the health risks of nonsmokers exposed to environmental tobacco smoke. This report describes the effectiveness of work site smoking control programs.

Health Promotion↗
PubMed1995

Sickle cell screening policies as portent: how will the human genome project affect public sector genetic services?

The Human Genome Project holds much promise for providing dramatic improvements in our understanding of and means to diagnose and treat many diseases. As this enormously important endeavor proceeds, research on ethical, legal, and social implications of this new science is being conducted to forecast problems and recommend policy option solutions to avoid what might otherwise become adverse consequences. Sickle cell screening is an example of a technology that was introduced in a manner that raised poignant issues. On the basis of sickle cell issues, we examined policy issues likely to occur as new genetic technologies are incorporated into medical practice. Discussion and development of a national consensus on the appropriate content and just delivery of public sector genetic services is vital; otherwise, the impact of Human Genome Project-derived technology may result in misadventures that amplify problems currently evident in newborn screening programs. New DNA-based diagnostic technologies and therapies will soon enter the stream of commerce. The recommendations offered here, while based on examination of sickle cell disease policies, are intended to address both current inequities as well as potential future issues related to stigmatization and distributive justice.

Anemia, Sickle Cell↗