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PubMed1998

[Dorsal sector of the liver].

The dorsal sector extends in front and to the sides of the inferior vena cava, separating the caval axis from the main liver (excepting superiorly the entrance of the main hepatic veins into the vena cava). The two elements, dorsal sector and retro-hepatic portion of the vena cava, actually make a single unit. It is made of two segments: left (segment I) larger than the Spieghel lobe, right (segment IX) incorporated in the posterior surface of the right liver. The "caudate process" is not a peculiar element: it is nothing else than the inferior margin of segment IX: the breadth gives information on the size of segment IX. The dorsal sector is the midportion of the posterior liver, it is absolutely independent of the right and left livers separated by the main portal fissure. Portal pedicles are numerous and ascendant, they arise from the posterior margin of the transverse portal arch (from right to left: segment VII vein, right lateral vein, right portal vein, left portal vein, segment II vein). The size of the dorsal sector is variable, and can be appreciated by an antero-posterior index. A voluminous sector may be a problem for the surgeon. Segment IX can be divided in three subsegments: IXb under the interval between the right superior hepatic vein and the middle hepatic vein (longer branches can ascend and supply a small portion of the upper surface in front of the vena cava), IXc under the very broad right superior vein, and posteriorly IXd, linked to segment VII. Only segment I and subsegment IXb receive branches from the right and from the left livers. Hepatic veins enter directly the caval axis, some enter the main hepatic veins. The dorsal sector is a large anastomosis between efferent veins and the vena cava. Anteriorly segment I is in contact with segment IV but also with segment VIII, subsegments IXb and IXc with segment VIII and IXd with segment VII. The fissural limit is difficult to locate. Posteriorly division of the triangular and coronary ligaments, section of the dorsal hepatic veins, the right middle and inferior veins allow separation of the liver from the posterior abdominal wall and the inferior vena cava, so the surgeon can reach the dorsal sector. A remarkable error has been commited when the main hepatectomies were described: the dorsal sector was not known and the caudate lobe was considered as a part of the left liver. Actually the dorsal liver is a separate entity covering the inferior vena cava which has no connexion with the main liver; when the main portal fissure is opened up to the anterior surface of the vena cava, the dorsal sector is opened vertically. Interruption of the pedicles must also be considered. For example, in a left hepatectomy, the left portal pedicle is divided, all the left branches for subsegment IXb (which will be preserved) are interrupted; but the left branches from the right portal pedicle are not interrupted and will bleed when the dorsal sector is divided. When splitting the liver for transplantation, some difficulties can occur, especially with the right transplant. A main practical interest is the possible propagation to the dorsal ducts of hilar carcinoma.

Hepatectomy↗
PubMed2004

The impact of the electronic health record on patient safety: an Alberta perspective.

Alberta is at the leading edge in developing its electronic health record (EHR ), a provincial initiative to provide healthcare providers with immediate access to a patient's medication history and laboratory test results, regardless of where they are in the province, or where the patient's drugs or other treatments were ordered. The Alberta EHR was launched in October 2003. So far 6,000 healthcare providers have voluntarily signed on to use it, and benefits to patient safety have been reported. The EHR is an important part of healthcare renewal that is required to improve patient safety; however, it must not be viewed as a stand alone cure-all solution to Canada's patient safety challenge. The EHR will only reach its full potential if it is part of an integrated approach to health renewal that stresses consistency of healthcare, practice and information standards, and consistency and standardization of healthcare data. Without a sector-wide EHR like Alberta's, the proliferation of computerized electronic medical records (EMRs) in hospitals, clinics and pharmacies might create "islands of information" that are not widely compatible. A national EHR approach must acknowledge the importance of improving broadly accepted practice standards and data consistency in order to reduce the islands of information and protect patients from medical errors as they move between them.

Alberta↗
PubMedDate not supplied

Organization of the Saudi health system.

Using existing data, we reviewed the organizational structure of the Saudi Arabian health system: its demography and history, principal health indicators, organization and management, type and distribution of facilities, financial base, and the impact on it of the Haj. We noted duplication of services, inadequate coordination between some health industry sectors, and the need for a more extensive and rational health centre network with improved information systems and data collection. We also noted scope for a greater role for the private health sector and increased cooperation between it and the public sector to improve health service delivery and population health.

Budgets↗
PubMed1987

Health care policy and regional epidemiology: international comparisons and a case-study from The Netherlands.

In a number of countries, regional levels of administration have assumed responsibilities for the health care sector. This paper presents a specification of epidemiological information that could be relevant for health care policy towards and within regions, as well as a review of British and Scandinavian attempts at using routinely available mortality data for these purposes. A Dutch case study is then presented. To determine whether regional mortality data by cause of death can be used as indicators of need for health care, and consequently be used as criteria for the allocation of financial resources, the correspondence between provincial disease-specific mortality, hospital admissions and new cases of disability benefits was analyzed. the findings were not convincing: for a number of diseases a reasonable correspondence between mortality and hospital admissions could be shown; for other conditions, however, especially ischaemic heart disease, none at all. It is concluded that: in the context of the formal allocation of health care resources to administrative units, a strong confidence in mortality data by cause of death is unwarranted; in the (broader) context of developing and evaluating regional health care policy, mortality data by cause of death can be useful for providing a focus on population health status and a starting point for further studies.

Catchment Area, Health↗
PubMed1994

The prevalence of informal caregiving to persons with AIDS in the United States: caregiver characteristics and their implications.

Based on U.S. national (N = 2673) and central cities (N = 8263) probability samples, this paper: (1) presents estimates of the proportion of the United States population that has provided informal care to persons with AIDS; (2) identifies socio-demographic characteristics of 'typical' AIDS caregivers in the U.S.; and (3) discusses social, economic and health-related implications of informal caregiving to persons with AIDS. Results indicate that 5.0% of all adults age 18-75 living within central cities and 3.2% of the entire adult U.S. population have provided care to a friend, relative or lover with AIDS. Although caregivers are distributed throughout different age and ethnic groups, the majority of caregivers are younger (< 40 years) and white. Males, gay and bisexual men in particular are over-represented among central cities caregivers. Data on the types of caregiving tasks performed show that 64.4% of all caregivers within central cities perform domestic types of caregiving tasks, while 27.7% are involved in personal care of AIDS patients. Caregivers are more likely than non-caregivers to have been tested for HIV, and among the tested, caregivers are more likely to have tested positive. While informal caregiving reduces costs to the formal medical sector, costs to the caregivers themselves should be considered. Physical and emotional stress, as well as reduced opportunity for social and economic development, represent potential outcomes of caregiving. Socio-demographic characteristics of AIDS caregivers, such as their typically young age, suggest that these caregivers may be at particular risk for detrimental consequences.

AIDS Serodiagnosis↗
PubMed1996

Treatment seeking for malaria: a review of recent research.

A review of literature on treatment seeking for malaria was undertaken to identify patterns of care seeking, and to assess what is known about the adequacy of the treatments used. There is considerable variation in treatment seeking patterns, with use of the official sector ranging from 10-99% and self-purchase of drugs ranging from 4-87%. The majority of malaria cases receive some type of treatment, and multiple treatments are common. The response to most episodes begins with self-treatment, and close to half of cases rely exclusively on self-treatment, usually with antimalarials. A little more than half use the official health sector or village health workers at some point, with delays averaging three or more days. Exclusive reliance on traditional methods is extremely rare, although traditional remedies are often combined with modern medicines. Although use of antimalarials is widespread, underdosing is extremely common. Further research is needed to answer the question of what proportion of true malaria cases get appropriate treatment with effective antimalarial drugs, and to identify the best strategies to improve the situation. Interventions for the private and public sector need to be developed and evaluated. More information is needed on the specific drugs used, considering resistance patterns in a particular area. In order to guide future policy development, future studies should define the nature of self-treatment, record multiple treatments and attempt to identify the proportions of all cases who begin treatment with antimalarials at standardized time intervals. Hypothetical questions were found to be of limited usefulness in estimating rates of actual treatments. Whenever possible, studies should focus on actual episodes of illness and consider supplementing retrospective surveys with prospective diary-type methods. In addition, it is important to determine the specificity of local illness terms in identifying true malaria cases and the extent to which local perceptions of severity are consistent with clinical criteria for severity and symptoms of complicated malaria.

Drug Resistance↗
PubMed1998

Modular workcells: modern methods for laboratory automation.

Laboratory automation is beginning to become an indispensable survival tool for laboratories facing difficult market competition. However, estimates suggest that only 8% of laboratories will be able to afford total laboratory automation systems. Therefore, automation vendors have developed alternative hardware configurations called 'modular automation', to fit the smaller laboratory. Modular automation consists of consolidated analyzers, integrated analyzers, modular workcells, and pre- and post-analytical automation. These terms will be defined in this paper. Using a modular automation model, the automated core laboratory will become a site where laboratory data is evaluated by trained professionals to provide diagnostic information to practising physicians. Modem software information management and process control tools will complement modular hardware. Proper standardization that will allow vendor-independent modular configurations will assure success of this revolutionary new technology.

Automation↗
PubMed2003

Use of the "partition" test in behavioral and pharmacological experiments.

he characteristics and potential applications of a test assessing animals' behavioral responses to another individual placed in the neighboring sector of the cage, divided in half by a transparent partition with holes, are discussed. The animals' behavioral responses differed depending on the physiological and psychological state of an individual, its social experience, type of partner in the neighboring sector, and line. The "partition" test can be informative and productive in experiments designed to study the neurochemical and neurophysiological mechanisms of sociability, anxiety, olfaction, aggressive and sexual behavior, and in experiments addressing the psychotropic properties of agents.

Aggression↗
PubMed2002

The use of information and communication technology in veterinary education.

The internet provides new opportunities to deliver distance and e-learning to the veterinary profession both at undergraduate and postgraduate levels. There are now numerous examples of successful computer-based educational projects in UK higher education, which provide useful models for veterinary science. This will present challenges for academics who will need to adapt their teaching methodologies and students who will have to develop new ways of learning. The future of Information and Communication Technologies (ICT) in the veterinary sector is difficult to predict but it is likely to have far reaching effects on the profession.

Computer-Assisted Instruction↗
PubMed2004

Professionals' views on the issues and challenges arising from providing a fertility preservation service through sperm banking to teenage males with cancer.

Interviews were undertaken with 22 health and social work professionals. Their analysis was completed using "selective transcription", noting understanding of process, issues and themes, and building a picture against which to consider the analysis of subsequent interviews with teenagers and parents. Professionals were also asked to identify areas for feedback from these participants. This work was part of a larger study of (i) the perceptions of adolescent males and their parents of fertility preservation services following a cancer diagnosis, and (ii) national postal surveys of common practices, areas of variance and issues experienced by professionals in UK regional paediatric oncology centres and licensed assisted conception centres. A large number of concerns were identified, which reflected professionals' difficulties in building and maintaining a relevant, adequate knowledge and skills base given the limited numbers of teenagers offered this service. The lack of appropriate training about the legal and consent frameworks, and the processes involved was also highlighted across all professional groups as was the confusion around professional and legal responsibilities for follow up. Thus, there was considerable professional uncertainty in a number of aspects of this sensitive area of service provision. Consideration needs to be given to the needs for national guidance, for training, support and updating, for liaison between the different health and social care sectors that may be involved, and for appropriate information systems. These need to be in place for each stage of the process, from diagnosis through to eventual discharge from the health system.

Adolescent↗
PubMed2001

Health promotion and the First Amendment: government control of the informational environment.

Government efforts to protect public health often include controlling health information. The government may proscribe messages conveyed by commercial entities (e.g., false or misleading), recommend messages from commercial entities (e.g., warnings and safety instructions), and convey health messages (e.g., health communication campaigns). Through well-developed, albeit evolving, case law, government control of private speech has been constrained to avoid impinging on such values as free expression, truthfulness, and autonomous decision making. No simple legal framework has been developed for the government's own health messages to mediate between the legitimate goals of health protection and these other values. Nevertheless, government recommendations on matters of health raise difficult social and ethical questions and involve important societal trade-offs. Accordingly, this article proposes legal and ethical principles relating to government control of the health information environment.

Advertising↗
PubMed2006

Use of health impact assessment in incorporating health considerations in decision making.

STUDY AIM: The aim of this project is to identify from a range of sources the factors associated with the success of a health impact assessment (HIA) in integrating health considerations into the final decision and implementation of a planned policy, programme, or project. DESIGN: Three methods were adopted: (a) a review of HIA case studies; (b) a review of commentaries, reviews and discussion papers relating to HIA and decision making; and (c) an email survey of a purposive sample of HIA academics, HIA practitioners, and policymakers. Information was captured on the following characteristics: information on the year undertaken; geopolitical level; setting; sector; HIA type; methods and techniques used; identification of assessors. MAIN RESULTS: Two groups of factors were identified relating to the decision making environment and to the technical conduct of the HIA. With regard to the environment, striking a balance between decision maker ownership and HIA credibility; organisational, statutory and policy commitment to HIA, and the provision of realistic, non-controversial recommendations were cited as enablers to the integration of HIA findings into the decision making process. Barriers included a lack of knowledge of the policymaking environment by those conducting HIA. Regarding factors relating to the conduct of the HIA: use of a consistent methodological approach; inclusion of empirical evidence on health impacts; timing of the HIA congruent with the decision making process; involvement of expert HIA assessors; and shaping of recommendations to reflect organisational priorities were cited as enablers while lack of a standardised methodology; lack of resources and use of jargon were cited as barriers. CONCLUSIONS: The findings emphasise the importance of considering the politico-administrative environment in which HIA operates. The extent to which HIA fits the requirements of organisations and decision makers may be as important as the technical methods adopted to undertake it.

Community Health Planning↗