Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Tertiary Sector”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 109 records · Page 6Linked to original sources
PubMed1999

An IT awareness programme for the health sector in Ireland.

This paper describes an Awareness Programme delivered throughout Ireland which aims to increase the level of understanding of healthcare professionals as to the benefits of Information and Communications Technology (ICT) and of emerging trends in Health Informatics in Europe. The programme examines the use of ICT across the whole health sector--primary, secondary and tertiary. It has been delivered at over 30 centres to more than 1500 health professionals.

Computer Literacy↗
PubMed2002

Medical negligence or diagnostic conundrum? A medico-legal case study.

India is a signatory to the UN backed Consumer Protection Resolution, and has enacted the Consumer Protection Act in 1986 to promote and protect the rights of consumers. A land-mark judgment of the Supreme Court of India in 1996, has paved the way for a number of lawsuits involving the public sector, including an eminent tertiary care medical institution. The case described in this study was filed with the State Consumer Dispute Redressal Commission in June 2000. The complainant was a fifty year old female who noticed a lump in her right breast; which was diagnosed as malignant by fine needle aspiration cytology (FNAC); and was treated by surgery and adjuvantradio-therapy (brachytherapy). Subsequently, the tissue sent for histo-pathological study was reported to be 'benign phyllodes tumour'; which was confirmed by other centres in India and the UK. The complaint filed for total damages amounting to Rupees 19 lacs (approx. 27,300 UK pounds) along with interest from the date of operation. Review of the relevant literature suggests that phyllodes tumour of the breast has various sub-types;and even borderline cases can develop malignancy at a later date. It is also clear that false positive cases had been reported previously in cases diagnosed by FNAC. Finally, avenues to minimise litigation through in-house mechanisms and a new concept of mediation have been explored.

Breast Neoplasms↗
PubMed2001

Implications for tertiary education: managerial competencies required of beginning practitioners in the health service sector.

Five hundred and three experienced practitioners involved in management from four professional fields (medical radiation science, occupational therapy, speech pathology and physiotherapy) representing a range of health care settings participated in a survey. The survey examined the importance attached to managerial competencies for the beginning practitioner. The most important grouping related to management of future planning. Underlying competencies included decision making regarding time management and communication with other staff. The second most important grouping of managerial competencies related to organisational practices. These competencies included strategic and organisation-wide management processes associated with change, vision, organisational awareness and decision making. The third grouping of managerial competencies related to knowledge regarding legislation and in particular compliance with occupational health and safety regulations. Other competencies were seen as less important for the beginning practitioner. The implications of these findings are discussed in relation to health science curriculum development in higher education.

Journal Article↗
PubMed1990

Advances in diagnosis, staging, and management of cervical and endometrial cancer, stages I and II.

The majority of patients with low stage cervical and endometrial cancer are cured. Results obtained in the past only in the categorical cancer centers are currently being achieved more broadly. This reflects the work of formally trained gynecologic oncologists often in collaboration with formally trained radiation therapists distributing themselves in a horizontal fashion to more and more university medical centers, teaching hospitals, and quality tertiary hospitals in the private sector. The formalization of training in gynecologic oncology has been pivotal in this development. This group of physicians, working with physicians in other disciplines, have impacted significantly on patient care and have provided many clinical and pathologic studies to better define favorable low stage cases and poor prognosis cases. The need to explore the use of currently available modalities in a variety of different combinations and to define and develop new techniques to apply to these poor prognosis subsets of disease represent areas of progress and challenge.

Combined Modality Therapy↗
PubMed2002

Developing an integrated care pathway to manage cancer pain across primary, secondary and tertiary care.

Throughout the palliative care journey, the patient encounters many different health professionals in a variety of settings so good channels of communication between these professionals is a prerequisite for successful continuity of care (Scottish Partnership Agency for Palliative and Cancer Care (SPA), 1994). Pain control has also long been documented as being ineffective and it has been indicated that pain affects up to 88% of cancer patients in the last year of their life (Addington-Hall and McCarthy, 1995). In order to attempt to resolve these important issues, a joint project was established between primary, secondary and tertiary care in the south sector of Glasgow to establish an integrated care pathway (ICP) for the management of chronic cancer pain. This article discusses how the joint project was successfully established, was instrumental in breaking down existing barriers across the traditional boundaries and developed a uniform system of assessing and managing chronic cancer pain with ICP documentation held in a patient-held record.

Attitude of Health Personnel↗
PubMed1990

The 1983 distribution of hospitals and hospital beds in the RSA by area, race, ownership and type.

This study used published data to analyse the 1983 distribution of hospitals and hospital beds in South Africa by 'race', geographical area, type of hospital (academic, specialist, general or other) and the nature of ownership (e.g. state, for-profit). Hospitals and hospital beds were found to be inequitably distributed. Overall bed ratios were 150 whites per bed compared with 260 blacks/Asians/coloureds per bed. The distribution of beds by geographical area was 130 people per bed for urban whites, 260 for rural whites and 150, 460 and 300 for urban, rural non-'homeland', and 'homeland' blacks/Asians/coloureds respectively. These differentials are inefficient and unjust, and should be regularly documented to spur their decline. The continued collection of population group information from health service users is required to monitor changes in 'race' disparities. The analysis of distribution by ownership and type suggested that only the public sector is able to provide a hospital service with the appropriate balance of all levels of care for the entire population; but within this sector the dominant position of tertiary care needs to be re-examined. The study highlighted the absence of adequate information on health care resource allocation and utillisation. Appropriate studies in these areas are required and consideration should be given to unifying the planning and management of all hospital resources.

Black or African American↗
PubMed2003

Models for future delivery of care in infertility: the role of the private sector.

An estimated 85% of infertility treatment at the tertiary level in the UK currently is funded by the infertile couples themselves. Of the 15% of couples who receive NHS funding for assisted reproductive technology (ART), a sizeable proportion is provided by private clinics. If the National Institute of Clinical Excellence (NICE) decides that the National Health Service (NHS) should provide funding for an increased number of treatments, then it is unlikely that wholly NHS ART clinics will be able to provide the extra number of cycles required. Those private clinics in the UK that bid to provide treatment funded by the NHS through primary care trusts (PCT) generally provide a cost-effective service in a 'patient friendly' environment. The case is made in this article that ART clinics in the private sector that wish to bid for PCT contracts, should be allowed to compete on an equal basis with NHS or NHS-private combined clinics. PCTs awarding contracts should be wholly driven by good evidence of clinical effectiveness, cost effectiveness and the provision of a quality service to patients.

Adult↗
PubMed2004

Conformational analysis and assignments of relative stereocenter configurations in fluoroalkyl-iridium complexes using 19F[1H] HOESY experiments. Comparison with solid-state X-ray structural results.

Solution conformations about the metal-carbon bond of the secondary fluoroalkyl ligands in iridium complexes [IrCp(PMe(3))(R(F))X] [Cp* = C(5)Me(5); R(F) = CF(CF(3))(2), X = I (1), CH(3) (2); R(F) = CF(CF(3))(CF(2)CF(3)), X = I (4), CH(3) (5)] have been determined using (19)F[(1)H] HOESY techniques. The molecules adopt the staggered conformation with the tertiary fluorine in the more hindered sector between the PMe(3) and X ligands, with CF(3) (and CF(2)CF(3)) substituents lying in the less hindered regions between PMe(3) and Cp or X and Cp. In molecules containing the CF(CF(3))(2) ligand, these conformations are identical to those adopted in the solid state. For compound 4, containing the CF(CF(3))(CF(2)CF(3)) ligand, two diastereomers are observed in solution. Solution conformations and relative stereocenter configuration assignments have been obtained using (19)F[(1)H] HOESY and correlated with the X-ray structure for the major diastereomer of 4, which has the (S(Ir), S(C)) or (R(Ir), R(C)) configuration. Relative stereocenter configurations of analogue 5, for which no suitable crystals could be obtained, were assigned using (19)F[(1)H] HOESY and proved to be different from 4, with 5 preferring the (S(Ir), R(C)) or (R(Ir), S(C)) configuration.

Journal Article↗
PubMedDate not supplied

Telemedicine: experience at SGPGIMS, Lucknow.

Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) located in Lucknow, capital of Uttar Pradesh, a state in Northern India, is a tertiary level referral academic medical center involved in teaching and training of super specialist medical professionals with 22 academic departments. It is the first tertiary care hospital in public healthcare sector in India to adopt Information Technology (IT) for healthcare delivery. The Hospital Information System (HIS) was implemented in 1998 to record, store, process and retrieve health data of all the patients. This software was developed in-house in collaboration with Center for Development of Advanced Computing (C- DAC), Pune. Later in the year 1999, telemedicine activities were initiated in the form of testing the concept and technology. The first research grant was availed of in the year 2001, which helped in creating an infrastructure for telemedicine. Regular tele-healthcare and tele-educational services were introduced for the postgraduate students of medical colleges of Orissa. These services have now been extended to educate the doctors of other medical colleges and community centers in other states. Besides, the Institute is associated with organizational activities and in policy initiatives of the government. All the activities are in project mode and are being financially supported by government agencies such as Indian Space Research Organisation (ISRO) and Department of Information Technology. Looking at the need of skilled manpower in the field of telemedicine and e-health, a school of telemedicine is coming up in the campus, which will also provide core infrastructure for research and development.

Academic Medical Centers↗
PubMed2003

Lessons learned from infertility investigations in the public sector.

OBJECTIVES: To determine the main factors causing infertility in an urban, tertiary hospital population. To establish if any such major causal factor could be used to rationalise and improve the service for infertile couples in the public sector. DESIGN: A retrospective analysis of the hospital records of 206 women who had a tubal patency test (hysterosalpingogram) performed and the results of the investigations performed in the couples with infertility. RESULTS: Of the 206 women 38 (18.5%) had normal fallopian tubes on hysterosalpingogram; 33 (16%) had unilateral obstruction and 135 (65.5%) had bilateral tubal obstruction. Of the latter group 81 (60%) had significant hydrosalpinges. Semen analysis results in 148 partners (71.8%) demonstrated a normal count in 85 (62%), normal motility in 70 (51%) and normal morphology in only 25 (18%). Testing for ovulation (mid-luteal phase progesterone) was positive in 91 of 124 women tested (73%). Compliance, technical and logistical problems were encountered with both semen analysis and mid-luteal phase progesterone tests. CONCLUSIONS: Infertility is a major problem in South Africa, with limited resources for investigation and treatment in the public sector. Tubal factor infertility was the most common cause of infertility demonstrated in this study. In the presence of bilateral tubal obstruction with hydrosalpinges the prognosis is so poor that unless assisted reproductive techniques are available and affordable, further infertility investigations do not seem justified. Recommendations on an approach to the infertile couple in the public sector is outlined.

Adult↗
PubMed2005

Monitoring political decision-making and its impact in Austria.

The range of services provided by the Austrian health care system has been greatly extended over the last few decades. The accompanying measures for long-term care bring the situation closer to the ideal concept of a 'seamless web' between primary, secondary and tertiary care. Due to the expansion in services it has become increasingly difficult to ensure the balance between the financing and degree of usage of the services. The reiterated political aim has been to achieve balanced financing via legally fixed social health insurance (SHI) contributions and taxation. A steadily expanding part is contributed by the private sector. In the 1980s, measures for SHI expenditure containment were implemented; in 1997 a new hospital financing system based on flat rates was introduced. In order to guarantee hospital financing, the historical financing shares of the SHI for the hospitals were introduced in the form of valorised global budgets. The contradictory incentives arising from the flat rates and global budgets lead hospitals to shift services to the primary and tertiary care sector, causing additional expenditure for SHI. Currently, attempts are being made to secure the financing by increasing the SHI contribution rates and patients' co-payments.

Austria↗
PubMed2003

Utilization of implantable defibrillators in Africa.

Sub-Saharan Africa is dominated by diseases of poverty. HIV/AIDS affects 28.5 out of a total of 600 million in the region. South Africa is the only country in sub-Saharan Africa in which implantable cardiovertor defibrillators (ICDs) are implanted (0.8/million in 2001). Only 3 of the 35 new ICDs were implanted in state-funded public hospitals. The pacemaker implantation rate for South Africa was 41/million in 2001. Approximately 20% of the population consume 56% of the health care expenditure, mainly funded by Medical Insurance. A tax-funded state health care system serves the rest of the population, but is concentrated on improving sanitation and primary health care. Diversion of funds from academic tertiary hospitals has reduced specialised services, particularly cardiology and cardiac surgery, and has resulted in an exodus of skilled personnel to the private sector. In the rest of sub-Saharan Africa, tertiary health care is mainly privately funded. Cardiology and cardiac surgery is not widely available. Many countries are crippled by debt and chronic local conflicts. Only one state hospital (Groote Schuur, Cape Town) provides an electrophysiology (EP) service including catheter ablation and ICD implantation, and training in EP, by two electrophysiologists. EP services are available privately in 3 centres. No EP service exists in the rest of sub-Saharan Africa.

Africa↗
PubMed2000

An industry, clinical, and academic telehealth partnership venture: progress, goals achieved, and lessons learned.

The goal of this project was to develop and test a multi-application telehealth workstation with an interface seamless to the end-users. This project required collaboration among the private sector, a clinical regional referral setting, a clinical tertiary receiving center, and a university academic unit. The project applied the usability testing methodology to design and test the workstation: (1) the developmental phase focused on planning, prototype workstation development, and end-user trials in the private sector research and development environment, and (2) the operational testing phase moved the workstation into the clinical setting. The latter included training of end-users and addressing policy and ethical issues. In addition, the partners documented the goals achieved and lessons learned. The project resulted in the refinement of the workstation for clinical applications. The unique, diverse, and at times complementary goals and lessons learned by each partner are noted. Collaboration around a shared goal was a key element in achieving the refined workstation. Collaborators reported that the lessons learned will aid them as they pursue telehealth activities.

Alberta↗
PubMed1999

Optical sector iridectomy in corneal opacities.

PURPOSE: To evaluate the visual outcome after optical sector iridectomy in cases of corneal opacities. METHODS: Seventeen eyes of 17 patients with preoperative visual acuity of <6/60 in the affected eye underwent sector iridectomy in a prospective clinical study at a tertiary eye care center. Of 17 cases, 11 had corneal opacities after healed keratitis, four after trauma, and one each due to alkali burns or trachoma. The sector iridectomy was undertaken in cases in which one sector of the cornea and lens was fairly clear. Success was defined as attainment of ambulatory visual acuity of 6/60 or better. RESULTS: Mean age of the patients was 32+/-2.3 years. Most eyes had deep vascularized corneal scars (13 eyes). Optical sector iridectomy was performed most frequently in the lower nasal quadrant (11 eyes) followed by the lower temporal quadrant (four eyes). Of 17 eyes, 16 achieved a visual acuity of 6/60 or better. No intra-or postoperative complications were encountered. CONCLUSION: Optical sector iridectomy in cases of corneal opacities is a simple and safe procedure that can improve visual outcome and provide ambulatory vision to patients. It is a valuable alternative to penetrating keratoplasty if penetrating keratoplasty is not possible or not promising for various reasons.

Adolescent↗
PubMed1992

Peripheral plasma met-enkephalin levels in ovulatory and anovulatory human menstrual cycles.

OBJECTIVE: To test the hypothesis that met-enkephalin has a role in human ovulation and that plasma levels may differ between ovulatory and anovulatory ovarian cycles. DESIGN: This is a descriptive study comparing levels of plasma met-enkephalin, gonadotropins, and ovarian steroids in 12 ultrasonically confirmed ovulatory cycles and 12 anovulatory cycles. SETTING: The study took place in the infertility clinic of a large teaching hospital receiving primary and tertiary referrals of both private and public sector patients. PATIENTS: All patients (n = 16) had infertility greater than or equal to 3 years and normal findings on previous investigation including evidence of ovulation. INTERVENTIONS: Ovarian cycles were defined using transabdominal ultrasound scanning. Biochemical analyses were by radioimmunoassay. MAIN OUTCOME MEASURES: The differences between plasma met-enkephalin levels in the two groups of cycles were compared. RESULTS: Met-enkephalin levels are significantly higher in ovulatory cycles with a significant peak in the 2 postovulatory days (Duncan's multiple range test; P less than 0.05). CONCLUSION: Human ovulation is associated with cyclic elevation of plasma met-enkephalin. Further studies are required to elucidate causality.

Anovulation↗
PubMed1999

Analysis of the user fee for health care policy in Eritrea.

OBJECTIVES: To assess the macro-context of the user fee policy design and implementation; to critically evaluate the content of the user free policy with respect to its implications for efficiency, equity, quality and utilisation of health care and to scrutinize the implementation of the scheme and identify the successes and problems encountered since the introduction of the user fee policy in 1996. DESIGN: Cross sectional. SETTING: Mekane Hiwot Central Referral Hospital and Semenawi Asmore Health Centre. SUBJECTS: 50 health professionals and support staff; 150 outpatients of which 100 patients were from the hospital and 50 from the health centre and 50 inpatients from the hospital. MAIN OUTCOME MEASURES: Service utilisation. RESULTS: The policy was launched against a conducive macro-economic, political and health sector background. Fees reduced attendance at the tertiary referral hospital and reversed the previous trend of sharply declining use of primary level facilities. However, the fee levels could not give an adequate signal to patients to use the appropriate cost effective levels of care and the referral system. The cost recovery ratio for the system as a whole was found to be one of the highest in sub-Saharan Africa. At some of the lowest levels of the health care system, however, the scheme does not seem viable. Fee waivers were infrequent, and the process of means testing was lengthy, thus adversely affecting equity. CONCLUSIONS: The new policy resulted in a cost recovery ratio. There was some indication of allocative efficiency achievement as a result of the price signals. The policy required some refinement in terms of expanding the exemption categories and revenue retention at the facility level.

Attitude of Health Personnel↗
PubMed1995

Resource allocation for public hospitals in Andhra Pradesh, India.

The composition of the hospital sector has important implications for cost effectiveness accessibility and coverage. The classification of acute general hospitals is reviewed here with particular reference to India and Andhra Pradesh. Approaches to arrive at a norm for allocation of hospital expenditure among secondary and tertiary hospitals are discussed. The actual allocation of public sector hospital expenditures is analyzed with data from Andhra Pradesh. The shift in allocative emphasis away from hospitals and in favour of primary health care during the 1980s was found to have been equally shared by secondary and tertiary hospitals. The shares of recurrent (non-plan) expenditure to secondary and tertiary hospitals were 51% and 49% respectively. This can be compared to a derived norm of 66% and 33%. The opportunity that new investment funds (plan schemes) could have provided to rectify the expenditure bias against secondary level hospitals was missed as two-thirds of plan expenditure were also spent on tertiary level hospitals. The share of secondary hospital bed capacity was 45.5% against India's Planning Commission norm of 70%. Public spending strategies should explicitly consider what mix of hospital services is being financed as well as the balance between hospital and primary health care expenditures.

Cost Allocation↗
PubMed2005

Overview of culturally-based mental health care in Vancouver.

This article is a description of how cross-cultural services in mental health have evolved in Vancouver. With 49% of Vancouver's total population described as a 'visible minority' by Statistics Canada, it has been essential for the city, in its efforts to provide health care that is accessible, available and acceptable to all, to develop health care that acknowledges racial and cultural diversities. Vancouver's Cross Cultural Mental Health Services had their beginnings over 25 years ago. The services encompass both formal and informal sectors of the healthcare system, are provided at primary, secondary and tertiary levels of healthcare delivery and are available through hospital- and community-based services. With recent regionalization of British Columbia's health services, the cross-cultural mental health service has experienced increased coordination under the administration of the Vancouver Coastal Health Authority (one of six British Columbia health regions). The initial elements of a cross-cultural mental health service consisted of the Vancouver Association for the Survivors of Torture, the Cross-Cultural Clinic at Vancouver General Hospital, and the Multicultural Liaison Workers Program of the Vancouver Community Mental Health Service. Collaboration and partnerships between the formal and informal sectors support each other, bridge gaps in services and provide a milieu for growth and development.

British Columbia↗