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PubMed2000

The future of male infertility management and assisted reproduction technology.

Intracytoplasmic sperm injection (ICSI) is undoubtedly a powerful, and sometimes the only effective, form of infertility treatment. Nonetheless, it is a non-specific treatment that, combined with increasingly heroic techniques to recover male germinal cells, has led to perceptions of men as just providers of gametes in the infertility equation. In response to this nihilist attitude, where women are investigated extensively and scant attention is paid to men, there is a re-emerging awareness of andrology--particularly in countries with limited healthcare resources. Structured management strategies, using diagnostic information to recognize causative factors amenable to simpler, even systemic, therapies with reasonable chances of pregnancy rather than resorting prematurely to assisted reproduction technology, represent rational, cost-effective approaches to infertility management. Furthermore, genetic testing (particularly cystic fibrosis gene defects and Y-chromosome microdeletions) is essential for couples to make fully informed decisions on their options. Recognition that free radical-induced damage to the sperm genome (e.g. from smoking or in-vitro sperm manipulation) underlies deleterious paternal effects on preimplantation development promotes further synergy between andrology and embryology. Although societies strike different balances between considerations of affordability and cost-effectiveness of assisted reproduction technology, ICSI represents a last resort, to be used when less-invasive, lower-cost treatments have been deemed inappropriate or have failed. Consequently, rather than assisted reproduction technology eliminating the need for andrology, the future will see increasingly tighter integration of multidisciplinary infertility care, embracing careful diagnosis and patient education before obtaining truly informed consent and embarking upon cost-effective treatment.

Delivery of Health Care↗
PubMed1985

Financing health promotion and education programs in HMOs.

Health education and promotion programs provide numerous benefits to HMOs, plan members, and society. There are many approaches to financing such programs, and their application varies across organizations, depending on organizational values, managerial styles, decision-making structures, resources, administrative preferences, and program objectives.

Budgets↗
PubMedDate not supplied

System review: a method for investigating medical errors in healthcare settings.

System analysis is a process of evaluating objectives, resources, structure, and design of businesses. System analysis can be used by leaders to collaboratively identify breakthrough opportunities to improve system processes. In healthcare systems, system analysis can be used to review medical errors (system occurrences) that may place patients at risk for injury, disability, and/or death. This study utilizes a case management approach to identify medical errors. Utilizing an interdisciplinary approach, a System Review Team was developed to identify trends in system occurrences, facilitate communication, and enhance the quality of patient care by reducing medical errors.

Drug Utilization Review↗
PubMed2002

Thrombolysis and its implications in the management of stroke in the accident and emergency department.

OBJECTIVES: Examination of initial management of stroke patients in the emergency setting to assess feasibility of thrombolysis for acute ischaemic stroke. METHODS: Retrospective analysis of all patients presenting with a clinical diagnosis of stroke over a two month period. Exclusion criteria for thrombolysis were applied to assess the number of patients that would potentially have been eligible for thrombolysis. RESULTS: Of 94 patients identified with clinical stroke, only 57 (60.6%) had a CT scan; 23 (24.4%) were confirmed as having had an acute ischaemic stroke. Mean delay in scanning was 2.2 days (range 0-15 days). Even if all patients had presented and been scanned within three hours (as required for thrombolysis), only six (6.4%) patients would have been eligible for thrombolysis. CONCLUSIONS: The great majority of patients presenting with clinical stroke do not fulfill the criteria for thrombolysis. Current practice involves significant delays in CT scanning, which has implications for resource structuring should thrombolysis become widely available.

Adult↗
PubMed2006

Dispersal strategies of phytophagous insects at a local scale: adaptive potential of aphids in an agricultural environment.

BACKGROUND: The spread of agriculture greatly modified the selective pressures exerted by plants on phytophagous insects, by providing these insects with a high-level resource, structured in time and space. The life history, behavioural and physiological traits of some insect species may have evolved in response to these changes, allowing them to crowd on crops and to become agricultural pests. Dispersal, which is one of these traits, is a key concept in evolutionary biology but has been over-simplified in most theoretical studies. We evaluated the impact of the local-scale dispersal strategy of phytophagous insects on their fitness, using an individual-based model to simulate population dynamics and dispersal between leaves and plants, by walking and flying, of the aphid Aphis gossypii, a major agricultural pest, in a melon field. We compared the optimal values for dispersal parameters in the model with the corresponding observed values in experimental trials. RESULTS: We show that the rates of walking and flying disperser production on leaves were the most important traits determining the fitness criteria, whereas dispersal distance and the clustering of flying dispersers on the target plant had no effect. We further show that the effect of dispersal parameters on aphid fitness depended strongly on plant characteristics. CONCLUSION: Parameters defining the dispersal strategies of aphids at a local scale are key components of the fitness of these insects and may thus be essential in the adaptation to agricultural environments that are structured in space and time. Moreover, the fact that the effect of dispersal parameters on aphid fitness depends strongly on plant characteristics suggests that traits defining aphid dispersal strategies may be a cornerstone of host-plant specialization.

Adaptation, Physiological↗
PubMed1996

Radiographic skills learning: procedure simulation using adaptive hypermedia.

The design and development of a simulation tool supporting learning of radiographic skills is reported. This tool has by textual, graphical and iconic resources, organized according to a building-block, adaptive hypermedia approach, which is described and supported by an image base of radiographs. It offers interactive user-controlled simulation of radiographic imaging procedures. The development is based on a commercially available environment (Toolbook 3.0, Asymetrix Corporation). The core of the system is an attributed precedence (priority) graph, which represents a task outline (concept and resources structure), which is dynamically adjusted to selected procedures. The user interface imitates a conventional radiography system, i.e. operating console, tube, table, patient and cassette. System parameters, such as patient positioning, focus-to-patient distance, magnification, field dimensions, tube voltage and mAs are under user control. Their effects on image quality are presented, by means of an image base acquired under controlled exposure conditions. Innovative use of hypermedia, computer based learning and simulation principles and technology in the development of this tool resulted in an enhanced interactive environment providing radiographic parameter control and visualization of parameter effects on image quality.

Computer Simulation↗
PubMed1997

[Characteristics of intensive care units in Sao Paulo].

This study is the first part in a series of the articles reporting results of a project conducted to analyse the structural resources of ICUs in São Paulo city. This article describes the characteristics of those Units, considering the quantity and geographic location, bed number, maintainer entity, type of assistance, type of client, as well the percentage of beds usage and length of stay. Forty three ICUs were analysed and a questionnaire answered by the ICU nurse coordinator was used to collect data. The results showed that the number of ICUs in the hospital varied from 1 to 4, being more frequently those with only one ICU (68.8%). 79.2% of the Units were in private hospitals, located in the central area of the city. ICU beds represented 8.0% of the total hospital beds and there was an average of 10 beds per Unit. There was a predominance of general ICUs (60.5%), destined only for adult patients (51.2%) and for clinical-surgical treatment (95.3%). The percentage of beds usage in majority of ICU was between 80 to 100% and the length of stay was 4,5 days.

Adult↗
PubMed2001

Age-related patterns in social networks among European Americans and African Americans: implications for socioemotional selectivity across the life span.

Socioemotional selectivity theory contends that as people become increasingly aware of limitations on future time, they are increasingly motivated to be more selective in their choice of social partners, favoring emotionally meaningful relationships over peripheral ones. The theory hypothesizes that because age is negatively associated with time left in life, the social networks of older people contain fewer peripheral social partners than those of their younger counterparts. This study tested the hypothesis among African Americans and European Americans, two ethnic groups whose social structural resources differ. Findings confirm the hypothesis. Across a wide age range (18 to 94 years old) and among both ethnic groups, older people report as many emotionally close social partners but fewer peripheral social partners in their networks as compared to their younger counterparts. Moreover, a greater percentage of very close social partners in social networks is related to lower levels of happiness among the young age group, but not among the older age groups. Implications of findings for adaptive social functioning across the life span are discussed.

Adolescent↗
PubMed2005

Geriatric education in US schools of pharmacy: a snapshot.

OBJECTIVE: The objective of this study was to assess the structure, resources, and activities of academic geriatrics courses in U.S. pharmacy schools. DESIGN: A cross-sectional study. PARTICIPANTS: Schools of pharmacy in the United States identified through the American Association of Colleges of Pharmacy (AACP). The survey was e-mailed (May 2003) to the academic chairs of the clinical pharmacy department and/or the head of geriatric pharmacy practice at each of the 84 schools of pharmacy in the United States. MEASURES: The primary measure was to assess the nature and extent of geriatrics course content in the responding schools. In addition, we elicited information on the type of geriatrics material taught, faculty involvement, student population, type of school, academic requirements, and experiential education. The questionnaire items were based on the current course content in geriatrics courses taught at the institution. Content validity of the questionnaire was assessed by administering the survey to three survey experts (including one in geriatrics); their suggestions were incorporated in redesigning the questionnaire. RESULTS: A total of 42 (50%) out of 84 schools responded. All responding schools had some form of geriatric education incorporated into their curriculum. However, the depth and breadth of the geriatric curriculum reported by the responding schools did not seem to be that different from results obtained by a 1985-1986 survey. CONCLUSION: Geriatric education in pharmacy schools has not increased proportionally with the expected increase in the geriatric population in the United States. Schools of pharmacy should make geriatric education a priority because the majority of patients whom pharmacists need to monitor or counsel currently are, and will continue to be, 65 years and older. Compared with a past study, the focus of current geriatrics education in pharmacy schools does not seem to have improved much despite the increasing need for geriatric practitioners and drug misadventures in the elderly.

Journal Article↗
PubMed1996

Concurrent process redesign and clinical documentation system implementation: a 6-month success story.

The need for accurate, timely, and complete clinical information has become critical as health care organizations compete on the basis of cost and quality. The automation of clinical documentation as part of the development of the computer-based patient record is a vital step in providing such information. As processes such as clinical documentation become automated, it is important that they are first redesigned both to maximize the capabilities of the new system and to increase their operational efficiencies. Riverside HealthCare in Kankakee, Illinois recognized this opportunity and successfully redesigned and automated its clinical documentation in 6 months. The article describes the necessary organizational commitment and project structure. Resource dedication, staff empowerment, physician involvement, and vendor partnership also are discussed. In addition, the documentation redesign, automation objectives, and lessons learned are reviewed.

Continuity of Patient Care↗
PubMed2000

[Positive and negative aspects of prenatal care in the district of Ribeirao Preto].

This study had the purpose to identify the positive and negative aspects of pre natal care at the public health system of the city of Ribeirão Preto-SP, considering users and health professionals' opinions. Authors used a qualitative approach and found some improvements regarding pre-natal care such as: the proximity of the Health Unit, the improvement of physical and human resources structures and the opening of places for the obstetrics unit. Despite these positive aspects, authors were unable to find a hospital reference at the different levels of the Unified Health System. Results also showed a lack of articulation among prenatal, birth and puerperium periods.

Attitude to Health↗
PubMedDate not supplied

[A proposal for programming at a didactic unit for nursing sciences (MED 45) in nursing degree courses].

Pre-registration nursing education in Italy has been recently transferred in University. Therefore, many changes, evaluations and innovations have been implemented in Insubria University (Università degli studi dell'Insubria, Varese). Starting from the reasons for the basis choice of three ample goals to reach in three years, a curricula proposal of the entire nursing disciplines and modules of the three years degree is presented. All nursing courses of the same disciplinary sectors ("MED 45" in the national university regulation) have been channelled into a few educational educational modules or units. The educational units of the first, second and third year are afterwards presented. The choice of these educational units is supported with examples while some tables show the topics of formal lectures together with the professionalising activities (i.e., laboratory, nursing skills acquisitiion, testimonies). Considering the difficulties one meets in evaluating teaching strategies, this three years experience has been positive for a few reasons. More precisely, it has contributed in decreasing the theory-practice gap, in developing critical thinking, and in answering to students'expectations at the beginning of the pre-registration course. The introductory module has favoured the development of skilla and abilities useful for self-education and the students' future professional development. The lack of human and structural resources together with the sometimes negative influence of the clinical placements climate (reality shock) is among the main difficulties found.

Curriculum↗
PubMed2004

Veterans' health care: balancing resources and responsibilities.

This paper looks at the health care benefits and services administered by the U.S. Department of Veterans Affairs. It examines management strategies adopted within the department to allocate resources, structure benefits, and improve quality. Some recommendations made by the General Accounting Office and the President's Task Force to Improve Health Care Delivery for Our Nation's Veterans are reviewed, in particular the emphasis of the latter on increased collaboration with the Department of Defense. Long-term proposals to balance service commitments and financing also are considered.

Delivery of Health Care, Integrated↗
PubMedDate not supplied

Integrative and facilitatory processes in premotor pathology and their application in training.

The role of the neurologist in rehabilitation goes beyond diagnosing the patient's disease and related functional disorders. This task, like dynamic diagnosis or the longitudinal evaluation of disease course and of the effects of treatments administered, can be carried out through consultations. In reality, the neurologist's direct intervention is required and should be oriented in three complementary directions. The role of the neurologist should be: 1) to define therapeutic interventions, both integrative and facilitatory training of the still preserved functions; 2) to identify patients in whom effective intervention is possible; 3) to make provision for methods and instruments designed, in both the exploratory and the therapeutic stages, to maintain the efficiency of, and to improve, the task-independent central functions. Motor pathology, whether of central origin secondary to pyramidal system damage, or of peripheral origin due to motor unit damage, falls within the field of task-specific executive processes. In the first instance, in which it is the first motor neuron that is affected, the most feasible intervention, in both an extensive and an intensive sense, is positional feedback and electrical stimulation (PFST) to prevent disuse of the short-range integrative and facilitatory functions, at the level of the praxic engram centres. In the second instance, in which it is the second motor neuron that is affected, the intervention is based mainly on classic physiokinesitherapy, in its various forms. The sector of interest to this symposium is that of premotor pathology, and its three main systems: initiation of movement, impairment of which gives rise to akinetic and dyskinetic syndromes; coordination of movement with inhibition of the antagonist muscles, impairment of which gives rise to primary ataxic syndromes: and spatial and temporal programming, impairment of which leads to various forms of apraxia. Furthermore, these three systems are associated, even at a preliminary level, with a structural resource and with two general mechanisms: mnesic memory stores and their coding and decoding function, impairment of which gives rise to phrenasthenic and dementia syndromes; vigilance mechanisms, impairment of which leads to confusional states; and purposeful attention mechanisms, whose impairment leads to dissociative mental states. Having identified the patients in whom integrative and facilitatory functions should be investigated, it remains to define the anatomical-functional substrate of these functions.

Brain Diseases↗
PubMedDate not supplied

[Census 2004 of the Italian renal and dialysis units--Abruzzo-Lazio-Marche-Molise-Umbria].

The Italian Society of Nephrology (SIN) promoted a national survey in order to collect detailed information from all Italian renal and dialysis units. This is the second paper, following the first one which focused on three northwestern regions, aim-ing to present the results of the survey. In this paper, data from the central regions (Abruzzo, Lazio, Marche, Molise and Umbria) are reported. The most relevant findings in the five regions were: A) epidemiology--prevalence of dialysis patients = 742, 781, 731, 814, 768 per million population (pmp); prevalence of transplanted patients = 162, 153, 296, 134, 304 pmp; incidence of dialysis patients = 175, 179, 184, 143, 162; gross mortality of dialysis patients = 12.3, 11.8, 15.9, 13.4, 14.0%; distribution of vascular access in prevalent dialysis patients: arteriovenous fistula = 90, 87, 82, 94, 80%, central venous catheter = 7, 10, 15, 4, 17%; vascular graft = 3, 3 ,3, 2, 3%. B) Structural resources--number of hospital beds = 52, 43, 39, 62, 44; dialysis places = 205, 260, 203, 301, 226. C) Personal resources--renal physicians = 50, 78, 47, 53, 47 pmp; renal nurses = 162, 172, 180, 224, 245 pmp; each renal physician takes care of 15, 10, 16, 15, 17 dialysis patients and each renal nurse cares of 4.6, 4.6, 4.1, 3.6, 3.1 dialysis patients. D) Activity--admission to hospital= 2334, 1689, 2652, 1255, 1377 pmp; renal biopsies = 59, 84, 97, 19, 80 pmp. Despite the differences we find among the regions, most indexes are similar and show a satisfactory level of renal care provided in the central regions examined.

Ambulatory Care Facilities↗
PubMedDate not supplied

[Census 2004 of the Italian Renal and Dialysis Units. Emilia-Romagna, Toscana].

The 2004 SIN census of the Italian nephrology and dialysis centres showed many interesting data about the epidemiology and the organization in the Regions of Emilia-Romagna (ER) and Tuscany (T). A) Epidemiology: incidence of dialysis patients 169 pmp (patients per million population) in ER, 147 ppm in T; prevalence of dialysis patients 639 pmp and 665 pmp, respectively; prevalence of transplanted patients 325 ppm in ER and 233 pmp in T; gross mortality of dialysis patients 16.3% and 13.4%, respectively; B) Type of vascular access in prevalently dialysis patients: arteriovenous fistula 83% and 78%; central venous catheter 13% and 12%; vascular graft 5% and 9%. C) Structural resources: nephrology beds 44 mp (per million population) and 50 mp; dialysis places 157 and 146 mp. D) Personnel resources : renal physicians 29 and 41 mp; renal nurses 171 and 202 mp ; each renal physician cares for 22 and 16 dialysis patients, and each renal nurse takes care of 3.7 and 3.3 dialysis patients. E) Activity: hospital admissions 1572, 1769 pmp; renal biopsies 115 and 166 pmp.

Ambulatory Care Facilities↗
PubMedDate not supplied

[The aortic aneurysms and therapeutic management].

The aorta was saw has a tube who transport blood from the heart to all the human economy, today we see the aorta like an specific organ who not only is design to transport the blood and it is elements, the aorta also produce hormones and elements of the inflammatory responds and control the systemic pressure. That's why the aorta has it specific illness. In the entire world the pathology of the aorta is quite frequent with the appearance of a lot of new cases and occupies a predominant place in the general mortality of countries like United States of America, Japan or Brazil. This pathology needs the utilization of large amounts of economics, human and structural resources. In Mexico do not have the statistical information of the aortic illness because it is few diagnosed, and when induce death it confusing to another diseases. In the present time with the new no invasive diagnostic methods more approachable to the general population this disease is easier to diagnose. That is why he need to develop a multidisciplinary specialize group who can make the diagnosed and do the specific treatment for these disease.

Aortic Aneurysm↗
PubMed1990

Nursing care delivery systems. A nursing administrative practice perspective.

The Nursing Administrative Practice Perspective (NAPP) is a macro, ecologic, open systems, conceptual model. This model guides the discovery, understanding, prediction, and use of key resources, structures, goals, and processes in the delivery of nursing care. NAPP encompasses and expands upon established domains of nursing, person, health, and environment as they influence nursing administration practice. A heuristic device, NAPP advances the understanding of relationships between nursing administrative practice, nursing care delivery systems, and organizations.

Environment↗