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At least 109 records · Page 6Linked to original sources
PubMed2005

Trends and cardiovascular co-morbidities of COPD patients in the Veterans Administration Medical System, 1991-1999.

Persons with Chronic Obstructive Pulmonary Disease (COPD) are at risk for developing other smoking-related complications, including cardiac and vascular diseases. Information about the prevalence and incidence of these conditions is needed to anticipate their occurrence in clinical research. We conducted a cohort study using longitudinal administrative data to describe the prevalence and incidence of cardiovascular (CV) diseases among COPD patients treated by the Veterans Administration Medical System. The COPD cohort included all persons with a diagnosis of COPD admitted to a Veterans Administration Medical System hospital (N = 70,679) or seen in a outpatient clinic (N = 314,209) in fiscal year 1998. Each COPD patient was matched to a Veteran of the same age and gender who did not have a COPD diagnosis, creating a non-COPD cohort for comparison. Among all hospitalized Veterans, the prevalence of COPD steadily increased from 1991 to 1999, although the total number of Veterans hospitalized during this time period decreased by more than one-third. Among COPD patients hospitalized in 1998, the prevalence of coronary artery disease, congestive heart failure, and atrial fibrillation were very high (33.6%, 24.4%, and 14.3%, respectively) and significantly higher than those seen among the matched non-COPD cohort (27.1%, 13.5%, and 10.4%; p < 0.001). Among COPD outpatients, increased complications were found in every CV disease category with rate ratios that were greater than observed among inpatients. We conclude that CV diseases are remarkably prevalent among Veterans with COPD, and their incidence is likely to increase as the Veteran population ages.

Adult↗
PubMed2006

Topical and systemic medications for wounds.

There are a plethora of topical and systemic medications available to the veterinary practitioner today that aid the wound healing process. Some of these help to maintain a moist environment. Others increase growth factors, provide local energy sources, control infection, provide for debridement, increase wound blood flow and temperature, or reduce wound edema. Modern wound care requires that the proper products(s)be used, depending on the condition of the wound and the phase of wound healing. This article discusses various wound care products and provides guidelines on their use.

Administration, Topical↗
PubMed1992

Role of a prehospital medical system in reducing heroin-related deaths.

OBJECTIVE: The mortality rate from heroin overdose in Italy between 1977 and 1987 increased significantly. However, in the same period, a significant increase was not observed in Tuscany, an administrative region in Italy. This study was performed to determine if the prehospital emergency medical system of Florence, the capital of Tuscany (the only one operating in Italy during the study period), affected this lower mortality rate. DESIGN: Retrospective study. SETTING: The Florence system consists of 17 mobile ICUs, each of which is staffed by a physician and three paramedics. These units are able to carry out advanced cardiopulmonary resuscitation with equipment transported to the scene of an emergency. PATIENTS: A total of 126 consecutive patients with heroin overdose, assisted by four mobile ICUs from January 1, 1984 through December 31, 1987. INTERVENTIONS: Common therapeutic protocol in the treatment of heroin overdose and of cardiac arrest. RESULTS: Fifty-two (41.3%) patients were in respiratory arrest, and seven (5.6%) patients were in cardiorespiratory arrest. The prehospital mortality rate was 1.6%, the inhospital mortality rate was 0.8%, and the overall mortality rate was 2.4%. During the period considered, the number of heroin overdose-related interventions increased significantly, as did the number of heroin overdoses complicated by respiratory arrest or by cardiorespiratory arrest, but the mortality rate remained low. CONCLUSION: We suggest that an emergency medical system can play an important role in reducing the mortality rate from heroin overdose.

Adolescent↗
PubMed2006

To compare argon laser peripheral iridoplasty (ALPI) against systemic medications in treatment of acute primary angle-closure: mid-term results.

PURPOSE: To compare the clinical outcome of argon laser peripheral iridoplasty (ALPI) against systemic medications in treatment of acute primary angle-closure (APAC). METHODS: Consecutive patients with APAC were recruited and randomized to receive one of two treatment options: immediate ALPI or systemic acetazolamide +/- mannitol. All eyes were followed up for at least 6 months after laser iridotomy. Main outcome measures were intraocular pressure (IOP) and requirement for glaucoma medications. RESULTS: A total of 41 eyes (39 patients) were randomized into the ALPI group, and 38 eyes (32 patients) into the medical treatment group. There were no significant differences between the two groups in sex, age, presenting IOP, and duration of attack. Mean follow-up duration +/- SD was 15.7 +/- 5.8 months. There were no significant differences between the two groups in mean final IOP and requirement for glaucoma medications. CONCLUSIONS: There were no statistically significant differences in mean IOP and requirement for glaucoma drugs between APAC eyes treated with ALPI and systemic medications.

Acetazolamide↗
PubMed1975

The health and medical system in Japan.

This has been a brief sketch of the health and medical system in Japan. While many health indices have improved since the end of World War II, the health system still has many problems to be solved. The shortage of professional personnel remains a glaring one. And especially detrimental to the effective functioning of a good system is the fragmentation of various institutions, schemes and functions. It is necessary to integrate all of these things into a comprehensive health care system, and to establish a comprehensive plan for health and medical services.

Community Participation↗
PubMed1984

Pogotowie Ratunkowe: the emergency medical system of Poland.

In March 1983, in conjunction with the Columbia University Affiliated Hospitals Residency in Emergency Medicine, Overlook Hospital, and under the auspices of the Ministry of Health in Warsaw, we visited Poland to study the country's emergency medical system. The emergency medical service, Pogotowie Ratunkowe, is responsible for civilian acute care throughout the nation. Its domain includes operation of the freestanding emergency medical care centers, all emergency transport and ambulance services, and several short-stay emergency hospitals. The system utilizes a modular concept, and the same basic organization is employed in each of the 49 provinces and five largest cities. The heart of each module is a central dispatch station, ambulance base, and emergency treatment facility. A hub of substations, with treatment areas and ambulance bases, completes the system. All ambulance dispatches come from the central office. A toll-free number provides access. An integral part of the central dispatch station is the information bureau. Individuals seeking a missing person can, by calling a single number find out if they have been picked up by any ambulance, admitted to any hospital, or treated in any ambulatory emergency center within the province. Ambulances are staffed by physicians and equipped with medications. Once on the scene the physician may elect to treat the patient, transport him to an emergency station, or admit him to a hospital. A system of general and specialized ambulances makes the best use of limited resources, such as cardiac resuscitation and trauma vehicles. The need for such technology as telemetry is averted because a physician is on the scene to read the electrocardiographic monitor.(ABSTRACT TRUNCATED AT 250 WORDS)

Allied Health Personnel↗
PubMed2001

Generation of an intelligent medical system, using a real database, to diagnose bacterial infection in hospitalized patients.

The initial diagnosis of bacterial infections in the absence of laboratory microbiological data requires physicians to use clinical algorithms based on symptoms, patient history and infection site. Optimization of such algorithms would be achieved by including as many variables associated with bacterial infection as possible. Demographic data are easily available and frequently used to sub-group human populations. A prospective investigation was, therefore, undertaken to examine the influence of demographic variables on bacterial infection rates, using data obtained from 173 patients presenting to Albert Einstein Medical Center. Data was randomly selected from 149 of these patients and used to generate fuzzy rules to model an intelligent medical system. To test the accuracy of this system at determining bacterial infection, based solely on demographic data, the program was given the remaining 24 patients' information. All 18 patients with either streptococcal, staphylococcal or Escherichia coli infections were correctly diagnosed. Non-E.coli GNR were misdiagnosed as E. coli infections in two patients resulting in an overall prediction rate for the 24 patients of 91.66%. This study suggests that the direct correlation of demographic variables with a predisposition to bacterial infection allow the design of an intelligent medical system, which shows great future potential as a diagnostic tool for all physicians.

Adult↗
PubMedDate not supplied

Design and implementation of secure medical database systems.

Medical database security plays an important role in the overall security of medical information systems and networks. This is both because of the nature of this technology and its widespread use today. Database security not only involves fundamental ethical principles, but also essential prerequisites for effective medical care. The development of appropriate secure medical database design and implementation methodologies is an important research problem in the area and a necessary prerequisite for the successful development of such systems. The general framework and requirements for medical database security are given and a number of parameters of the secure medical database design and implementation problem are presented and discussed in this paper. A secure medical database development methodology is also presented which could help overcome some of the problems currently encountered.

Computer Security↗
PubMedDate not supplied

Quest for the ideal: a redesign of the medication use system.

Medication use systems in hospitals are complex and prone to error. A redesign of the system using idealized design methodology is a starting point in preventing patient harm from medication errors. An interdisciplinary team identified system properties, proposed and gathered feedback on an ideal design, and established a structure to plan changes in the system and monitor their impact.

Drug Prescriptions↗
PubMed1992

China's Cooperative Medical System: its historical transformations and the trend of development.

The rural Cooperative Medical System (CMS) in China came into existence in the 1950s. Along with the development of the collective economy of agriculture and the promotion of this system by the Chinese Government, the coverage rate of the CMS in the rural areas increased from 1955 through the end of the 1970s, when it was estimated that 90 percent of the rural population was covered by the CMS. Since the rural economic reform in the early 1980s destroyed the rural collective economy on which the CMS was based, The coverage rate of the CMS went down to 5 percent. After 1985, the coverage rate of the CMS began to increase gradually because of the development of the collective fund for supporting the CMS and the governments' efforts to strengthen the CMS. The structure of CMS has changed over time. Traditionally, the CMS was organized at the village level. In order to increase the risk-sharing ability of this system, the trend is for it to be organized at the township level in the future.

China↗
PubMed2004

[Assessment of psychiatric emergencies by physicians in the pre-hospital emergency medical system. A re-evaluation after 7 years].

OBJECTIVE: In the German emergency medical system (EMS) psychiatric emergency situations (PES) are now responsible for up to 15% of all calls for the emergency physician (EP). A survey which was first conducted in 1996 to reveal knowledge about PES, reported a significant need for training. Seven years later it is interesting to investigate whether different conditions in the EMS may have changed assessments and attitudes. METHODS: The questionnaire of 1996 was modified to enable a comparison of PES and other frequent emergency situations with respect to the estimated number and the subjective stress. Open and multiple-choice questions or visual analogue scales were used to obtain the following data: demographic data, frequency of and stress by PES and other medical emergencies, own knowledge, and interest about training programs. RESULTS: Of the EPs 274 responded (male/female: 74/26%, mean age: 38 years, mean experience as an EP 6 years, anaesthesiologists 69%). The frequency of PES was estimated at 5% and 44% of EPs thought that there had been an increase in recent years. Personal knowledge was judged to be good by only 24%. The interest in training programs even increased slightly compared to the first survey; of particular interest was training in drug abuse disorders. Subsequent to internal, neurological and surgical emergencies, PES are considered to rank fourth in frequency, however the strain imposed by PES is significantly higher than for these other emergency situations. DISCUSSION: The results indicate an increase of relevance of PES in the German EMS, however, assessments made by the EP only changed marginally over the time period. The subjective awareness of the frequency of PES underestimates the reality in emergency medicine. The importance of training programs remains high to improve knowledge and to reduce feelings of incapability.

Adult↗
PubMed1993

The amateur Radio Emergency Service (ARES) and the National Disaster Medical System (NDMS).

The rescue, treatment, and evacuation of thousands of patients from a natural disaster or armed conflict that is coordinated by the National Disaster Medical System must be performed in accordance to health care standards recognized in this country. Without an effective communication system, morbidity and mortality will needlessly rise. A medical communication protocol that addresses this problem is proposed.

Communication↗
PubMed1998

International development of emergency medical systems: educational techniques for the future.

An ongoing collaborative partnership between the University of Massachusetts Medical Center, Boston University Medical Center, the Armenian Ministry of Health, and the Emergency Hospital of Yerevan, Armenia has been established since 1993. The primary goal of this partnership is to reform and improve the delivery of emergency medical care through a process of education and training that is reproducible, practical, and self-sustaining for the advancement of health care into the future. A six-step educational process was developed, using Armenia as the initial model site for this format. Through the development of a regional training center and two emergency medicine training curricula, the partnership has trained over 1800 health care workers and first responders. Preliminary results from pre- and post-course examinations show a significant overall improvement in scores. An ongoing trauma database collection also shows significant improvement in the number of advanced life support measures being implemented since the inception of this educational training programme. This educational strategy has subsequently been replicated in nine similar partnerships in other countries of the New Independent States, formed after the dissolution of the former Soviet Union in 1990. We believe this six-step educational format is effective for the development and improvement of emergency medical systems in developing countries worldwide.

Armenia↗
PubMed1996

Causation, incidence, and costs of traumatic brain injury in the U.S. military medical system.

Hospital discharge records from military facilities and private facilities reimbursed by Civilian Health and Medical Program of the Uniformed Services for fiscal year 1992 were reviewed to identify head injury admissions. Incidence rates, case fatality rates, causes of head injuries, and direct cost for hospital admissions were computed in this well-defined population. For fiscal year 1992, there were 5,568 hospitalized cases of noncombat head injury in the military medical system. The age-adjusted head injury rates for ages 15-44 years are higher in active-duty individuals compared with other beneficiaries (1.6 times greater for men and 2.5 times greater for women). The total cost for hospitalization in this population was $43 million. Private facility rehabilitation accounted for 26% of all private facility costs but only 6% of head injury cases. Firearms and motor vehicle crashes caused the most severe injuries for cases admitted to military facilities. Motor vehicle crashes, falls, and fighting accounted for 80% of the total military facility cost for head injuries. Military active-duty individuals are at increased risk for noncombat head injury. Prevention of head injury in military settings should focus on motor vehicle crashes, fist fights (assault), and falls.

Accidental Falls↗