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At least 1,081 records · Page 60Linked to original sources
PubMed1999

Interpretation of dietary change in the United States: fat as an indicator.

Measurement of dietary trends poses methodologic issues of great complexity and intellectural challenge. Confidence in the ability to draw inferences about trends increases when the results of various measurement methods point in the same direction, are of comparable magnitude and are consistent with one another as well as with external sources of related data. This paper illustrates these issues by reviewing inconsistencies in available data sources since the early 1970s on intake of fat in the United States.

Diet↗
PubMed1994

A population-based Danish data resource with possible high validity in pharmacoepidemiological research.

The incomplete understanding of drug effects at the time of marketing has led to ongoing epidemiological monitoring. The Danish National Health Service covers part of the expenses for most kinds of prescription drugs. The accounting system within the pharmacies is increasingly computerized. In 1992 we found that 96% of the pharmacies were computerized. The computerized accounting systems give no information about adverse drug effects, but this can be obtained from the Danish Hospital Register by cross-checking registries, and in some cases from the register of birth and the register of congenital malformations. There is a great need for new data sources in pharmacoepidemiology. In spite of some evident methodological problems, the Danish data sources probably have high validity compared with international sources, since they are population based.

Computer Simulation↗
PubMed1995

Does prenatal care improve birth outcomes? A critical review.

OBJECTIVE: To evaluate evidence that prenatal care improves birth outcomes. DATA SOURCES: The MEDLINE data base was searched for appropriate studies for the years 1966-1994; a review of published studies was also conducted. METHODS OF STUDY SELECTION: Published observational and experimental studies of prenatal care that met specified criteria were selected. DATA EXTRACTION AND SYNTHESIS: Studies were graded based on the system used by the United States Preventive Services Task Force. Data were assessed using established criteria for the evaluation of prenatal interventions: temporal relationship, biologic plausibility, consistency, alternative explanations, dose-response, strength of association, and cessation effects. Current evidence did not satisfy the criteria. CONCLUSION: Prenatal care has not been demonstrated to improve birth outcomes conclusively. However, policymakers deciding on funding for prenatal care must consider these findings in the context of prenatal care's overall benefits and potential cost-effectiveness. Cost-effective reductions in low birth weight deliveries may be beyond the statistical powers of detection of current studies.

Bias↗
PubMed1979

Job stress and employee behaviors.

The relationship between four job stresses (role ambiguity, role overload, underutilization of skills, and resource inadequacy) and two employee withdrawal behaviors (absenteeism and turnover) was investigated. The joint prediction of employee withdrawal from measures of job stress and selected backgroundd variables was also investigated. Data were obtained regarding 651 employees in five organizations through personal interviews and company records. Analysis indicated that job stress is related to employee withdrawal behaviors, that prediction of subsequent behaviors is stronger than prediction of prior behaviors, and that the predictive power of job stress and background variables taken together is as strong as, or stronger than, the predictive power of background variables alone. Confidence in the strength of the findings is enhanced by the use of multiple data sources and multiple data points.

Absenteeism↗
PubMed2005

["Iodine allergy": point of view].

OBJECTIVE: The aim of this literature review is to suggest a diagnostic and a preventive attitude in patients having presented an immediate hypersensitivity reaction due to an iodinated drug. DATA SOURCES: Literature review. Data were searched in the Medline database from 1967 to 2004 in English and French language. Complementary references were selected from the bibliography of selected references or from authors' personal databases. The following key-words were used separately or combined: Hypersensitivity, Immediate; Allergy; Contrast Media; Povidone-Iodine; Iodine; Iodine Compounds; Iodides; Amiodarone; Seafood, Parvalbumins; Tropomyosin. STUDY SELECTION: Randomized studies, epidemiological studies, original articles, clinical cases, and letters to the editor were selected. DATA SYNTHESIS: The implication of iodine has never been demonstrated during allergic hypersensitivity reactions due to iodinated drugs. However, IgE-mediated allergic hypersensitivity reactions have been published with contrast media or iodinated antiseptics and will be described in this development. In a wider sense, allergic hypersensitivity reactions due to seafood are evoked because often improperly considered as a risk factor of allergic reaction to iodinated drugs. The allergenic determinant responsible of patient sensitization is not known for iodinated contrast media, but is probably due to povidone in case of iodine povidone. In fish, the allergen is described as the protein M. There has also been strong immunological evidence that tropomyosin is a cross-reactive allergen among crustaceans and molluscs (shellfishs). In case of hypersensitivity reaction occurring with iodinated drug, an allergological assessment is required to confirm the immune mechanism, to identify the culprit drug or substance and to identify cross-reactivity especially with iodinated contrast media. CONCLUSION: Asking a patient if he/she is "allergic to iodine" is a question that should be avoided because its significance is null. A diagnosis of drug allergy, essentially relying on clinical symptoms, biological tests and cutaneous tests, is required to take adequate preventive measures.

Anti-Infective Agents, Local↗
PubMedDate not supplied

Implementing evidence-based guidelines for radiography in acute low back pain: a pilot study in a chiropractic community.

OBJECTIVE: To evaluate the ability of a systematic educational intervention strategy to change the plain radiography ordering behavior of chiropractors toward evidence-based practice for patients with acute low back pain (LBP). DESIGN: A quasi-experimental method was used comparing outcomes before and after the intervention with those of a control community. SETTING: Two communities in southern Ontario. DATA SOURCE: Mailed survey data on the management of acute LBP. Outcome Measures Plain radiography use rates for acute LBP based on responses to mailed surveys. RESULTS: Following the intervention, there was a 42% reduction in the self-report need for plain radiography for uncomplicated acute LBP (P <.025) and a 50% reduction for patients with acute LBP < 1 month (P <.025) in the intervention community. There was no significant change in the self-report need for plain radiography in the control community (P >.05). CONCLUSIONS: The educational intervention strategy used in this study appeared to have an effect in reducing the perceived need for plain radiography in acute LBP.

Adult↗
PubMedDate not supplied

Purchasing population health: aligning financial incentives to improve health outcomes.

OBJECTIVE: To review the concept of population health, including its definition, measurement, and determinants, and to suggest an approach for aligning financial incentives toward this goal. DATA SOURCE, STUDY DESIGN, DATA EXTRACTION: Literature review, policy analysis PRINCIPAL FINDINGS: The article presents the argument that a major reason for our slow progress toward health outcome improvement is that there is no operational definition of population health and that financial incentives are not aligned to this goal. Current attempts at process measures as indicators of quality or outcome are not adequate for the task. It is suggested that some measure of health-adjusted life expectancy be adopted for this purpose, and that integrated delivery systems and other agents responsible for nonmedical determinants be rewarded for improvement in this measure. This will require the development of an investment portfolio across the determinants of health based on relative marginal return to health, with horizontal integration strategies across sectoral boundaries. A 20-year three-phase development strategy is proposed, including components of research and acceptance, integrated health system implementation, and cross-sectoral integration. CONCLUSIONS: The U.S. health care system is a $1 trillion industry without a definition of its product. Until population outcome measures are developed and rewarded for, we will not solve the twenty-first century challenge of maximizing health outcome improvement for the resources available.

Delivery of Health Care, Integrated↗
PubMed1997

Transvaginal repair of vault prolapse: a review.

OBJECTIVE: To provide a critical assessment of the published literature on transvaginal reconstructive techniques used to suspend a prolapsed vaginal vault. DATA SOURCE: A Medline data base search and a bibliographic review of the relevant articles were conducted to identify all English-language articles on repair of vaginal vault prolapse. METHODS OF STUDY SELECTION: Our literature search identified 34 articles published in peer-review journals and one article reported in another format, describing five different techniques. TABULATION, INTEGRATION AND RESULTS: The size of each study population, modifications of the original surgical technique, complications, and results were tabulated and summarized for each surgical approach. Only sacrospinous ligament vaginal vault suspension and endopelvic fascia vaginal vault fixation had a sufficient number of cases to allow an informative evaluation of their effectiveness in managing vaginal vault prolapse. Of the 1229 patients who had undergone sacrospinous ligament suspension, 1062 were available for varying periods of follow-up; 193 (18%) of these developed recurrent pelvic relaxation--including 32 vaginal vault eversions, 81 anterior vaginal wall defects, 24 posterior vaginal wall prolapses, and 56 support defects at unspecified or multiple sites. Of the 367 patients who had undergone endopelvic fascia vaginal vault fixation, 322 were available for follow-up ranging from 1 to 12 years; 34 (11%) of these patients developed recurrent pelvic relaxation including nine vaginal vault prolapses, two anterior vaginal wall defects, 11 posterior vaginal wall relaxations, and 12 support defects at unspecified or multiple sites. CONCLUSION: Published experience suggests that sacrospinous ligament suspension and endopelvic fascia fixation are effective in managing vaginal vault prolapse. Because of study limitations--including an absence of standardized outcome evaluation, relatively short follow-up periods, a substantial number of patients lost to follow-up, concomitant surgical procedures, and failure to assess visceral and sexual functions--the true efficacy of these two procedures remains inconclusive.

Fascia↗
PubMed1998

Outcomes and effectiveness in reproductive health.

Measuring reproductive health is problematic. Awareness of the problems needs to be raised both among those collecting and those using data on reproductive health. This paper discusses two major measurement questions--one related to ascertainment and the other to attribution. The first question is to what extent the observed levels and patterns of reproductive health outcomes in women are valid as opposed to artefacts of the data sources and the data collection methods? The second question is can lack of evidence of effectiveness for any reproductive health intervention ever confidently be separated into no effects vs an inability to measure effects? Determining the effectiveness of health interventions is notoriously difficult. Reproductive health may not be a case for special pleading in the competition for scarce resources, but equally it should not be a case for special standards of proof of the effectiveness of interventions--standards which have not indeed been met by many other, and yet unquestioned, health care priorities. "What works" in reproductive health should in fact be judged from at least four different perspectives: from that of women and their families, health professionals, the scientific community, and national and international policy-makers.

Data Collection↗
PubMed1998

A weapon-related injury surveillance system in New York City.

CONTEXT: Assault injuries and deaths are a major public health problem in New York City but they are poorly understood because there is a dearth of information concerning them. OBJECTIVE: Develop and implement a low-cost, efficient, permanent weapon-related injury surveillance system (WRISS) for the city. DESIGN: WRISS was established, using a hierarchical exclusionary model, to capture all weapon-related (gunshot, stab, blunt instrument trauma) mortality and morbidity. SETTING: The five boroughs of New York City: The Bronx, Brooklyn, Manhattan, Queens, and Staten Island. PARTICIPANTS: NYC Vital Statistics Office, New York State hospital discharge database, Statewide Planning and Research Cooperative Systems (SPARCS), hospital emergency departments, and the police department. MAIN OUTCOME MEASURES: Surveillance system simplicity, acceptability, flexibility, cost. RESULTS: NYC WRISS is a simple surveillance system depending on both existing data sources and active data collection, and is therefore acceptable to providers. It is flexible and has allowed assault injuries without weapons to be added to better reflect domestic assaults. The cost is low, less than $60,000 per year. CONCLUSIONS: NYC WRISS is an efficient, cost-effective surveillance system, particularly suited to big cities with many assault injuries. Its low cost and obvious importance as a public health tool have allowed for its institutionalization, reflected by a permanent health department position, and annual reports alongside the more traditional public health surveillance systems. Analyses of data from 1990 to 1996 have lent new understanding to the decrease in homicides and assaults in New York City during that period.

Adolescent↗
PubMedDate not supplied

In their own voices: definitions and interpretations of physical activity.

Terms such as physical activity, exercise, and leisure are perceived and interpreted differently by people differing in gender, class, and sociocultural factors. We accessed multiple diverse data sources (including qualitative data recently collected in research and evaluation studies) to explore African-American and American Indian women's (age 40+) definitions, meanings, and interpretations of "physical activity". These women reported that physical activity is typically considered to be structured "exercise" and not incidental activities of daily life. The term "leisure" was interpreted from a cultural perspective as being lazy. These women also had difficulty understanding the meaning of "intensity" (e.g., "moderate", "vigorous"). Researchers must acknowledge and understand inconsistencies that arise and how these might influence design of, and responses to, self-report assessment of physical activity.

Adult↗
PubMed2003

Meeting the reproductive health care needs of adolescents: California's Family Planning Access, Care, and Treatment Program.

PURPOSE: To examine the effect of the California Office of Family Planning's Family Access, Care, and Treatment Program (Family PACT), which was established in 1997 to provide comprehensive, reproductive health services for low-income adolescents and adults. Program evaluation was used to measure access to services, develop a profile of users, identify service utilization patterns, and assess the sensitivity of the health care system to the needs of adolescents. METHODS: Data sources include baseline data on California's previously established family planning services, enrollment, and claims data for the first 4 years of Family PACT, client exit interviews, and on-site observations. RESULTS: Adolescents represented 21% of all clients served by Family PACT in fiscal year 2000-2001 (FY 2000-2001). Adolescent clients served increased from 100,000 in FY 1995-1996 to more than 260,000 in FY 2000-2001(161% increase). The proportion of males has increased from 1% to 11%. In FY 2000-2001, Hispanics comprised 50% of adolescent clients, followed by 32% white, 9% African-American, and 6% Asian, Filipino, or Pacific Islander. Over one-half were aged 18 or 19 years, 42% were aged 15 to 17 years, and 5% were aged younger than 15 years. Contraceptive methods most often dispensed were barrier methods (55% for females, 72% for males), oral contraceptives (44%), contraceptive injections (16%), and emergency contraceptives (7%); 57% received sexually transmitted infection screening. CONCLUSIONS: By linking eligibility determination to the delivery of services, removing cost barriers, increasing the numbers and types of providers offering publicly funded services, and ensuring confidentiality, greater numbers of adolescents obtained needed reproductive health care, thus ensuring an opportunity to reduce unintended pregnancies and sexually transmitted infections.

Adolescent↗
PubMed1998

Designing and implementing an outcomes-based performance improvement project: behavioral health care.

1. All performance measurement and improvement initiatives should be planned. Planning should reveal the origins of the project, define and validate the project purpose, specify the desired effect of the project, develop project success measures, specify necessary resources, describe any constraints, anticipate problems, and specify milestones and deadlines. 2. An interdisciplinary team is usually created to implement the improvement project. This team is generally composed of staff from different disciplines, organizational entities, and levels throughout the facility. 3. Am improvement team typically consists of an executive coach, a team leader, a facilitator, and multiple team members. Sometimes a measurement specialist is included in the team. Additional subject matter experts serve as ad hoc team members as needed. 4. Data management is a process comprising the following discrete activities: determination of data needs, specification of indicators, definition of data elements, specification of data sources, creation of data collection instruments, determination of data analysis strategies, completion of a data collection plan, pilot testing of data collection and analysis, and modification of data management tactics based on the results of the pilot test. 5. There are two fundamental kinds of studies: quantitative and qualitative. Quantitative studies present numeric performance data, such as averages, correlations,and variation. Qualitative studies provide narrative data, such as content and theme analyses, and individual quotes. 6. Effective data collection requires valid and reliable data collection instruments and trained data collectors. 7. Analysis of performance data may be quantitative or qualitative and may compare an organization's performance to itself over time, as well as to external benchmarks. 8. Root cause analysis is based on tools such as the process flow diagram, cause-effect diagram, scatter diagram, Pareto analysis, and repetitive why to determine the causes of achieved performance. 9. Improvement ideas should be tested on a small scale by using a systematic approach such as the PDCA cycle. 10. Findings and results of performance measurement and improvement initiatives should be communicated to internal and external audiences via a variety of approaches.

Behavior Therapy↗
PubMed2004

Safety profile of budesonide inhalation suspension in the pediatric population: worldwide experience.

OBJECTIVE: To review the worldwide safety data for budesonide inhalation suspension (Pulmicort Respules) to provide a budesonide inhalation suspension pediatric tolerability profile. DATA SOURCES: Clinical study data were obtained from AstraZeneca safety databases used by the US Food and Drug Administration to support the approval of budesonide inhalation suspension and from postmarketing surveillance reports (January 1, 1990, through June 30, 2002). STUDY SELECTION: Completed parallel-group studies of patients with asthma 18 years and younger. RESULTS: Safety data for budesonide inhalation suspension were pooled from 3 US, 12-week, randomized, double-blind, placebo-controlled studies (n = 1,018); data from their open-label extensions (n = 670) were pooled with data from a fourth US open-label study (n = 335). Data for 333 patients 18 years and younger enrolled in 5 non-US studies also were analyzed. No posterior subcapsular cataracts were reported in any study, and the frequencies of oropharyngeal events and infection with budesonide inhalation suspension were comparable with those of reference treatments. No increased risk of varicella or upper respiratory tract infection was apparent, and budesonide inhalation suspension did not cause significant adrenal suppression in studies assessing this variable. There were small differences in short-term growth velocity between children who received budesonide inhalation suspension and those who received reference treatment in 2 of 5 trials that evaluated this variable. No increased risk of adverse events was apparent from postmarketing reports. CONCLUSIONS: Short- and long-term treatment with budesonide inhalation suspension, using a wide range of doses, is safe and well tolerated in children with asthma.

Administration, Inhalation↗
PubMedDate not supplied

Eating disorders: current concepts.

OBJECTIVE: To review for the community pharmacist common eating disorders and suggest strategies for pharmacist-directed patient education. DATA SOURCES: Current literature. DATA SYNTHESIS: Women are much more likely than men to develop eating disorders, and Western culture's emphasis on thinness contributes to the prevalence of eating disorders in the United States. Regardless of the type, all eating disorders are rooted in emotions, often traced to problems during adolescence. Anorexia nervosa patients continually set and strive to obtain lower goal weights to the point that their general well-being is compromised. Bulimia nervosa is characterized by excessive eating followed by purging that is an apparent attempt to relieve the tension and guilt associated with the initial overeating. Rather than directly dealing with tension and anger, a patient suffering from binge eating overindulges in food. Most overeaters are aware that excess weight is detrimental to their health, but they cannot control their overeating behavior. CONCLUSION: In treating eating disorders, it is important to address patients' emotional and psychological needs as well as physical symptoms. Patients often need encouragement to seek and continue treatment, and pharmacists are in an ideal position to provide that support.

Feeding and Eating Disorders↗
PubMedDate not supplied

Medication challenges in the assisted living facility.

OBJECTIVE: To review current challenges to the provision of safe and effective pharmaceutical care in assisted living facilities. DATA SOURCES: Current literature. DATA SYNTHESIS: The assisted living industry has experienced tremendous growth and offers pharmacists lucrative business opportunities. However, pharmacists must understand the varied nature of both the facilities and the residents. Assisted living residents are entitled to independence and privacy, a fact that presents many challenges in terms of monitoring the safe and accurate administration of medications. CONCLUSION: Assisted living facilities provide elderly residents a new and unique blend of independent living and daily support. To provide effective pharmacy services to these facilities, pharmacists must consider their specific needs in terms of medication use processes, packaging, delivery, documentation, and storage.

Aged↗
PubMed2003

Data representation for joint kinematics simulation of the lower limb within an educational context.

Three-dimensional (3D) visualization is becoming increasingly frequent in both qualitative and quantitative biomechanical studies of anatomical structures involving multiple data sources (e.g. morphological data and kinematics data). For many years, this kind of experiment was limited to the use of bi-dimensional images due to a lack of accurate 3D data. However, recent progress in medical imaging and computer graphics has forged new perspectives. Indeed, new techniques allow the development of an interactive interface for the simulation of human motions combining data from both medical imaging (i.e., morphology) and biomechanical studies (i.e., kinematics). Fields of application include medical education, biomechanical research and clinical research. This paper presents an experimental protocol for the development of anatomically realistic joint simulation within a pedagogical context. Results are shown for the lower limb. Extension to other joints is straightforward. This work is part of the Virtual Animation of the Kinematics of the Human project (VAKHUM) (http://www.ulb.ac.be/project/vakhum).

Arthrography↗
PubMed2003

Health information systems challenges: the Heidelberg conference and the future.

OBJECTIVES: To present a summary of the state of the art in Health Information Systems (HIS), as discussed during the Heidelberg HIS Working Group Conference, and to examine possible strategies for continuous improvement of the field. METHODS: The state of the art in HIS is briefly described, and the historical trends are examined that emerge from a review of the previous HIS Working Group conferences. To extrapolate from those trends and suggest possible new directions, we consider whether perceived difficulties in the diffusion of HIS systems are simply a product of technological factors, or whether fundamental social factors have been ignored. RESULTS: The experience with HIS environments is 'reasonably good' but not excellent, and true HIS success stories are not common. One of the apparent difficulties is that the typical HIS does not regard communication among clinical users as its core mission, even though repeated studies of information needs and practice patterns show that communication is the leading cost in today's health care environment. It is suggested that progress in the HIS arena will benefit from increased emphasis on the social aspects of health care, and better integration of diverse data to promote the organizational communication and workflow. Improvements could also come from a change to a highly participatory and evolutionary software engineering process, focusing on communication behavior and co-operative work practices. CONCLUSIONS: Future HIS development should view provider-provider and provider-patient communication as a core function, and incorporate features such as seamless support and tracking of communication, automatic gathering and presentation of data from multiple sources, data collection in atomic units by the most qualified provider, and integrated management, resource utilization, and tracking. The steps towards HIS that support these features might be smaller than generally suspected, once the appropriate changes in the reference point have been made.

Congresses as Topic↗