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At least 1,099 records · Page 61Linked to original sources
PubMed2005

Surgical management of colorectal cancer in south-western Sydney 1997-2001: a prospective series of 1293 unselected cases from six public hospitals.

BACKGROUND: The aim of the present study is to provide local data for the management of colorectal cancers in the south-western Sydney health area from 1997 to 2001. METHODS: The data were collected prospectively. Follow up was conducted in late 2001 and early 2002. Data were cross-validated with hospital and area databases and with data from the New South Wales Registry of Births, Deaths and Marriages. RESULTS: This was an unselected series of 1293 patients from 36 surgeons; 16.5% of patients presented as emergencies. Only 3% presented as a result of bowel cancer screening. Of the 1293 patients, 1270 received an operation. There were 598 elective colonic resections with the mortality rate of 1.2%, reoperation rate of 2.7% and anastomotic leak rate of 0.8%. For the 410 elective rectal resections, the rates were 2.9%, 2.7% and 1.2%, respectively. For the 290 emergency operations, the rates were much worse at 7.7%, 6.6% and 4.8%, respectively. The corrected overall 3-year survival rate was 64%. For Dukes' A, B, C and D, the figures were 94%, 87%, 61% and 7%, respectively. CONCLUSIONS: Colorectal cancer is a major cause of mortality and morbidity in our community. Very few bowel cancers were discovered at the asymptomatic stage. This paper strongly supports community bowel cancer screening and early diagnosis. The local database has provided a rich source of information to benchmark management and outcomes of bowel cancer patients treated in the South Western Sydney Area Health Service. An area-wide computer network with online data input facilities at individual workplaces will improve data integrity and data collection efficiency.

Adult↗
PubMed2001

History and trends in clinical information systems in the United States.

PURPOSE: To provide a synopsis of issues about clinical information systems for nurses not schooled in nursing informatics. ORGANIZING CONSTRUCT: The past, present, and future of clinical computing, including major factors resulting in the early hospital information systems (HIS) and decision support systems (DSS) in the United States, current advances and issues in managing clinical information, and future trends and issues. METHODS: Literature review and analysis. FINDINGS AND CONCLUSIONS: The first HIS and DSS were used in the late 1960s and were focused on applications for acute care. The change from fee-for-service to managed care required a change in the design of clinical information systems toward more patient-centered systems that span the care continuum, such as the computer-based patient record (CPR). Current difficulties with CPR systems include lack of systems integration, data standardization, and implementation. Increased advances in information and technology integration and increased use of the Internet for health information will shape the future of clinical information systems.

Decision Making, Computer-Assisted↗
PubMed2001

Comments on the process and product of the health impacts assessment component of the national assessment of the potential consequences of climate variability and change for the United States.

In 1990 Congress formed the U.S. Global Change Research Program and required it to conduct a periodic national assessment of the potential impacts of climate variability and change on all regions and select economic/resource sectors of the United States. Between 1998 and 2000, a team of experts collaborated on a health impacts assessment that formed the basis for the first National Assessment's analysis of the potential impacts of climate on human health. The health impacts assessment was integrated across a number of health disciplines and involved a search for and qualitative expert judgment review of data on the potential links between climate events and population health. Accomplishments included identification of vulnerable populations, adaptation strategies, research needs, and data gaps. Experts, stakeholders, and the public were involved. The assessment is reported in five articles in this issue; a summary was published in the April 2000 issue of Environmental Health Perspectives. The assessment report will enhance understanding of ways human health might be affected by various climate-associated stresses and of the need for further empirical and predictive research. Improved understanding and communication of the significance and inevitability of uncertainties in such an assessment are critical to further research and policy development.

Animals↗
PubMed1992

[Management of the health sector in the 80's, in the state of São Paulo, Brazil].

The shared management put into effect by the "Ações Integradas de Saúde" (Integrated Health Actions) in the State of S. Paulo (Brazil), in the early 80s is analysed. The relevant data were collected from the minutes of the meetings of the "Comissão Interinstitutional de Saúde" (Interinstitutional Health Committee). The data collected show the most frequent subjects discussed by the members at the meetings, the number of members related to each of the different government levels, in addition to the kind of resolutions taken at the meetings. The data analysis has demonstrated that important changes took place in public health management in the State of S. Paulo in the decade in question. The shared management process was replaced by one in which government powers were clearly divided a towards the end of the 80s. Those changes have led the public health members from each level of governmental administration to give up the common goals and the shared negotiations among them.

Brazil↗
PubMed2006

Projecting future drug expenditures--2006.

PURPOSE: Drug expenditure trends in 2004 and 2005, projected drug expenditures for 2006, and factors likely to influence drug costs are discussed. SUMMARY: Various factors are likely to affect drug costs, including drug prices, drugs in development, and generic drugs. In 2004 there was a continued moderation of the increase in drug expenditures. Drug expenditures increased by 8.7% from 2003 to 2004. Through the first nine months of 2005, expenditures increased by only 8.1% compared with 2004. This moderation can be attributed to several factors, including the continued trend toward higher prescription drug cost sharing for insured consumers, growing availability of generic drugs, and lack of "blockbuster" new drugs in recent years. Drug expenditures in 2006 will likely be influenced by similar factors, with few costly new products reaching the market, increased concern over product safety slowing the diffusion of those new agents that do reach the market, and several important patent expirations, leading to slower growth in expenditures. CONCLUSION: Forecasting and managing rising drug expenditures remains a challenge. Pharmacy managers must remain vigilant in monitoring drug costs in their health system and take a proactive role in pursuing efficient drug utilization. The dynamic health policy environment further complicates drug budgeting and must be considered, especially in integrated health systems responsible for managing inpatient, outpatient, and clinic drug costs. The comparison of health-system-specific data and trends with the national information presented in this article may provide a useful context when presenting institutional drug costs to senior management.

Biomedical Research↗
PubMed2003

Client and staff views on facilities and services, before and after the convergence of sexual, reproductive and women's services.

OBJECTIVE: To evaluate client and staff views on existing facilities and services, before and after the convergence of sexual, reproductive and women's services. METHODS: Evaluation involved questionnaire survey of clients and staff, one-to-one interviews with staff and review of routinely collected clinical activity data. RESULTS: The integration of the three services led to a reduction in stigma associated with attending sexual health services. Despite some staff concerns, the number of men attending the services did not decrease. There was increased satisfaction with the new service, especially the quality of facilities. There were increased numbers of referrals between clinical services in the Sandyford Initiative. CONCLUSIONS: Sexual, reproductive and women's services can be integrated to provide improved facilities for clients.

Adult↗
PubMed1980

Expanding food-animal veterinary services through nutritional consultation.

Practitioners can increase their value to their clients as well as increase the gross veterinary product by developing supplemental expertise in nontraditional disciplines. This can be accomplished through continuing education and the utilization of technical support services such as the professional nutritionist. In addition, contemporary technology such as the electronic moisture tester and the pH meter can be implemented in the acquisition of nutritional diagnostic data. A comprehensive herd health program is precisely the delivery system into which such complimentary expertise can be integrated successfully.

Animal Feed↗
PubMed2005

Self-care of women growing older with HIV and/or AIDS.

The purpose of this report is to describe the ways older women living with HIV perceive of and practice self-care. Data are taken from a culturally diverse subsample of 9 women age 50 years or older who participated in a larger longitudinal qualitative study of women who were HIV infected. During a period of 2 years, 10 semistructured narrative interviews were conducted with each of the 9 participants to gain an in-depth understanding of their experiences with symptom management, adherence to medical regimens, reduction of HIV risk, access to health care and social services, and personal efforts to maintain their health. Transcribed data were managed using Nvivo software and analyzed using multistaged narrative analysis. Findings suggest that mature women living with HIV integrate actions to maintain bodily comfort and improve physical well-being with actions that champion and conserve the existential self. Excerpts from their interviews illustrate this dialectical understanding of self-care.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Self-transcendence and mental health in oldest-old adults.

Patterns of self-transcendence that older adults report as being important to their emotional well-being are described in this study, and the relationship between self-transcendence and mental health symptomatology in oldest-old adults is investigated. The sample consisted of 55 independent-living older adults, 80 to 97 years old. Methodological trianglulation was used whereby qualitative data together with quantitative findings were examined. Four patterns of self-transcendence, congruent with the investigator's definition, were identified by the participants as being important to their sense of well-being: Generativity, Introjectivity, Temporal Integration, and Body-Transcendence. Results of Pearson correlation analysis and matrix analysis of data supported a relationship between self-transcendence and mental health found in previous research, thus demonstrating the importance of the expansion of self boundaries in older adults.

Aged↗
PubMed1997

Post-integration of a tumor documentation system into a HIS via middleware.

Integrating autonomous applications is a difficult task since they usually represent similar informations in different data schemes. Any communication requires an agreement of sender and receiver on a common data representation. The number of interfaces to convert one data representation into another is minimized if all participants of an information system agree on one data representation such as Health Level Seven (HL7) or Edifact. Even more convenient is the use of a middleware solution like the Distributed Healthcare Environment (DHE) that keeps message transfer completely transparent to the integration process. This paper discusses a project that aims at the integration of a cancer registry system into a DHE based Hospital Information System (HIS). The project is a cooperation between the universities of Giessen and Magdeburg within the framework of the European Communities Telematics Research Project HC 1019 HANSA (Healthcare Advanced Networked System Architecture). The concept of a so called 'DHE-Adapter' to integrate existing legacy systems is explained. This adapter converts a data or message format of a legacy system into calls of the DHE programming interface. To develop a DHE-Adapter for our cancer registry system we intend to design a DHE-Adapter-Generator which would be able to produce DHE-Adapters for different systems and export formats, e.g. HL7 or Edifact. That would allow a variety of software vendors to integrate their products into the DHE without entering deeply into the DHE's programming interface.

Computer Communication Networks↗
PubMed1998

Information management in national tuberculosis control programmes and national health information systems.

A good notification system is one of the key elements for the success of national tuberculosis programmes (NTPs). The national health information system (NHIS) in low income countries is often weak and unreliable. When restructuring this system, what circuit should be used to integrate TB data: the NTP or the NHIS? Experience from several countries shows that unlike the NHIS, only the data generated by the NTP are reliable and complete, and arrive rapidly enough to be used for programme management. It is therefore the duty of the NTP to collect this information and transmit it to the NHIS at each level of the health system. These were the conclusions of a seminar held in Cotonou, Benin, organised by the International Union Against Tuberculosis and Lung Disease, which involved the leaders of the NHIS and of NTPs of six West African countries.

Africa↗
PubMed1999

A taxonomy of health networks and systems: bringing order out of chaos.

OBJECTIVE: To use existing theory and data for empirical development of a taxonomy that identifies clusters of organizations sharing common strategic/structural features. DATA SOURCES: Data from the 1994 and 1995 American Hospital Association Annual Surveys, which provide extensive data on hospital involvement in hospital-led health networks and systems. STUDY DESIGN: Theories of organization behavior and industrial organization economics were used to identify three strategic/structural dimensions: differentiation, which refers to the number of different products/services along a healthcare continuum; integration, which refers to mechanisms used to achieve unity of effort across organizational components; and centralization, which relates to the extent to which activities take place at centralized versus dispersed locations. These dimensions were applied to three components of the health service/product continuum: hospital services, physician arrangements, and provider-based insurance activities. DATA EXTRACTION METHODS: We identified 295 health systems and 274 health networks across the United States in 1994, and 297 health systems and 306 health networks in 1995 using AHA data. Empirical measures aggregated individual hospital data to the health network and system level. PRINCIPAL FINDINGS: We identified a reliable, internally valid, and stable four-cluster solution for health networks and a five-cluster solution for health systems. We found that differentiation and centralization were particularly important in distinguishing unique clusters of organizations. High differentiation typically occurred with low centralization, which suggests that a broader scope of activity is more difficult to centrally coordinate. Integration was also important, but we found that health networks and systems typically engaged in both ownership-based and contractual-based integration or they were not integrated at all. CONCLUSIONS: Overall, we were able to classify approximately 70 percent of hospital-led health networks and 90 percent of hospital-led health systems into well-defined organizational clusters. Given the widespread perception that organizational change in healthcare has been chaotic, our research suggests that important and meaningful similarities exist across many evolving organizations. The resulting taxonomy provides a new lexicon for researchers, policymakers, and healthcare executives for characterizing key strategic and structural features of evolving organizations. The taxonomy also provides a framework for future inquiry about the relationships between organizational strategy, structure, and performance, and for assessing policy issues, such as Medicare Provider Sponsored Organizations, antitrust, and insurance regulation.

American Hospital Association↗
PubMed2003

Human health and environmental risk assessment: the need for a more harmonised and integrated approach.

Historically the procedures for human risk assessment and for risk assessment have developed separately with different terminologies and separate data bases. The identification that there are many common features and that sharing of certain types of data for risk assessment purposes would be beneficial is a driver towards a better integration of their procedures. Risk assessors are facing increasing challenges from governments, stimulated by public pressure for (i) human and environmental risk assessments of an ever growing number of products and processes, (ii) further restrictions of the use of animal tests and human studies on ethical grounds, (iii) the requirement to demonstrate that the assessments are independent, transparent and of high quality, (iv) reducing resources in particular a diminishing number of individuals with the scientific depth, breadth and independence act as risk assessors, (v) the need to incorporate new sciences continually and new discoveries into the risk assessment process. It is important for society that these challenges are met successfully. This requires changes in both risk assessment procedures and in the infrastructure needed to support them. Risk assessment is a science based process for establishing the likelihood of adverse effects to human health and to the environment from specific chemical, biological and physical agents. In the last few years there has been a renewed effort, by international bodies such as WHO, OECD and the EU, to achieve a more integrated and harmonised approach to risk assessment. Before examining the potential for a more integrated approach to risk assessment it is timely to consider the key factors which have led to the current position.

Databases, Factual↗
PubMed2001

Do you Mini-Med School? Leveraging library resources to improve Internet consumer health information literacy.

Popular for engaging public interest in medical science while promoting health awareness, Mini-Med School (MMS) programs also afford important if largely unrealized opportunities to improve the health information literacy of attendees. With a growing population using the Internet to make health decisions, needed venues for improving Internet Consumer Health Information (CHI) literacy may be found in the MMS platform. Surveyed directors of MMS programs understand the need to include CHI, and successful programs at SUNY Stony Brook and elsewhere demonstrate the potential for collaboration with affiliated health sciences libraries to integrate CHI instruction into MMS curricula.

Academic Medical Centers↗
PubMed1995

Assessing healthcare market trends and capital needs: 1996-2000.

An analysis of recent data suggests several significant trends for the next five years, including a continuation of market-based reform, increases in managed care penetration, growth of Medicare and Medicaid health maintenance organizations, and erosion of hospital profits. A common response to these trends is to create integrated delivery systems, which can require significant capital investment. The wisest capital investment strategy may be to avoid asset-based integration in favor of "virtual integration," which emphasizes coordination through patient-management agreements, provider incentives, and information systems, rather than investment in large number of facilities.

Capital Expenditures↗
PubMed2001

[Integrated health information system based on Resident Assessment Instruments].

The paper explores the meaning of Resident Assessment Instruments. It gives a summary of existing RAI instruments and derived applications. It argues how all of these form the basis for an integrated health information system for "chain care" (home care, home for the elderly care, nursing home care, mental health care and acute care). The primary application of RAI systems is the assessment of client care needs, followed by an analysis of the required and administered care with the objective to make an optimal individual care plan. On the basis of RAI, however, applications have been derived for reimbursement systems, quality improvement programs, accreditation, benchmarking, best practice comparison and care eligibility systems. These applications have become possible by the development on the basis of the Minimum Data Set of RAI of outcome measures (item scores, scales and indices), case-mix classifications and quality indicators. To illustrate the possibilities of outcome measures of RAI we present a table and a figure with data of six Dutch nursing homes which shows how social engagement is related to ADL and cognition. We argue that RAI/MDS assessment instruments comprise an integrated health information system because they have consistent terminology, common core items, and a common conceptual basis in a clinical approach that emphasizes the identification of functional problems.

Aged↗
PubMed2026

Precision medicine in mental health: applications, challenges, and recommendations.

Mental disorders represent a major and growing public health challenge in Europe and worldwide, characterised by marked clinical, biological, and functional heterogeneity, that limits the effectiveness of current diagnostic and therapeutic approaches. In recent years, advances in precision medicine have initiated a paradigm shift in psychiatry, offering new opportunities to improve prevention, prediction, diagnosis, treatment selection, and long-term management by integrating biological, psychological, social, and environmental information.This EPA Guidance Paper provides an overview of the current state of precision medicine in mental health and outlines its potential clinical, scientific, and policy implications. We review key advances in genomics, epigenetics, neuroimaging, transcriptomics, digital technologies, and artificial intelligence, highlighting their relevance across the full clinical pathway, from risk prediction and early detection to treatment personalisation and monitoring. We also examine major barriers to implementation, including limited biomarker validation, insufficient representativeness of research populations, ethical and regulatory challenges, data protection concerns, and inequalities in access across healthcare systems.Based on the available evidence, we propose strategic recommendations to support the responsible and equitable integration of precision approaches into mental health care in Europe. These include strengthening translational research, promoting multidisciplinary collaboration, updating regulatory and ethical frameworks, enhancing professional training, and prioritising mental health within national and European research and health agendas. By addressing these challenges, precision psychiatry has the potential to contribute to more effective, person-centred, and sustainable mental health care, while supporting innovation, reducing stigma, and improving outcomes for patients and society.

Humans↗