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PubMedDate not supplied

Rational planning and responsiveness: the case of the HSAs.

American government in the twentieth century has been faced with a serious value conflict between the need for rational allocation of scarce resources through planning, and the need to be responsive to a diverse society. Two ideal types of planning correspond to these two values. Rational planning emphasizes the importance of the planner's expertise in achieving the "best" path to socially defined goals. Advocacy planning emphasizes the importance of responsiveness to group interests since all planning decisions are basically a matter of value choice. Citizen participation in planning often combines elements of these two models, embodying the value conflict in planning agency procedures. Health systems agencies are examined as a typical case of such planning. Their failure to build a constituency is viewed as a consequence of role conflict reduction strategies by representatives who did not know whether to play the planner or the advocate role, and how to play either.

Community Participation↗
PubMed1976

Rationalizing the delivery of health care--part III.

Attempts to regionalize and rationalize the delivery of personal health services and eye care services in particular are beset with social, political and economic problems. A review of past attempts in this direction points out some of the difficulties. Recent legislative and professional developments provide clues as to the likelihood that the delivery of eye care will be rationalized in the future.

Delivery of Health Care↗
PubMed1999

A rational request behavior: the development of prediction instruments regarding thyroid function tests in primary care.

A prospective study was performed to encourage a rational thyroid-stimulating hormone (TSH) test request behavior of physicians, using prediction instruments. The latter give direct feedback about request adequacy on the basis of pretest probabilities of hyperthyroidism using patients' signs and symptoms. For instrument design, stepwise logistic regression was used on diagnostic data acquired through questionnaires, answered by 80 physicians and 668 patients for whom physicians requested a TSH test. Instruments were designed for clinical and subclinical hyperthyroidism and for clinical hyperthyroidism alone. Use of the instrument for clinical or subclinical hyperthyroidism on the selected group, at a 5% probability threshold, can result in a 37% reduction of unnecessary TSH test requests. With the instrument for clinical hyperthyroidism at a 5% probability threshold, the number of unnecessary test requests can be reduced by 57%. Therefore, it can be concluded that the instruments can determine TSH test request adequacy and encourage a rational TSH test request behavior of physicians at low pretest probability thresholds.

Adolescent↗
PubMed1999

[Nutrition of horses: ration calculation and assessment].

In various situations it is desirable to evaluate the diet of horses. Such situations occur when nutrition is considered as the cause of disease or symptoms or and when a diet or diet change raises concern about whether the animal is receiving sufficient nutrients. Ration evaluation consists of translating feed ingredients into nutrients supplied and comparing this with nutrient requirements. The basics of ration evaluation are illustrated by means of four examples of horse diets.

Animal Feed↗
PubMed1999

[Rational laparoscopic intervention in laparoscopically-assisted vaginal hysterectomy (LAVH): prospective study].

INTRODUCTION: Despite evidence that the vaginal route of surgery is associated with fewer complications and faster recovery, more than two-thirds of hysterectomies are performed abdominally. Diagnostic and operative laparoscopy leads to an increasing number of hysterectomies performed vaginally, although laparoscopy may lead to serious complications. The object of the study was to evaluate the rational share of laparoscopy during laparoscopically assisted vaginal hysterectomy. METHOD: 100 consecutive women subjected to hysterectomy were indicated for laparoscopically assisted vaginal hysterectomy. The procedures were performed by the same surgical team experienced in laparoscopy and vaginal route hysterectomy which evaluated the rational share of laparoscopy during laparoscopically assisted vaginal hysterectomy. The mean age of the patients was 48.1 years (range 34-71 years). 7 were nulliparae. 69 patients were indicated for operation due to myomas, 20 for the previous operation in the pelvic area, 6 for adnexal cystic masses, 5 for the associated indications. At the same time bilateral adenexectomy was performed in 74 patients. Uterine descensus was diagnosed in 9 patients preoperatively and the operations for stress urine incontinence were performed in 7 cases (Kelly-Stoeckel 4 and Pereyra 3 respectively). Ovarian vessels were coagulated by bipolar coagulation during laparoscopy and uterine vessels were ligated by the vaginal route. RESULTS: The uterus was extripated electively by the abdominal route in 2 patients after diagnostic laparoscopy (unfavourabl localised intraligamentous myoma, distended bowels after using Tractrium by the anestesiologist). Hysterectomy by the vaginal route was completed in 98 patients. The mean operation time was 80 minutes (range 55-180 minutes) and the mean operation time of the laparoscopic part of the operation was 35 minutes (range 25-45 minutes). The estimated blood loss was 300 ml (range 100-550 ml). In 2 patients lysis of dense pelvic adhesions during the laparoscopic part caused that the vaginal part of surgery was safe. 10 complications were encountered postoperatively (3 cases of bleeding from the vaginal vault and 1 from ovarian vessels respectively, 3 cases of pelvic inflammatory disease, 2 injuries of the urinary bladder were recognized and treated peroperatively and 1 case of stress urinary incontinence 10 weeks after hysterectomy). DISCUSSION: According to the literature a different extent of surgical laparoscopy in vaginal hysterectomy is possible. Nulliparity or uterine myomas are no contraindications for vaginal hysterectomy. The main contribution of surgical laparoscopy for vaginal hysterectomy consists in lysis of dense adhesions in the pelvic area and in evaluating or operating adnexal cystic masses. Other indications are controversial because of prolonging the operative time and general risks of diagnostic and surgical laparoscopy. CONCLUSION: The main contribution of laparoscopy for the purposes of vaginal hysterectomy remains the assessment and treatment of dense pelvic adhesions or adnexal pathology rather than hysterectomy itself. Bipolar coagulation of ovarian vessels decreases the blood loss in cases of enucleation of morcellation of myoma(s) during the vaginal part of the operation.

Adult↗
PubMed1975

[Material-testing studies for the rationalization of the technology of stomatological cold curing-plastics].

Materials scientific studies on the rationalization of the processing of stomatological cold-curing plastics. Hydropneumatic overpressure polymerization leads to a considerable rationalization of the processing of stomatological cold-curing plastics, but its effects on the course of polymerization and the properties of the polymerizate are yet not sufficiently elucidated. For this reason, the author studied in several test series the effects of various processing parameters (flask and overpressure vessel; varying mixing ratios, pressures and temperatures) on the polymerization of Kallocryl-AS, a cold-curing plastic. The results obtained indicate that, under certain processing conditions, overpressure polymerization of cold-curing plastics may be recommended from the viewpoint of materials science.

Cold Temperature↗
PubMedDate not supplied

[Rational anti-epileptic polytherapy. Drug interactions and choice of treatment].

INTRODUCTION: Following twenty years of antiepileptic biotherapy, monotherapy superseded this when it was shown to be equally effective, have fewer problems of drug interactions and the patients were more likely to actually take their drugs. However, the development of the so-called new antiepileptic drugs gives rational biotherapy a new chance. OBJECTIVE: In this article we discuss the basis of reasoned polytherapy and some of the possible interactions between antiepileptic and other drugs. DEVELOPMENT AND CONCLUSIONS: When polytherapy is considered, antiepileptic drugs with different modes of action and profiles of adverse effects should be used. Some epileptic patients may attain control of their seizures with rational polytherapy. The drug reactions between the antiepileptic drugs themselves and with other drugs are frequent but not usually of clinical importance. We discuss some of the more relevant interactions. Choice of the initial antiepileptic drug is based on various factors, basically the type of seizure, age of the patient, epileptic syndrome, possibility of pregnancy, family and job considerations.

Anticonvulsants↗
PubMed2000

[Uncertainty of practitioners between rational and evidence-based dermatology].

In opposition to intuitive and empirical approaches, rigorous medicine relies on two axes of development. Evidence-Based Medicine is currently put forward. However, it can not replace rational medicine rooted in physiopathological explanations. Dermatology does not escape such conceptual duality. Dermatopathology is one major pillar of rational dermatology. Such situation is jeopardized by health planners who deny the perennial skill of dermatologists and concede hegemony of dermatopathology to general pathologists.

Decision Making↗
PubMed2000

[Rationalization of risk factors for venous thromboembolism in medical inpatients. A prospective study].

BACKGROUND: In terms of preventive management of venous thromboembolism in medical inpatients, very large differences may be observed. Rationalization of behaviour requires the evaluation of simple and logical parameters, which takes into account both patient safety and economic considerations. AIM: The aim of this study was to evaluate a preventive scheme including the rationalization of the indications and the use of low molecular weight heparin. METHODS EXPERIMENTAL DESIGN: Epidemiologic investigation. SETTING AND PATIENTS: Patients hospitalized in five medical departments in the Hospital Center of Nantes, France. INTERVENTION: The risk of venous thromboembolism was rated as high, intermediate and low. Patients with high or intermediate risk were eligible for prevention therapy (table I). MEASURES: The main criterion was the occurrence during hospital stay of deep or superficial venous thrombosis of the lower limbs, pulmonary embolism, or unexplained sudden death. The screening was based on clinical features double-checked by venous doppler ultrasonography of the lower limbs and/or ventilation-perfusion lung scanning. RESULTS: 24,497 patients were eligible (table II), 15% were considered at risk and treated with Nadroparin, 6% had the same risk profile but were not treated and 14. 7% had low risk and no prevention. No bleeding event was reported. The incidence of venous thromboembolism was 0.75%, 1.7% and 0.14% respectively (p <0.01) (table III). This efficacy does not appear to depend on body weight or the existence of multiple risk factors observed (table IV and V). CONCLUSIONS: This analysis of risk factors separates two populations with rates of incidence dramatically and significantly different. The prevention of venous thromboembolism by fixed dose of low molecular weight heparin remains justified since it reduces the risk of venous thromboembolism by a factor of 2.5.

Adult↗
PubMed2000

Rational migraine management: optimising treatment with the triptans.

In the last two years, a number of 5-HT1B/1D agonist triptans with enhanced lipophilicity (TELs) relative to the first drug of this class, sumatriptan, have been approved for marketing in most countries of the world (naratriptan, rizatriptan and zolmitriptan). In addition, at least three others are in advanced stage of clinical development (almotriptan, eletriptan, and frovatriptan). This paper sets out to review the recent data with the aim of identifying: 1) What are the critical differences between the TELs and sumatriptan? 2) How do the currently licensed TELs compare? 3) Is it possible to provide a rational approach to migraine therapy based on objective differences in the clinical profile of these new drugs? Recent randomised controlled and comparator data were reviewed, including the independent FDA assessment of rizatriptan. Critical differences for the new TELs (naratriptan, rizatriptan and zolmitriptan) which may lead to more rational migraine management: Both rizatriptan (10 mg) and zolmitriptan (2.5 mg and 5.0 mg) have demonstrated superior efficacy to sumatriptan 100 mg, and 25 and 50 mg respectively. Therefore, for first line use either rizatriptan or zolmitriptan would be appropriate for moderate and severe headache. Rizatriptan has a more rapid onset of action than sumatriptan 100 mg. Both rizatriptan and zolmitriptan have a more rapid onset of action than naratriptan. Therefore, for a rapid onset of action either rizatriptan or zolmitriptan would be appropriate. Naratriptan would appear to have a lower recurrent headache rate than sumatriptan, rizatriptan or zolmitriptan. However, 24-hour efficacy rates for zolmitriptan 2.5 mg were significantly greater than for sumatriptan 25 mg and 50 mg and were not significantly different from naratriptan. Therefore, for headaches of long duration and with a tendency to recur (e.g. menstrual headaches) either naratriptan or zolmitriptan would be appropriate. Naratriptan has lower reported adverse event rates comparable with placebo. This would support the use of naratriptan 2.5 mg in patients who have demonstrated poor tolerance to the "triptan type" adverse events.

Humans↗
PubMedDate not supplied

The rational approach to the electrical exploration of the heart.

A rational approach is inevitable in any scientific activity. Such an approach is opposed not only to irrationality, at all inadmissible in scientific thinking, but also to empiric reasoning. Many years ago, Sodi Pallares introduced the rational method in the electrical exploration of the heart based on experimental findings obtained in his laboratory. This method has progressively been accepted and used with good results for diagnoses and has led to logical therapeutic inferences. To confirm the results from the logical interpretation of electrical tracings, we present some examples of its application in three fields: arrhythmias, myocardial infarction, and left ventricular hypertrophy. In the studied cases--two with tachycardia, one with a posterior infarct, and two with left ventricular hypertrophy--a very satisfactory correlation has been observed between the electrical exploration findings and those obtained through direct examination of the heart. It is desirable, and even profitable, to analyze in this way the electrical tracings to get as close as possible to reality, rejecting the stereotyped aspects of a simple routine exploration, which often induce errors and lead to some fallacious asseverations.

Electrocardiography↗
PubMedDate not supplied

[Influence of methandrostenolone on some aspects of protein metabolism in rats in the context of various protein rations].

Wistar male-rats receiving by mouth dianobol for 10 days and 9 months and fed on rations with different proportions of protein were investigated. Dianobol is shown to produce under definite conditions changes in the intensity of the protein synthesis in the muscle tissue and liver of the test animals and also to raise the activity of tryptophan-peroxidase and of alanine-amintransferase, the protein level in the ration being here of substantial importance. With its long-term administration to rats dianobol displays an androgenic effect on the gonads and the supernumerally genitals without exercising any stimulating action on the weight gain.

Alanine Transaminase↗
PubMed1979

[Effect of varying amounts of lysine in the ration on chickens].

The effect of varying lysine quantities given in the daily ration to 20 day-old chickens was studied for a 40 day-period. Highest body gain (157% as compared to the control group) was observed in group I (0.20% lysine). Two and four per cent of lysine in the ration reduced the basic body gain by 69.7% and 66.9% respectively. The level of calcium, blood sugar, carotene and vitamin A rose considerably, while phosphorus and magnesium content was reduced. SGOT and SGTP values remained without significant changes. The relative kidney weight increased.

Animals↗
PubMedDate not supplied

[Rational ways for disseminating information to physicians about medical aid to patients with sexually transmitted diseases].

The article is devoted to problems of rational information insurance of the practical health care system. The most rational ways are defined for dissemination among physicians of information about different aspects of the profile medical care delivery to patients with infections caught by sexual intercourse or genital contact. Rating of different sources of information has been formed, with optimum patterns of information supplies delinated. Based on the analysis of the medical care delivery system, the most characteristic shortcomings of those information sources having received the worst rating are presented together with merits of those sources of obtaining information to have received a good rating.

Humans↗
PubMed2002

Commercial sport drinks versus light meal combat rations: effect on simulated combat maneuvers.

This study compared a light meal combat ration (LMCR) to specific commercial sport drinks (CSD) and the effect of their ingestion on time to exhaustion during simulated combat maneuvers (SCM). The SCM consisted of three activities: a 2-hour march at 50% of maximal aerobic capacity (VO2max); a subsequent 1-hour run at 70% VO2max; and a run to exhaustion at 80% VO2max. During SCM, the subjects consumed one of four different meals: three CSD (Ergo, Go Sports, and Gatorlode), and the LMCR. In addition, one SCM was conducted with half-rations. Oxygen consumption, heart rate, and rating of perceived exertion were evaluated during each phase of the SCM. Time in minutes (mean +/- SD) to exhaustion at 80% VO2max for Ergo (42.3 +/- 8.9), Go Sports (39.4 +/- 13.3), and Gatorlode (37.7 +/- 8.6) was not significantly different from that for LMCR (36.4 +/- 13.0) but was greater than that for half-LMCR (30.3 +/- 9.3). O2 consumption, heart rate, and rating of perceived exertion were not affected by meal type but did increase over time for each stage of the SCM. We conclude that the amount of calories ingested was responsible for the differences noted in time to exhaustion. We further conclude that the CSD represent a readily available source of energy and fluid that could be used to replace and/or supplement the current LMCR.

Adult↗
PubMed2001

[Did Wilhelm Kopp possess the Par. gr. 2254 and 2255? A study on his translation of Hippocrates' De victus ratione in morbis acutis].

In the preface of his Greek edition of Hippocrates, published in Basle in 1538, Janus Cornarius of Zwickau mentions a manuscript of the French physician Nicolas Kopp among the textual sources used by him to review the preceding edition. It is known that Nicolas inherited the library of his father Wilhelm, who made the translations of two Hippocratic treatises, Prognostikon and De victus ratione in morbis acutis, published in Paris in 1511. It is suggested that the manuscript used by Cornarius for his edition and earlier by Wilhelm Kopp for his translations can be identified with the Par. gr. 2254 and 2255. This proposal is verified in the present article by an examination of the translation by Wilhelm Kopp of the treatise De victus ratione in morbis acutis, which is contained in the original part of the manuscript Par. gr. 2254.

France↗
PubMed2003

[The evaluation of nitrate, nitrite and antioxidant vitamin intake in daily food ration of children aged 1-6 year of age].

The aim of this study was evaluation of nitrates, nitrites and antioxidant vitamins intake in daily food rations of children aged 1-6 years. The levels of nitrites and nitrates in daily food rations were calculated using menu data and literature nitrites and nitrates content data in food products and compared with the acceptable daily intake (ADI). The percentage contribution of selected groups of products in nitrates and nitrites supply was calculated. Antioxidant vitamins level was calculated with using menu data and Food composition tables and compared to the recommendations. Nitrates content exceeded acceptable daily intake (ADI) for children aged 1-6 twice, but level of nitrites was below (88% ADI). The main food source of nitrates were vegetables supplied 90% of one. The main sources of nitrite were meat products supplied 27.6% of one, vegetables and their products--26.2% and cereals supplied 24.6% of nitrites. All calculated vitamins (A, E, C) exceeded recommendations what protected children from high level of nitrates.

Antioxidants↗