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PubMedDate not supplied

Narrative literature review: sexual dysfunction in the patient on hemodialysis.

Sexual dysfunction is common in patients on hemodialysis. This narrative literature review utilized Roy's Adaptation Model to identify sexual dysfunction and its effect on adaptive modes in patients on hemodialysis. The majority of studies reviewed indicated a physiologic effect in men (78%). Fewer studies reported an effect on self-concept (66%), intimate relationship (21%), or family/social roles (less than 1%). Findings also revealed minimal patient expression of sexual dysfunction to health care providers.

Adaptation, Psychological↗
PubMed2005

Determinants of computed tomography and magnetic resonance imaging utilization in Taiwan.

OBJECTIVES: Magnetic resonance imaging (MRI) and computerized tomography (CT) scanners are high-tech equipment with the highest utilizations and expenditures in Taiwan. This study investigates the factors that affect MRI and CT utilization, such as whether supply-side factors have more impact than demand-side factors, and the effect of utilization control policies. METHODS: This study used the nationwide CT and MRI claim data for the years 1998 to 2001 from the Bureau of National Health Insurance (BNHI) in Taiwan. Multiple regression analysis was the statistical method used to determine the relative factors that influence CT and MRI utilization. RESULTS: CT: population ratio, hospital-based physician: population ratio, female ratio, pediatric (< or =14 years) : population ratio, and family income significantly influenced CT utilization. MRI : population ratio and hospital-based physician : population ratio, female ratio, and family income significantly influenced MRI utilization. However, the proportion of the aged (> or =65 years of age) did not significantly influence CT or MRI utilization after controlling for other factors. The rates of CT and MRI utilization for the outpatient and inpatient settings and the repeated uses of CT or MRI have decreased significantly after a utilization review was implemented by BNHI, which suggests that CT and MRI have been overused. CONCLUSIONS: Increases in supply-side factors significantly increase CT/MRI utilization, and supply-side factors impact CT/MRI utilization more than demand-side factors. The results show that the utilization instant report policy effectively decreases repeated uses of CT/MRI.

Diffusion of Innovation↗
PubMed1984

Phenotypic analysis of established diffuse histiocytic lymphoma cell lines utilizing monoclonal antibodies and cytochemical techniques.

Ten diffuse histiocytic lymphoma (DHL) cell lines were extensively characterized with monoclonal antibodies and histochemical techniques. The original biopsy specimens, representing nine of ten cases from which the cell lines were derived, were reviewed utilizing the International Working Formulation. Eight of ten cell lines reacted with anti-immunoglobulin reagents and/or a subset of B-lymphocyte surface markers, supporting a B-cell derivation. Only U-937, a monocytoid DHL cell line reactive with OKT4 and 6, displayed any T-cell markers. Cytochemical analysis alone proved to be of little value in the subclassification of the DHLs. The pathologic review revealed that, despite disparate immunologic phenotypes, five of the diffuse large cell lymphomas were subclassified as large, noncleaved lymphomas. Our analysis confirms the phenotypic diversity of this subgroup of malignant lymphomas and underscores the value of monoclonal reagents for the immunologic evaluation of the hematologic malignancies. These well characterized cell lines constitute a valuable resource for the laboratory investigation of the lymphomas.

Adult↗
PubMed2005

Therapeutic facet joint interventions in chronic spinal pain: a systematic review of effectiveness and complications.

BACKGROUND: Facet joint interventions are used frequently for managing chronic spinal pain. Evidence continues to accumulate supporting the clinical effectiveness of these procedures and defining potential complications. OBJECTIVE: To evaluate the effectiveness of three types of facet joint interventions (facet joint injections, medial branch blocks and facet joint neurotomy) in managing spinal pain. STUDY DESIGN: A systematic review utilizing the criteria established by the Agency for Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials and Cochrane Musculoskeletal Review Group for randomized trials. METHODS: Data sources included relevant literature of the English language identified through searches of MEDLINE and EMBASE (January 1966 to November 2004), manual searches of bibliographies of known primary and review articles, and abstracts from scientific meetings within the last 2 years. Analyses were performed for the different modes of facet joint interventions of cervical, thoracic and lumbar spine, to determine short- and long-term outcome measurements and complications associated with the procedures. OUTCOME MEASURES: The primary outcome measure was pain relief. For facet joint injections and medial branch blocks, short-term pain relief was defined as relief less than 6 weeks, and long-term as 6 weeks or longer. For medial branch radiofrequency neurotomy, short-term relief was defined as pain relief of less than 3 months, and long-term as 3 months or longer. Other outcome measures included functional improvement, improvement of psychological status, and return to work. RESULTS: For lumbar intraarticular facet joint injections, there was moderate evidence for short-term improvement, and limited evidence for long-term improvement. The evidence was negative for cervical intraarticular facet joint injections. For cervical and lumbar medial branch blocks with local anesthetics and steroids, the evidence was moderate. The evidence for pain relief with radiofrequency neurotomy of medial branch nerves was moderate to strong. CONCLUSION: The evidence for facet joint interventions ranged from negative to strong.

Journal Article↗
PubMed2000

Standardizing social indicators to enhance medical case management.

With the advent of Medicaid Managed Care, health care professionals and administrators have sought ways to increase patient compliance and appropriate utilization of services under a capitated system. The major focus has been on medical managed care and utilization review to control cost. This paper focuses on the development and standardization of social indicators to identify the biopsychosocial problems that cause medical noncompliance and inappropriate utilization of medical services by the Medicaid patient. The development of what is called Life Indicators is discussed and serves as a basis for enhancing the medical case management model to control cost when providing services to patients with complex medical and social problems.

Baltimore↗
PubMed2006

The 8 dimensions of quality.

Healthcare providers can better develop strategies for achieving and maintaining high-quality care by reviewing quality of care laws and metrics in relation to eight dimensions of quality: Reporting. Documentation. Quantity or access to care. Patient satisfaction. Provider reputation. Clinical processes. Utilization review. Medical necessity determinations.

Efficiency, Organizational↗
PubMed2005

Role of epidural steroids in the management of chronic spinal pain: a systematic review of effectiveness and complications.

BACKGROUND: Epidural steroid injections are commonly used for chronic spinal pain. However, there is no conclusive evidence regarding their effectiveness, and debate continues as to their value in managing chronic spinal pain. OBJECTIVE: To evaluate various types of epidural injections (interlaminar, transforaminal, and caudal) for managing chronic spinal pain (axial and radicular). STUDY DESIGN: A systematic review utilizing the criteria established by the Agency for Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials, and criteria of the Cochrane Musculoskeletal Review Group for randomized trials. METHODS: Data sources included relevant English literature identified through searches of MEDLINE and EMBASE (January 1966 to November 2004), manual searches of bibliographies of known primary and review articles and abstracts from scientific meetings within the last 2 years. Three reviewers independently assessed the trials for the quality of their methods. Subgroup analyses were performed for trials with different control groups, with different modes of epidurals (interlaminar, transforaminal, and caudal), with different injection sites (cervical/thoracic, lumbar/sacral), and with timing of outcome measurement (short- and long-term). OUTCOME MEASURES: The primary outcome measure was pain relief. Other outcome measures were functional improvement, improvement of psychological status, and return to work. Short-term improvement was defined as less than 6 weeks, and long-term improvement was defined as 6 weeks or longer. RESULTS: For lumbar radicular pain with interlaminar lumbar epidural steroid injections, the level of evidence was strong for short-term relief and limited for long-term relief. For cervical radicular pain with cervical interlaminar epidural steroid injections, the evidence was moderate. The evidence for lumbar transforaminal epidural steroid injections for lumbar nerve root pain was strong for short-term and moderate for long term improvement. The evidence for cervical transforaminal epidural steroid injections for cervical nerve root pain was moderate. The evidence was limited for lumbar radicular pain in post lumbar laminectomy syndrome. The evidence for caudal epidural steroid injections was strong for short-term relief and moderate for long-term relief. For managing chronic postlumbar laminectomy syndrome and spinal stenosis the evidence was limited for low back and radicular pain. The evidence was moderate for chronic low back pain. CONCLUSION: The evidence for effectiveness of epidural injections in managing chronic spinal pain ranged from limited to strong.

Journal Article↗
PubMed2004

CT scans may not reduce the negative appendectomy rate in children.

BACKGROUND/PURPOSE: Concern about an increased lifetime risk of cancer in children who have undergone a single computed tomography (CT) scan prompted us to review utilization of this diagnostic test in our appendicitis population. METHODS: From 1998 to 2001, the records of 720 children admitted to our hospital with a diagnosis of appendicitis were reviewed for adjunct diagnostic modalities, including ultrasonography (USG) and CT scanning. Negative appendectomy rates were determined by the final pathologic report. Statistical comparisons were made using the chi(2) test, and significance was assigned at P <.05. RESULTS: The use of ultrasound scan for diagnosing appendicitis decreased from 20.0% in 1998 to 7.0% in 2001 (P <.01). Conversely, the use of CT scans increased from 17.6% in 1998 to 51.3% in 2001 (P <.001). During this time period the difference in the negative appendectomy rate was not statistically significant (P < 0.20). Of the negative appendectomies, 11 of these patients had a USG interpreted as positive for appendicitis (22.0%), and 9 had a CT scan interpreted as positive (18.0%). CONCLUSIONS: Liberal use of CT scans in diagnosing appendicitis in children has not resulted in a decreased negative appendectomy rate. Potentially harmful radiation exposure should prompt pediatric surgeons to reevaluate the role of CT scanning in the management of children with suspected appendicitis.

Adolescent↗
PubMed1995

[Quality assurance in health care and its economic aspects].

The author defines the term of quality assurance as a cycle of activities to ensure the best possibly attainable standard of provided health care and characterizes its attributes. Within the range of a review he analyzes different constituents of quality assurance, in particular with regard to effectiveness and efficiency of health care. In view of the increasing costs of high standard health care efforts of optimization and utilization review of health care are an essential parallel process of quality assurance. The decisive factor is motivation of doctors and health professionals for both mentioned processes, which at present lacks systemic support in this country. The author gives an account of experience assembled abroad pertaining to suggestions for improvement of the standard and optimization in utilization of health care as well as inevitable steps for introducing a programme for quality assurance in health institutions. In the conclusion the asset of this process is summarized.

Czech Republic↗
PubMed1992

Gestational diabetes in a rural setting.

Women who are already diabetic and become pregnant, as well as women who develop gestational diabetes, have increased risks of complications to both fetus and mother. These risks in gestational diabetes mellitus (GDM) can be reduced to near that of a non-diabetic mother by normalizing the blood sugar. The current recommended standards are reviewed. Utilizing a team approach, care was provided to patients with GDM in a rural primary care setting in order to attempt to normalize the blood sugar to the recommended level. Review of the outcomes of these pregnancies supports the conclusion that acceptable care for patients with GDM can be provided away from the tertiary care centers and in the primary care setting.

Adult↗
PubMed1993

Enhanced length of stay management through monitoring of discharge planning parameters.

Traditional data collection in discharge planning programs has been largely retrospective, measuring the patient's length of stay and unnecessary hospital days at the point of discharge. Although the data collection is useful, it does not lend itself to corrective actions on a concurrent basis. Carney Hospital has developed a data base that monitors patient status daily in order to identify when a length of stay problem is developing and when corrective actions are succeeding. The Patient Tracking System is an interactive computer report utilized by Continuing Care staff, Utilization Review staff, and clinical managers on the patient care units. It is a caseload register that operates from the admission transfer discharge (A/T/D) system of the hospital and sorts inpatients by discharge planning status, length of stay, discharge planning worker, and nursing unit. It is the basis for a weekly management review that identifies numbers of patients and average length of stay to date of key groups of patients proven to impact the overall length of stay in the hospital. Carney Hospital has successfully utilized this system to alert managers to any length of stay "creep," to identify the sources of the length-of-stay problem, and to mobilize key personnel to take corrective actions. The system is easy to use and is an effective length-of-stay management tool.

Boston↗
PubMed1989

Seven years of experience with a pharmacokinetic service.

There have been several reports describing the impact of pharmacokinetic services on cost containment. The purposes of this report are to describe seven years of experience with the operation of a pharmacokinetic service, and the processes used to implement and maintain the service along with a discussion of the impact of the service on hospital cost and patient charge containment. The major functions of the pharmacokinetic service are to; 1) provide clinical pharmacokinetic and pharmacology consultation upon physician request, 2) coordinate the scheduling of serum drug levels (SDLs), and 3) provide quality assurance and utilization review reports related to the service. Data gathered from the service are reported to the medical staff monthly and are incorporated into the hospital's on-going drug usage evaluation. The results of continuous review demonstrate that direct intervention of a pharmacokineticist and a systematic approach to drug level scheduling yielded less than 1% of inappropriately collected SDLs, and in the latest year, a yearly patient charge savings of +116,304. In another study evaluating the service, it was demonstrated that when aminoglycoside dosages are adjusted by a pharmacokineticist, a patient charge savings of +491 per patient is realized. This review of seven years of experience with a pharmacokinetic service supports the conclusion that these services can have a beneficial impact on hospital costs. Furthermore, data gathered from the service can be utilized for the hospital's overall quality assurance program.

Cost Control↗
PubMed1980

The hospital's perspective on cost containment.

Cost containment has long been a concern of hospitals and the American Hospital Association (AHA). In recent years, however, cost containment has assumed a special prominence in hospitals, becoming both a political and social necessity. The hospitals' and AHA's activities in cost containment fall into four major categories: first, the Voluntary Effort to Contain Health Care Costs, of which AHA is a founding partner; second, administrative effectiveness; third, capital effectiveness, and, finally, medical effectiveness. Some programs to promote administrative effectiveness are shared administrative services, energy conservation, careful attention to staffing patterns and management effectiveness review. Capital effectiveness involves technology assessment and other means of deciding how to make the most of the hospital's dollar. Medical effectiveness can be accomplished by such methods as medical audits, utilization reviews and shared clinical services.

American Hospital Association↗
PubMed2001

Celiac disease: fertility and pregnancy.

Celiac disease (gluten-sensitive enteropathy) may manifest clinically with an array of nongastrointestinal symptoms among which are: dermatitis herpetiformis; dementia; depression; various neurological symptoms; osteoporosis; osteomalacia; dental enamel defects, and anemia of various types. Important data have accumulated in recent years regarding the association between celiac disease, fertility and pregnancy. Many primary care obstetricians and gynecologists and perinatologists are not aware of these important relationships. The aim of this review, utilizing a MEDLINE search from 1966 through March 2000 of the English language, is to describe the possible effects of celiac disease and its treatment upon the reproductive cycle, fertility, pregnancy, and menopause. Review of the literature reveals that patients with untreated celiac disease sustain a significantly delayed menarche, earlier menopause, and an increased prevalence of secondary amenorrhea. Patients with untreated celiac disease incur higher miscarriage rates, increased fetal growth restriction, and lower birth weights. It appears that improvement of celiac disease, as reflected by restoration of small bowel mucosa associated with implementation of a gluten-free diet, may decrease miscarriage rates, improve fetal nutritional support and overall perinatal outcome.

Celiac Disease↗
PubMed1997

Inappropriate drug prescriptions for elderly residents of board and care facilities.

OBJECTIVES: Using 1993 data, this study examines the prevalence of presumptively inappropriate prescriptions among residents, aged 65 and older, of board and care homes. METHODS: Inappropriate drug prescriptions were identified through the use of established criteria developed for application to older nursing home residents and to community-dwelling elderly. This research used a sample of 2054 elderly residents from 410 facilities in 10 states. Weighted analyses were performed with SUDAAN, which accounted for the complex, multistage sampling design. RESULTS: Depending on the criterion applied, between 20% and 25% of residents had at least one inappropriate prescription. Propoxyphene, long-acting benzodiazepines, dipyridamole, and amitriptyline were prescribed most frequently. Residents with inappropriate drug prescriptions had more complex drug regimens prescribed on a routine basis. CONCLUSIONS: The results are a conservative estimate of the extent of inappropriate drug prescribing and utilization in board and care facilities. Increased involvement by pharmacists and physicians in systematic drug utilization review is warranted.

Aged↗
PubMed1978

Peer review in community mental health.

The paper discusses the medical origins of the peer review legislation and its adaptation to community mental health. Three models of peer eview are presented which could be used in community mental health centers. They are the problem model, the sequential model, and the Psychiatric Utilization Review and Evaluation Project (PURE) model. All three require a review of records by a committee of respected clinical staff, regardless of profession.

Community Mental Health Centers↗
PubMed2000

Patients' and providers' perceptions of outpatient treatment termination in a managed behavioral health organization.

OBJECTIVE: A common complaint about managed care is that treatment decisions of patients and providers are frequently altered by concurrent review of ongoing outpatient treatment. The objective of this study was to examine this perception from the perspectives of patients and providers. METHODS: A total of 190 patients and their providers were surveyed about the reason that outpatient treatment was terminated. The sample was randomly drawn from completed outpatient treatment episodes of a large national managed behavioral health organization. RESULTS: In more than three-quarters of the cases, outpatient treatment ended because patients and providers agreed that treatment goals were partially or completely met. Only 5 percent of patients and 3 percent of providers said that treatment ended because the managed care organization denied ongoing treatment. Agreement between patient-provider pairs was generally poor regarding the perceived reason for termination, except when termination was attributed to concurrent review by the managed behavioral health organization. CONCLUSIONS: In this study of a single large managed behavioral health organization, outpatient treatment was most likely to end based on the decisions of patients and providers rather than utilization review decisions.

Adult↗
PubMed1979

Pharmacists expand their roles through clinical services.

This article highlights various educational forums that were held at the 13th annual Midyear Clinical Meeting of the American Society of Hospital Pharmacists. Among the areas covered by the article are justification for clinical pharmacy services, administrative considerations in a drug utilization review program, and the expanding role of the pharmacist in the emergency department.

Congresses as Topic↗